Drospirenone and Estradiol (Oral)

Overview

Drospirenone-estradiol is a medication often prescribed to help alleviate or reduce the symptoms of menopause, which usually occurs in women past their middle ages, although it may sometimes be prescribed for other health conditions as well. These symptoms can include hot flashes, which are episodes of redness and warmth, as well as sweating, of the upper body and face, as well as vaginal itching, dryness and burning. They occur when the body no longer produces enough estrogen. Drospirenone is a progestin and is added to estradiol, which is a form of estrogen, in order to decrease the risk of uterine cancer. Patients who have had their uteruses removed do not require the progestin.

For patients who only wish to treat certain menopausal symptoms such as vaginal itching, burning or dryness, it is recommended that they try topical solutions such as vaginal creams, before they turn to hormone drugs such as drospirenone-estradiol.

The use of estrogens has been linked to an increased risk in cancer, heart attacks, blood clotting and dementia. It is recommended that patients use estrogen medicine at the lowest dosage that is still useful, for as short a time as possible. While using drospirenone-estradiol, patients should monitor themselves carefully for any unusual signs or symptoms. It is also advised for patients to undergo regular checkups to make sure that no unwanted effects are developing.

There are several medical conditions that may interact with drospirenone-estradiol. Patients should let their doctors know of their medical history, particularly if they include cancer, heart problems or problems with blood clotting.

Other significant interactions with this medication include grapefruit, alcohol and tobacco, which patients should avoid during treatment.

While there are chances of side effects, drospirenone-estradiol is an effective medicine which is able to treat and reduce menopausal symptoms, which can be distressing or unpleasant to patients. Patients can also further reduce the chance of unwanted effects by ensuring they follow their doctor's instructions carefully, and by making sure they go for all medical appointments and check-ups.

Conditions Treated

  • Menopause symptoms

Type Of Medicine

  • Hormones

Side Effects

When taking drospirenone-estradiol, as with any other medication, there is a chance of developing side effects, although not all patients will experience them. The following is an incomplete list of side effects; if the patient encounters any of them, or any unusual symptom that is not listed here, they should contact their doctor as quickly as possible for further medical advice.

  • Swelling of the hands and feet

Use of drospirenone-estradiol may lead to a higher incidence of cancer. Patients should watch out for:

  • Lumps in the breast(s) or under the arm

It is rare but possible that drospirenone-estradiol may cause serious blood clotting problems. These include strokes, heart attacks, pulmonary embolism and deep vein thrombosis. If patients encounter any of the following they should seek emergency medical treatment.

  • Warmth, swelling or pain in the groin or calf

There are some side effects that are more common and less severe. These effects should go away by themselves, although the patient should contact their doctor if they persist or become worse.

  • Dizziness

While rare, some patients may have allergic reactions to drospirenone-estradiol that should be treated immediately. These include symptoms like:

  • Rashes

Dosage

Each patient's dose may differ based on their condition and their needs. This guide lists an average dose of drospirenone and estradiol. If the patient's prescription differs from the average, they should not change their dosage or dose schedule without consulting with their doctor. To help with remembering to take the medicine, patients should take their medication at about the same time each day.

For treating hot flashes and other symptoms of menopause:

  • Adults: One tablet per day, which contains 0.25 miligrams (mg) of drospirenone and 0.5mg of estradiol, or 0.5mg of drospirenone and 1mg of estradiol.

For treating vulvar and vaginal atrophy from menopause:

  • Adults: One tablet per day, containing 0.5mg of drospirenone and 1mg of estradiol.

If the patient has missed a dose, they should resume it as quickly as possible. However, if the timing is too close to the next dose, they should skip the missed dose and resume the dosing schedule. Patients should refrain from double dosage. If the patient has missed more than one dose, they should contact their doctor for further advice.

Skipping several doses may cause bleeding to occur.

Drospirenone-estradiol is usually available in packaging containing three blister packs containing 28 tablets. Patients are required to take them continuously, with or without food. They should swallow the tablet whole, with liquids, and without breaking, crushing or chewing them.

Interactions

Drugs may interact with each other to cause unwanted side effects or decrease the effectiveness of the medication. Prior to starting drospirenone-estradiol, patients should make a note of any other drugs, supplements or herbal products that they are currently consuming or have recently consumed, so that they can share the list with their doctor or pharmacist, in order to prevent any unwanted interactions. However, in certain situations, the doctor may find it necessary to prescribe other medicines that have been known to interact with drospirenone-estradiol. In these cases, the patient should discuss their condition and any questions with the doctor, for options to minimise the chance of side effects.

Patients should not start, stop or alter the dosage of any medication they are taking without the knowledge of their doctor.

