How does this medication work? What will it do for me?
This is a combination product contains two medications: drospirenone and estradiol. Drospirenone belongs to the class of medications called progestins. Estradiol belongs to the class of medications called estrogens. This medication is used as an oral hormone replacement therapy.
This medication is used to relieve menopausal symptoms and vaginal symptoms associated with menopause. It should be not be used by women whose only symptom is vaginal dryness. Other medications that can be applied topically (directly to the affected area) are available for vaginal dryness.
This medication is designed for women who have not had a hysterectomy (removal of the uterus or womb). These women require progestin while taking estrogen to prevent complications associated with taking estrogen alone, such as the overgrowth of the uterine lining (endometrial hyperplasia).
Estrogens and progestins are female hormones. They are produced by the body and are necessary for the normal sexual development of the female and for the regulation of the menstrual cycle during the childbearing years. During and after menopause, the ovaries start to produce less of these hormones. A deficiency of estrogen can result in symptoms associated with menopause such as hot flashes, unusual sweating, chills, dryness of the vagina, and sleep disturbances.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each round, biconvex, dark pink, film-coated tablet, embossed on one side with the letters "DU" inside a regular hexagon, contains 1 mg of drospirenone and 1 mg of estradiol. Nonmedicinal ingredients: corn starch, hydroxypropyl methylcellulose, ferric oxide pigment, lactose monohydrate, macrogol 6000, magnesium stearate, modified starch, povidone 25 000, talc, and titanium dioxide.
How should I use this medication?
The recommended dose of drospirenone - estradiol is one tablet once daily with or without food. Swallow the tablets whole with a glass of water. Drospirenone - estradiol tablets are to be taken every day; there are no "pill-free" days.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children. Do not refrigerate or freeze.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to drospirenone, estradiol, or any ingredients of this medication
- are breast-feeding
- are or may be pregnant
- have a history of known or suspected estrogen-dependent or progestin-dependent tumours, such as breast cancer or endometrial cancer
- have active liver disease or tumours of the liver
- have classic migraine
- have endometrial hyperplasia (thickening of the inner lining of the uterus)
- have had a hysterectomy (surgical removal of the uterus)
- have or have had a stroke or heart attack or coronary heart disease
- have or have had active blood clotting disorders (e.g., thrombophlebitis, deep vein thrombosis, or pulmonary embolism)
- have partial or complete loss of vision from blood vessel disease of the eyes
- have severe hypertriglyceridemia (high level of fatty acids in the blood)
- have severe kidney disease
- have unusual vaginal bleeding that has not been checked by a doctor
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Stop taking the medication and seek immediate medical attention if any of the following occur:
- pains in chest, groin, or leg, especially in calf of leg
- signs of an allergic reaction (such as difficulty breathing, hives, rash, swelling of the face or throat)
- sudden and unexplained shortness of breath
- sudden loss of coordination
- sudden loss or change of vision
- sudden or severe headache
- sudden slurring of speech
- weakness or numbness in arm or leg
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Note the following important information about estrogen replacement therapy:
The Women's Health Initiative (WHI) study results indicated an increased risk of heart attack, stroke, breast cancer, blood clots in the lungs, and blood clots in the leg veins in postmenopausal women during 5 years of treatment with 0.625 mg conjugated equine estrogens and 2.5 mg medroxyprogesterone compared to women receiving sugar tablets. Other combinations of estrogen and progestins were not studied. However, until additional data are available, the risks should be assumed to be similar for other hormone replacement products. Therefore,
- estrogens with or without progestins should be used at the lowest dose that relieves your menopausal symptoms for the shortest time period possible, as directed by your doctor; and
- estrogens with or without progestins should not be used to prevent heart disease, heart attacks, or strokes.
Bleeding: If you miss taking several doses of this medication, vaginal bleeding may occur. Also, irregular menstrual bleeding may occur while taking drospirenone - estradiol, especially within the first 6 months of starting this medication. This decreases with time and women may experience no bleeding after using this medication for a while.
Blood clotting disorders: Estrogens with or without progestins are associated with an increased risk of blood clots in the lungs (pulmonary embolism) and legs (deep vein thrombosis). This risk also increases with age, a personal or family history of blood clots, smoking, and obesity. The risk of blood clots is also increased if you are immobilized for prolonged periods and with major surgery. If possible, this medication should be stopped 4 weeks before major surgery. Talk about the risk of blood clots with your doctor.
Blood pressure: Women may experience increased blood pressure when using hormone replacement therapy. Ask your doctor how often you should have your blood pressure checked.
Breast and ovarian cancer: Studies indicate an increased risk of breast and ovarian cancer with the use of combined estrogen and progestin therapy. If you have a history of breast cancer, you should not use estrogens. If your family has a history of breast cancer or if you have a history of breast lumps, breast biopsies, or abnormal mammograms, your doctor will monitor your condition closely while you are using estrogens.
Have a mammogram before starting hormone replacement therapy. Have regular breast examinations and become familiar with your breasts so you can let your doctor know if anything has changed.
Dementia: Women over age 65 receiving combined hormone replacement therapy may be at increased risk of developing dementia (loss of memory and intellectual function). If you are over 65, talk to your doctor about whether you should be tested for dementia.
Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking this medication, as it may affect blood sugar control.
Endometrial cancer: There is evidence that estrogen replacement therapy can increase the risk of cancer of the endometrium (lining of the uterus). Women who have an intact uterus and are taking estradiol alone are at risk for developing a condition called endometrial hyperplasia, which can lead to the development of cancer of the uterus (endometrial cancer). The drospirenone (progestin) in this medication should counteract the risk of endometrial cancer.
Endometriosis: Estrogen replacement therapy can cause endometriosis to reappear or get worse. If you have or have had endometriosis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Familial hypertriglyceridemia: If you have a condition known as familial hypertriglyceridemia (a disorder leading to high levels of fats known as triglycerides in the blood), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Follow-up examinations: It is important to have a follow-up examination 3 to 6 months after starting this medication to assess the response to treatment. Examinations should be done at least once a year after the first one. Make sure you keep all appointments made with your doctor.
Gallbladder disease: This medication can aggravate gallbladder disease or increase the risk of developing it. If you have gallbladder disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Heart disease and stroke: Studies indicate an increased risk of heart disease and stroke with estrogen (with or without progestin) for postmenopausal women. Get immediate medical attention if you experience symptoms of a heart attack (chest pain, tightness, or pressures; sweating; nausea; feeling of impending doom) or stroke (sudden dizziness, headache, loss of speech, changes in vision, weakness or numbness in the arms and legs).
Hypercalcemia and kidney disease: Prolonged use of estrogens can change the metabolism of calcium and phosphorus. If you have a disorder that changes the levels of calcium and phosphorus in the blood, such as metabolic or malignant bone diseases or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Kidney or liver disease: If you have or have had kidney or liver problems, you may require special monitoring by your doctor while you use this medication. Make sure to tell your doctor if you have ever had kidney or liver problems.
Other medical conditions: Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed, if you have any of the following conditions:
- heart disease
- reduced kidney function
Uterine fibroids: Existing uterine fibroids may increase in size during estrogen use. This increase is usually minimal. However, if pain or tenderness occurs, inform your doctor as soon as possible. In some cases, the medication may need to be stopped.
Pregnancy: This medication must not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: Estrogen passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. This medication is not recommended for breast-feeding women.
Children: The safety and effectiveness of using this medication have not been established for children. This medication is not intended for use by children.
What other drugs could interact with this medication?
There may be an interaction between drospirenone - estradiol and any of the following:
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.