Premarin (Conjugated Estrogens)

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This medication is a female hormone (ie estrogen pills).

It is used by women to help reduce symptoms of menopause (such as hot flashes, vaginal dryness). These symptoms are caused by the body making less estrogen. If you are using this medication to treat symptoms only in and around the vagina, products applied directly inside the vagina should be considered before medications that are taken by mouth, absorbed through the skin, or injected.

Certain estrogen products may also be used by women after menopause to prevent bone loss (osteoporosis). However, there are other medications (such as raloxifene, bisphosphonates including alendronate) that are also effective in preventing bone loss and may be safer.

These medications should be considered for use before estrogen treatment.

Certain estrogen products may also be used by men and women to treat cancers (certain types of prostate cancer, breast cancer that has spread to other parts of the body) and by women who are not able to produce enough estrogen (for example, due to hypogonadism, primary ovarian failure).

Talk to your physician about the benefit of using Premarin (Conjugated Estrogens), as well as discuss the risk associated with it. Your doctor will determine which treatment is best for the symptoms you are experiencing.  

 

Premarin (Conjugated Estrogens Tablets) Medication Information

Uses

Premarin is a prescription tablet that contains a mixture of estrogen hormones. 

Premarin is approved for use after menopause (the end of monthly menstrual periods) to treat the following conditions:

  • Reduce moderate to severe hot flashes, which can happen when estrogen levels decline due to menopause.
  • Treatment of moderate to severe vulvar and vaginal atrophy.  This occurs when the vaginal walls and surrounding areas become thin, dry, and irritated due to declining estrogen levels.
  • Reduce your risk of osteoporosis (thinning, weak bones). 

Premarin may also be prescribed to treat certain conditions in women before menopause if the ovaries do not make enough estrogen naturally.  Also, Premarin can help men and women to relieve the symptoms of certain cancers that have spread through the body.

Dosage

Premarin is an oral tablet that comes in five strengths: 

  • 0.3 mg
  • 0.45 mg
  • 0.625 mg
  • 0.9 mg
  • 1.25 mg 

Premarin is usually taken once daily, with or without food.  Take Premarin exactly as instructed by your doctor.

Precautions

Premarin contains a blend of estrogens, which may have serious health risks.  Premarin may increase your risk of blood clots, stroke, heart attack, gallbladder disease, or cancer of the breast, uterus, or ovaries.  If you have certain health problems, Premarin could make your condition worse.  Before taking Premarin, make sure to tell your doctor if you’ve had any of the following conditions:

  • Unusual vaginal bleeding
  • Breast cancer
  • Blood clots or bleeding problems
  • Stroke or heart attack
  • Liver problems
  • Allergic reaction to Premarin or its ingredients

 Discuss the risks and benefits of Premarin treatment with your doctor.

Side Effects

Like all medications, Premarin has the potential for causing side effects.  Some people may experience mild side effects or, less commonly, serious side effects.  

Mild side effects are common with Premarin and may include:

  • Headache
  • Breast pain
  • Vaginal bleeding or spotting
  • Nausea and vomiting
  • Stomach pain or bloating
  • Hair loss
  • Fluid retention
  • Vaginal yeast infection

Less commonly, Premarin can cause serious side effects.  These may include:

  • Heart attack
  • Stroke
  • Blood clots
  • Dementia
  • Cancer of the breast, uterus, or ovary
  • High blood pressure
  • High blood sugar
  • Gallbladder problems
  • Liver problems
  • Severe allergic reactions

For more information on the possible side effects of Premarin, talk with your doctor or pharmacist.

Interactions

Some medications can interact with estrogen-containing drugs. Harmful effects could occur when Premarin is taken with certain medicines.  Or the interacting medications could become less effective.  Some examples include:

  • Carbamazepine
  • Clarithromycin
  • Erythromycin
  • Ketoconazole
  • Phenobarbital
  • Ritonavir

Grapefruit and grapefruit juice can also increase the risk of side effects and should be avoided.

Talk with your doctor or pharmacist before taking any other medications or herbal supplements with Premarin. 

Storage

Store Premarin in a sealed container at room temperature, around 25°C (77°F).

Pharmacists Tips

  • It doesn’t matter what time of day you take Premarin.  Take it consistently around the same time each day.
  • If you miss a dose of Premarin, take it as soon as you remember that day.  If you forget until the next day, skip the missed tablet.  Don’t double your dose of Premarin.
  • If your doctor prescribed Premarin to prevent osteoporosis (thin bones), you should continue to exercise, calcium, and vitamin D supplements as recommended by your doctor.

Premarin FAQs

Is there anything I can do to reduce my chances of severe side effects from Premarin?

Talk with your doctor regularly about whether you should continue taking Premarin, as this medication may not be safe to take long-term for some people.  If you have a uterus, talk to your doctor about adding progestin.  Progestin is another hormone that may reduce your chance of getting uterine cancer from estrogens.

Also, to reduce your chances of serious side effects, you should get preventative screenings and make choices that support your health, such as seeing your doctor regularly.  Don’t miss pelvic exams or mammograms.  

Talk with your doctor about ways to reduce your risk of heart disease, such as controlling your blood pressure, cholesterol, and weight.  And if you smoke, ask your doctor for help quitting.  

 

What if I have unusual vaginal bleeding or spotting?

You should see your doctor right away.  Premarin contains a blend of estrogen hormones.  Estrogen is associated with an increased risk of serious side effects, including cancer of the uterus. It’s possible that vaginal bleeding or spotting after menopause could be a warning sign of uterine cancer.  

  

Related Products

References

  1. Premarin- estrogens, conjugated tablet. Philadelphia, PA; Pfizer: 2018.  http://labeling.pfizer.com/showlabeling.aspx?id=131#PI Accessed January 26, 2021.
  2. Peacock K, Ketvertis KM. Menopause. StatPearls. Treasure Island, FL; StatPearls Publishing: 2020. https://www.ncbi.nlm.nih.gov/books/NBK507826/ Accessed January 26, 2021.

PharmD Medical Writer

Author: Dr. Patricia Weiser, PharmD

Patricia Weiser, PharmD, is a licensed pharmacist and medical writer.  She has clinical experience in community and hospital pharmacy.  Patricia is a 2007 graduate of the University of Pittsburgh. She resides in Pennsylvania with her husband and two daughters.

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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.

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