The following is an incomplete list of medications that may cause an interaction with drospirenone-estradiol:

  • Anti-seizure medication (such as carbamazepine or phenobarbital)

Drospirenone-estradiol should not be paired with the following drugs as they may lead to very serious interactions:

  • Aromatase inhibitors (such as anastrozole or exemestane, and etc.)

The use of drospirenone-estradiol may increase the levels of potassium in the blood. Patients should tell their doctors or healthcare givers if they are taking any other medicines that may raise their potassium blood levels, as overly high levels of potassium may lead to severe side effects. They should also follow their doctor's instructions strictly, and take their medicine according to their prescriptions. If patients have been scheduled for any medical appointments so that their condition, especially their potassium blood levels, can be monitored, they should take care not to miss any of them. The following medications may interfere with the patient's potassium levels:

  • Aliskiren

Alcohol and tobacco are likely to interact with medications. Patients who smoke or drink alcohol regularly, should especially consult with their doctor on any possible interactions. Grapefruit and its products are also likely to interact with drospirenone-estradtiol, and may change the absorption of the medicine by the body. It is advisable to check with the doctor to see if there are any other foods that should be avoided.

There are certain medical conditions and illnesses that may affect the use of drospirenone-estradiol, or may even worsen the patient's condition. Patients should let their doctor know of their medical history, especially if they have had or are currently experiencing:

  • Adrenal gland disease

Warnings

Prior to starting treatment with drospirenone-estradiol, patients should read all available information on the medication that is available to them via their doctor. They should also clarify all questions and doubts beforehand. While the patient is using drospirenone-estradiol, the doctor should check on them regularly to make sure that the medication is working as expected, and if dosage should be adjusted or if the patient can stop taking the medicine. The patient may be required to undergo tests such as mammograms, pelvic and breast exams to check that they are not developing unwanted effects.

Allergic reactions to the medication or its inactive ingredients are rare but may occur. Patients should notify their doctors or pharmacists of any allergies they may have, whether it is to the drug, or to any other medication or material, including food, dyes and herbal products.

If the patient is scheduled for a lab test, they should let their doctor or healthcare givers know that they are currently on or have recently consumed drospirenone-estradiol, as the medicine may affect the results of the test.

As certain medical conditions may affect how drospirenone-estradiol works, patients should share their medical history with their doctor. These conditions include heart problems, thyroid dysfunctions, kidney diseases and etc.

It is advisable for patients to also share a list of current drugs, supplements (such as vitamins) or herbal products, if they are using any, with their doctors or healthcare givers in order to avoid unwanted interactions from happening with their medication.

Drospirenone-estradiol may cause dizziness or lightheadedness, and the effect can be exacerbated by the use of alcochol, tobacco or marijuana. Tobacco, in particular, may increase the risk of blood clots, high blood pressure, strokes and heart attacks, especially for patients who are older than 35 years of age. The patient should speak with their doctor if they use any of these substances for further advice. Patients should refrain from activities that require mental alertness, such as driving or operating machinery, until they are certain they can perform them safely.

Patients who use or are planning to use potassium supplements or salt substitutes containing potassium may want to refrain from them or consult their doctor or pharmacist for further advice, as drospirenone-estradiol may increase potassium levels.

Melasma is a possible side effect of this medication, which appear as blotchy and dark areas on the skin, and which may worsen with exposure to sunlight. Patients should avoid tanning booths or sunlamps, and are advised to limit their time in the sun. In order to minimise exposure to the sun, patients can use sunscreens or sunblocks, and wear protective clothing outdoors.

Another possible side effect with drospirenone-estradiol is the formation of blood clots. Patients with a history of blood clotting problems should be especially vigilant. If the patient is scheduled for surgery, or anticipates being confined to bed or a chair for a long period of time, such as with long plane rides, they should let their doctor know beforehand, as lack of movement may cause blood clotting, or thrombosis.

While using this medication, patients who wear contact lenses or who are near-sighted may experience problems with their vision or with wearing contact lenses. They should contact their opthamologist (or eye doctor) if such problems occur.

The use of drospirenone-estradiol in elderly patients may lead to a higher risk of breast cancer, strokes or dementia.

Drospirenone-estradiol is not safe for patients who are pregnant, and they should seek immediate medical advice if they think they may be pregnant while under treatment with this medication. Patients who are planning to become pregnant should consult with their doctors prior to starting a course of this medicine. There is currently insufficient information about the use of drospirenone-estradiol with breastfeeding patients, although small amounts of this medicine may pass into breast milk, which may affect both its quality and quantity.

This medicine should not be used for preventing a miscarriage.

Storage

Drospirenone-estradiol should be kept in a closed container, in a cool and dry place, away from direct sunlight and humidity. As bathrooms may have excessive humidity, the medicine should not be stored there. It should also not be exposed to freezing temperatures.

Medicine should be kept out of reach of children and animals.

