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Conjugated estrogens and medroxyprogesterone usually come with patient directions. Read them carefully before taking this medicine.

Take this medicine only as directed by your doctor. Do not take more of it and do not take it for a longer period of time than your doctor ordered. The length of time you take the medicine will depend on the medical problem for which you are taking conjugated estrogens and medroxyprogesterone. Discuss with your doctor how long you will need to take these medicines.

If you are taking the estrogen or progestin hormones in a certain order (i.e., conjugated estrogens tablets followed by conjugated estrogens and medroxyprogesterone tablets), be sure you know in which order you need to take the medicines. If you have questions about this, ask your health care professional.

Nausea may occur during the first few weeks after you start taking estrogens. This effect usually disappears with continued use. If the nausea is bothersome, it can usually be prevented or reduced by taking each dose with food or immediately after food.

Dosing

The dose of these medicines will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

For conjugated estrogens, and conjugated estrogens and medroxyprogesterone
• For oral dosage form (tablets):
  • To prevent loss of bone (osteoporosis) or for treating itching or dryness of the genital area (atrophy of the vulva), inflammation of the vagina (atrophic vaginitis), or symptoms of menopause:
    • Adults One tablet (containing 0.625 mg conjugated estrogens) once a day on Days 1 through 14; then, one tablet (containing 0.625 mg conjugated estrogens and 5 mg medroxyprogesterone) once a day on Days 15 through 28. Repeat cycle.

For conjugated estrogens and medroxyprogesterone
• For oral dosage form (tablets):
  • To prevent loss of bone (osteoporosis) or for treating itching or dryness of the genital area (atrophy of the vulva), inflammation of the vagina (atrophic vaginitis), or symptoms of menopause:
    • Adults One tablet (containing 0.3 mg conjugated estrogens and 1.5 mg medroxyprogesterone) once a day for twenty-eight days. Repeat cycle. If vaginal bleeding or spotting continues and it is undesired, your doctor may increase your dose to the next highest strength tablet (0.45 mg conjugated estrogens and 1.5 mg medroxyprogesterone). It should be taken once a day for twenty-eight days. Repeat cycle.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For conjugated estrogens and medroxyprogesterone, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to estrogens or progestins. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Conjugated estrogens and medroxyprogesterone are not recommended for use during pregnancy. Becoming pregnant or maintaining a pregnancy is not likely to occur around the time of menopause. Tell your doctor right away if you suspect you are pregnant.

Breast-feeding Conjugated estrogens and medroxyprogesterone pass into the breast milk. This medicine is not recommended for use during breast-feeding.

Older adults Conjugated estrogens and medroxyprogesterone may increase your chance of having a stroke, memory problems, or breast cancer that spreads to other parts of your body.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking conjugated estrogens and medroxyprogesterone, it is especially important that your health care professional know if you are taking any of the following:

• Acetaminophen (e.g., Tylenol) (with long-term, high-dose use) or
• Amiodarone (e.g., Cordarone) or
• Anabolic steroids (nandrolone [e.g., Anabolin], oxandrolone [e.g., Anavar], oxymetholone [e.g., Anadrol], stanozolol [e.g., Winstrol]) or
• Androgens (male hormones) or
• Anti-infectives by mouth or by injection (medicine for infection) or
• Antithyroid agents (medicine for overactive thyroid) or
• Carmustine (e.g., BiCNU) or
• Chloroquine (e.g., Aralen) or
• Dantrolene (e.g., Dantrium) or
• Daunorubicin (e.g., Cerubidine) or
• Disulfiram (e.g., Antabuse) or
• Divalproex (e.g., Depakote) or
• Etretinate (e.g., Tegison) or
• Gold salts (medicine for arthritis) or
• Hydroxychloroquine (e.g., Plaquenil) or
• Isoniazid or
• Mercaptopurine (e.g., Purinethol) or
• Methotrexate (e.g., Mexate) or
• Methyldopa (e.g., Aldomet) or
• Naltrexone (e.g., Trexan) (with long-term, high-dose use) or
• Phenothiazines (acetophenazine [e.g., Tindal], chlorpromazine [e.g., Thorazine], fluphenazine [e.g., Prolixin], mesoridazine [e.g., Serentil], perphenazine [e.g., Trilafon], prochlorperazine [e.g., Compazine], promazine [e.g., Sparine], promethazine [e.g., Phenergan], thioridazine [e.g., Mellaril], trifluoperazine [e.g., Stelazine], triflupromazine [e.g., Vesprin], trimeprazine [e.g., Temaril]) or
• Plicamycin (e.g., Mithracin) Use of these medicines with conjugated estrogens and medroxyprogesterone may increase the chance of problems occurring that affect the liver

• Aminoglutethimide (e.g., Cytadren) or
• Barbiturates, especially phenobarbital or
• Carbamazepine (e.g., Tegretol) or
• Phenytoin (e.g., Dilantin) or
• Rifampin (e.g., Rifadin) or
• St. John's wort (Hypericum perforatum These medicines may decrease the effect of conjugated estrogens or medroxyprogesterone

• Cyclosporine (e.g., Sandimmune) Conjugated estrogens can prevent cyclosporine's removal from the body; this can lead to cyclosporine causing kidney or liver problems

• Asthma or
• Heart problems or
• Epilepsy or
• High blood pressure or
• Kidney problems, severe or
• Migraine headaches Rarely, water retention caused by conjugated estrogens or medroxyprogesterone may worsen these conditions; on the other hand, blood pressure and some heart or blood vessel problems can improve for most patients

• Blood clotting problems (or history of during previous estrogen therapy) Estrogens usually are not used until blood clotting problems stop; using estrogens is usually not a problem for most patients without a history of blood clotting problems due to estrogen use

• Bone cancer or
• Breast cancer or
• Cancer of the uterus (active or suspected) or
• Fibroid tumors of the uterus Estrogens may interfere with the treatment of breast or bone cancer, worsen cancer of the uterus, or increase the size of fibroid tumors

• Changes in genital or vaginal bleeding of unknown causes Estrogens may make these conditions worse; some irregular vaginal bleeding may be a sign that the lining of the uterus may be growing too much or is a sign of cancer of the uterus lining

• Changes in vision This medicine may make cause changes in vision; your medicine may need to be stopped if these conditions become worse

• Diabetes mellitus (sugar diabetes) Conjugated estrogens or medroxyprogesterone may slightly change the amount of blood sugar for some patients, but for most patients with sugar diabetes, there is no change in blood sugar

• Endometriosis or
• Gallbladder disease or gallstones (or history of) or
• High cholesterol or triglycerides (or family history of) or
• Jaundice (yellow skin) or
• Liver disease, including jaundice (or history of) or
• Pancreatitis (inflammation of pancreas) or
• Porphyria (liver problem) Conjugated estrogens or medroxyprogesterone may worsen these conditions; using estrogens can lower blood cholesterol in many patients with high cholesterol

• Low blood calcium, severe Estrogens should be used with caution in patients with this condition

• Underactive thyroid A change in dose of thyroid medication may be needed. Your doctor will watch for this.