Estradiol Administration
NOTE: Patients should be reevaluated at 3 - 6 month intervals to determine if changes in hormone replacement therapy (HRT) are needed or if continued HRT is appropriate. In women with an intact uterus, estrogen therapy should be given cyclically or combined with a progestin for at least 10 - 14 days each month to minimize the risk of endometrial hyperplasia. Taking estrogen with progestin may have additional health risks for the patient; risk must be determined individually.
Oral Administration
- Administer with or immediately after food to decrease nausea.
Intramuscular Administration
- Estradiol cypionate and estradiol valerate are administered intramuscularly. These products are NOT for intravenous or subcutaneous administration.
Reconstitution:
- Estradiol cypionate and estradiol valerate: Injections are oil based. No reconstitution is necessary.
- Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Intramuscular injection:
- Estradiol cypionate, estradiol valerate: Roll vial and syringe between the palms to ensure even dispersion prior to withdrawal and administration of the injection. For these oil-based products, a needle of at least 21 gauge is recommended; a dry, sterile syringe should be used.
- All intramuscular injections: Inject deeply into the upper, outer quadrant of the gluteal muscle. Aspirate prior to injection to avoid injection into a blood vessel.
Intravaginal Administration
- Estradiol is administered intravaginally.
- Estradiol vaginal cream: Instruct patient on proper use of intravaginal products. Advise patient that they should remain recumbent for at least 30 minutes following application of the cream. A sanitary napkin may be used to protect clothing after applying vaginal cream, however, tampons should not be used.
- Estradiol vaginal ring insert: Instruct patient on proper administration and use of the intravaginal ring (see Patient Information and packaging for the specific vaginal ring prescribed). The ring insert is placed in the upper third of the vagina and is worn continuously for 90 days. After 90 days, the ring should be removed and a new insert is applied. Alternatively, within the 90-day dosage period, the patient may remove the insert, rinse it with lukewarm (not hot or boiling) water, and re-insert the ring as needed. After 90 days, a new insert is applied.
- Estradiol vaginal tablet: Instruct patient on proper use of intravaginal tablet and applicator).
Transdermal Administration
- Estradiol is administered percutaneously via a transdermal patch system.
- Patients who are converted from oral estrogens to transdermal dosage systems should wait one week after oral estrogen withdrawal before beginning the skin patches.
- Wash hands before and after transdermal system application.
- Instruct patient on proper application of patch. Each patch brand has instructions regarding where the patch may be applied. Do not apply to the breasts. Do not apply to the waistline or other areas where the patch may not adhere properly.
- The sites of application must be rotated, with an interval of at least one week allowed between applications to the same site.
- The transdermal system should not be exposed to the sun for prolonged periods of time. Patients may bathe while wearing the system.
- If a system should fall off, the same system may be reapplied to another area. If necessary, a new system may be applied, in which case, the original treatment schedule should continue.
- Always remove the old patch/system before applying a new transdermal patch.
Topical Administration
- Estradiol is administered percutaneously via a topical emulsion or gel.
- Wash hands before and after application of any topical estradiol product.
Topical skin emulsion, i.e., Estrasorb™:
- Instruct patient on proper application of the topical emulsion. Absorption of topical emulsion has only been studied on the thighs, calves, and buttocks.
- The areas to which the topical emulsion has been applied should be allowed to dry completely before covering with clothing to avoid transfer to other individuals.
Topical gel, EstroGel™:
- Instruct patient on proper application of the topical gel. One application is to be applied to one arm.
- The areas to which the topical gel has been applied should be allowed to dry completely before covering with clothing to avoid transfer to other individuals.
[ Last revised: 5/14/2004 2:28:00 PM ]
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