Once the medicine is expired or unwanted, it should be disposed of properly. If the patient is unsure on how to handle medical waste, they should approach their doctor or local waste management to ask how the medicine can be discarded properly.

Summary

Drospirenone and estradiol are hormones, respectively progestin and estrogen, and they are used together to alleviate symptoms of menopause in older women, as well as low amounts of estrogen in women who have uteruses. These symptoms of menopause and low estrogen can include dryness, itching or burning of the vagina and hot flashes. This medicine is usually available only via a doctor's prescription.

There are several medical conditions which can interact with this medicine to produce unwanted effects. It is important that patients share their medical history with their doctor so that they can monitor and reduce the risk of such effects, especially if they have had or are still experiencing conditions such as heart problems, thyroid problems or liver problems.

Drospirenone-estradiol may also cause thrombosis, which are blood clots that are lodged in arteries, as well as an increased risk of cancer such as uterine or breast cancer. Patients should take care to read all available information on the medicine and consult their doctors if they have any questions or concerns about the medication at all.

Patients should be careful to avoid certain products while on treatment, such as grapefruit and its products, or alcohol and tobacco, as they may lead to undesirable interactions with their medication.

Pregnant patients, or patients intending on becoming pregnant, should avoid drospirenone-estradiol as any benefits of this medicine are vastly outweighed by its negative effects. Breast-feeding patients should consult with their doctor on whether it is safe to use, as small amounts of drospirenone-estradiol does pass into breast milk.

As this medication affects the amount of hormones in the body, patients who only wish to treat external symptoms such as vaginal dryness may wish to consider topical medication first, before proceeding with drospirenone-estradiol if they consider it necessary.

Despite possible side effects, drospirenone-estradiol is effective at treating symptoms of menopause, which can be distressing or annoying to patients. In order to maximise its effectiveness, patients should follow their doctor's prescription as closely as possible.

Links

1. https: //www.mayoclinic.org/drugs-supplements/drospirenone-and-estradiol-oral-route/description/drg-20063089
2. https: //www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0013544/
3. https: //www.webmd.com/drugs/2/drug-94472/drospirenone-estradiol-oral/details
4. https: //www.rxlist.com/angeliq-drug.htm
5. https: //www.drugs.com/cdi/drospirenone-and-estradiol.html

Drospirenone and estradiol are two separate hormones which, when paired together, are an effective treatment for menopausal symptoms.

  • Yellowing of the eyes or skin
  • Pain in the stomach or abdominal area
  • Changes in mood or mental condition (loss of memory, depression, etc.)
  • Deterioration of a seizure condition
  • Signs of diabetes (increased thirst, increased urination, etc.)
  • Symptoms of high potassium blood level (muscle weakness, slow or irregular heartbeat and etc.)
  • Discharge from nipples
  • Inverted nipple
  • Unusual vaginal bleeding (spotting, prolonged or returning bleeding, etc.)
  • Tingling, weakness or numbness in the arms or legs
  • Pain in the chest, jaw or left arm
  • Sudden shortness of breath
  • Sudden dizziness or fainting
  • Coughing up of blood
  • Unusual sweating
  • Confusion
  • Weakness on one side of the body
  • Slurred speech
  • Sudden changes to the vision (such as partial or complete blindness)
  • Unusual, sudden or severe headaches
  • Worsening migraines
  • Lightheadedness
  • Headaches
  • Irritability
  • Change in sleep patterns
  • Nausea
  • Stomach upset
  • Bloating
  • Change of interest in sex
  • Change in vaginal discharge
  • Tenderness in breast
  • Itching or swelling, especially of the face, tongue and throat
  • Severe dizziness
  • Trouble with breathing
  • Children: Use of this medicine is not recommended for children.
  • Children: Use of this medicine is not recommended for children.
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  • Angioedema
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  • Edema (fluid retention, or body swelling)
  • Endometriosis
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  • Glucose intolerance
  • Heart attacks
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  • Hypercalcemia i(high levels of calcium in the blood)
  • Hyperkalemia (high levels of potassium in the blood)
  • Hyperlipidemia (high levels of fat, cholesterol and/or triglycerides in the blood)
  • Hypertension
  • Hypocalcemia (low levels of calcium in the blood)
  • Hyponatremia (low levels of sodium in the blood)
  • Jaundice (from pregnancy, or hormonal therapy)
  • Kidney problems or diseases
  • Liver disease
  • Melasma
  • Mental or mood disorders (such as depression)
  • Migraines
  • Otosclerosis
  • Porphyria
  • Strokes
  • Systemic lupus erythematosus
  • Thyroid dysfunction
  • Unusual vaginal bleeding
  • Uterus problems
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Last Reviewed:
March 26, 2018
Last Updated:
April 08, 2018