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Divigel (Estradiol) Dosage and Side Effects
DIVIGEL is approved for the replacement of estrogen in menopausal women with symptoms of menopause, which may include hot flushes, disturbed sleep and vaginal dryness.
Proper Use of this medication
DIVIGEL should be applied once a day, around the same time each day.
Apply to clean, dry, and unbroken (without cuts or scrapes) skin. If you take a bath or shower, be sure to apply your DIVIGEL after your skin is dry. The application site should be completely dry before dressing or swimming.
Apply to either your left or right upper thigh. Change between your left and right upper thigh each day to help prevent skin irritation.
How and when to apply DIVIGEL:
(See package insert for illustrations.)
- Wash and dry your hands thoroughly.
- Sit in a comfortable position.
- Cut or tear the DIVIGEL packet.
- Using your thumb and index finger, squeeze the entire contents of the packet onto the skin of the upper thigh.
- Gently spread the gel in a thin layer on your upper thigh over an area of about 5 by 7 inches, or two palm prints. It is not necessary to massage or rub in DIVIGEL.
- Allow the gel to dry completely before dressing.
- Dispose of the empty DIVIGEL packet in the trash.
- Wash your hands with soap and water immediately after applying DIVIGEL to remove any remaining gel and reduce the chance of transferring DIVIGEL to other people.
Important things to remember when using DIVIGEL
- Wash your hands with soap and water after applying the gel to reduce the chance that the medicine will be spread from your hands to other people
- Allow the gel to dry before dressing. Try to keep the area dry for as long as possible
- Do not allow others to come in contact with the area of skin where you applied the gel for at least one hour after you apply DIVIGEL
- You should not allow others to apply the gel for you. However, if this is necessary, the individual should wear a disposable plastic glove to avoid direct contact with DIVIGEL
- Do not apply DIVIGEL to your face, breast, or irritated skin. If you get DIVIGEL in your eyes, flush your eyes right away with lukewarm tap water
- Never apply DIVIGEL in or around the vagina
- DIVIGEL contains alcohol. Alcohol based gels are flammable. Avoid fire, flame or smoking until the gel has dried
In the case of accidental overdosage or ingestion (swallowing) of DIVIGEL, contact your doctor and/or your local Poison Control Centre.
If you miss a dose, do not double the dose on the next day to catch up. If your next dose is less than 12 hours away, it is best just to wait and apply your normal dose the next day. If it is more than 12 hours until the next dose, apply the dose you missed and resume your normal dosing the next day. Do not apply more than once each day. If you accidentally spill some of the contents of a DIVIGEL packet, do not open a new packet. Wait and apply your normal dose the next day.
Adverse drug reactions occur most commonly during the first months of treatment. They are usually mild and subside with continued treatment. Very rarely skin irritation can occur with DIVIGEL. Using alternate thighs for each dosing is recommended.
The following side effects generally do not require medical attention, and will go away as your body adjusts to DIVIGEL:
Common: headache, breast pain, breast tenderness, bloating, weight increase, nausea/vomiting, abdominal pain (cramping), skin irritation.
Uncommon: migraine, changes in mood.
If you think you are reacting poorly to DIVIGEL or are having other problems, please tell your doctor.
Warnings and Precautions
It should not be used by women with an intact uterus unless it is prescribed in association with a progestin.
This medication should be used only under the supervision of a doctor, with regular follow-up at least once a year to identify side effects associated with its use. Your first follow-up visit should be within 3 to 6 months of starting treatment. Your visit may include a blood pressure check, a breast exam, a Pap smear and pelvic exam. You should have a mammogram before starting treatment and at regular intervals as recommended by your doctor. Your doctor may recommend some blood tests.
Serious Warnings and Precautions
Therefore, you should carefully consider the following:
- There is an increased risk of developing invasive breast cancer, heart attack, stroke and blood clots in both lungs and large veins with the use of estrogen plus progestin therapy.
- There is an increased risk of stroke and blood clots in the large veins with the use of estrogen-alone therapy.
- Estrogens with or without progestins should not be used to prevent heart disease or stroke.
- Estrogens with or without progestins should be used at the lowest effective dose and for the shortest period of time possible. Regular medical follow-up is advised.
Overgrowth of the lining of the uterus and cancer of the uterus:
In some studies the use of estrogen-alone therapy and estrogen plus progestin therapies for 5 or more years has been associated with an increased risk of ovarian cancer.
The use of estrogen-alone therapy by post menopausal women who still have a uterus increases the risk of developing endometrial hyperplasia (overgrowth of the lining of the uterus), which increases the risk of endometrial cancer (cancer of the lining of the uterus).
If you plan to take estrogen therapy and you still have your uterus, you should take a progestin medication (another hormone drug) regularly for a certain number of days of each month to reduce the risk of endometrial hyperplasia.
You should discuss progestin therapy and risk factors for endometrial hyperplasia and endometrial carcinoma with your doctor. You should also report any unexpected or unusual vaginal bleeding to your doctor.
If you have had your uterus removed, you are not at risk of developing endometrial hyperplasia or endometrial carcinoma. Progestin therapy is therefore not generally required in women who have had a hysterectomy.
Abnormal Blood Clotting:
The risk of blood clots also increases with age, if you or a family member has had blood clots, if you smoke or if you are severely overweight. The risk of blood clots is also temporarily increased if you are immobilized for long periods of time and following major surgery. You should discuss risk factors for blood clots with your doctor since blood clots can be life-threatening or cause serious disability.
The use of estrogens by postmenopausal women has been associated with an increased risk of gallbladder disease requiring surgery.
BEFORE you use, talk to your doctor or pharmacist if you:
- have a history of allergy or intolerance to any medications or other substances
- have a personal history of breast disease (including breast lumps) and/or breast biopsies, or a family history of breast cancer
- have experienced any unusual or undiagnosed vaginal bleeding
- have a history of uterine fibroids or endometriosis
- have a history of liver disease, jaundice (yellowing of the eyes and/or skin) or itching related to estrogen use or during pregnancy
- have a history of migraine headache
- have a history of high blood pressure
- have a personal or family history of blood clots, or a personal history of heart disease or stroke
- have a history of kidney disease, asthma or epilepsy (seizures)
- have a history of bone disease (this includes certain metabolic conditions or cancers that can affect blood levels of calcium and phosphorus)
- have been diagnosed with diabetes
- have been diagnosed with porphyria (a disease of blood pigment)
- have a history of high cholesterol or high triglycerides
- are pregnant or may be pregnant
- have had a hysterectomy (surgical removal of the uterus)
- have a thyroid problem (hypothyroidism)
Interactions with this medication
Drugs that may interact include:
Barbiturates, hydantoins, carbamazepine, meprobamate, phenylbutazone or rifampin, atorvastatin, antibiotics, aminoglutethimide, some herbal products (e.g., St. John's Wort), phenobarbital, phenytoin, troglitazone, ascorbic acid, acetaminophen, oral contraceptives containing ethinyl estradiol, progestin.
Estrogens may diminish the effectiveness of anticoagulant (substances that prevent coagulation), antidiabetic (drugs treating diabetes mellitus) and antihypertensive agents (drugs treating high blood pressure).
Tell your doctor or pharmacist if you are taking any other medications, including prescription medications, over-the-counter medications, vitamins or herbal products.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.