Names and pronunciation
Enjuvia
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Drug reference
Enjuvia
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Func. class.: Estrogen, hormone
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Do not confuse: Premarin/Provera Enjuvia/Januvia
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ACTION: Needed for adequate function- ing of female reproductive system; affects release of pituitary gonadotropins, inhibits ovulation; adequate calcium use in bone
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USES: Vasomotor symptoms (meno- pause), inoperable breast cancer, pros- tatic cancer, abnormal uterine bleeding, hypogonadism, primary ovarian failure, prevention of osteoporosis, castration, atrophic vaginitis
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Unlabeled uses: Hyperparathyroidism, infertility
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CONTRAINDICATIONS: Preg- nancy, breastfeeding, thromboembolic disor- ders, reproductive cancer, genital bleeding (abnormal, undiagnosed), hypersensitivity, MI, stroke, thrombophlebitis
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Black Box Warning: Endometrial, breast cancer, thromboembolic diseases Precautions: Hypertension, asthma, blood dyscrasias, HF, diabetes mellitus, depression, migraine headache, seizure disorders, gallbladder/bone/hepatic/ renal disease, family history of cancer of breast or reproductive tract, smoking, hypothyroidism, obesity, SLE Black Box Warning: Dementia Black Box Warning: Breast, endome- trial cancer: estrogens should not be used in known, suspected, or history of these disorders Black Box Warning: Stroke, thrombo- E embolic disease of MI: should not be used in these conditions or known pro- tein C deficiency, protein S deficiency, or antithrombin deficiency • Blood glucose if diabetic patient; hy- perglycemia may occur • Weight daily; notify prescriber of weekly weight gain >5 lb; if increase, diuretic may be ordered; check for edema; B/P baseline and periodically • Hepatic studies: AST, ALT, bilirubin, alkaline phosphatase • Hypertension, cardiac symptoms, jaundice, hypercalcemia • Mental status: affect, mood, behav- ioral changes, aggression • Female patient for intact uterus; if so, progesterone should be added to estro- gen therapy to decrease risk of endome- trial cancer; abnormal uterine bleeding, breast exam; Pap smear • Use lowest dose/shortest time pe- riod: estrogen therapy should be lim- ited to the shortest duration of therapy and lowest effective dose; individualize risks and benefits with each patient • Beers: avoid oral and topical patch in older adults; evidence of carcino- genic potential (breast, endometrial) • Pregnancy/breastfeeding: do not use in pregnancy; estrogens decrease milk production; use only if clearly needed Black Box Warning: To report breast lumps, vaginal bleeding, edema, jaun- dice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain; leg pain and redness, numbness or stiffness; chest pain; males to report impotence or gynecomastia • To avoid sunlight or wear sunscreen; burns may occur • To notify prescriber if pregnancy is suspected • That vasomotor symptoms improve in 2 wk, max relief in 8 wk HIGH ALERT
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SIDE EFFECTS CNS: Dizziness, headache, migraine, depression, seizures, mood disturbances CV: Hypertension, thrombophlebitis, edema, thromboembolism, stroke, pulmo- nary embolism, MI, chest pain EENT: Contact lens intolerance, increased myopia, astigmatism GI: Nausea, vomiting, diarrhea, anorexia, pancreatitis, cramps, constipation, increased appetite, cholestatic jaundice, hepatic adenoma, weight gain/loss GU: Amenorrhea, cervical erosion, breakthrough bleeding, dysmenorrhea, vaginal candidiasis, breast changes, gynecomastia, testicular atrophy, impotence, increased risk of breast can- cer, endometrial cancer, libido changes INTEG: Rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura, melasma META: Folic acid deficiency, hypercalce- mia, hyperglycemia
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INTERACTIONS toxicity—cycloSPORINE, Increase: dantrolene Increase: action of corticosteroids Decrease: action of estrogens—anticon- vulsants, barbiturates, phenylbutazone, rifAMPin, bosentan Decrease: action of anticoagulants, oral hypoglycemics, tamoxifen, thyroid, tricyclics Drug/Food Increase: estrogen level—grapefruit juice Drug/Lab Test Increase: T4, serum sodium, platelet aggregation, thyroxine-binding globulin (TBG), prothrombin; factors VII, VIII, IX, X; triglycerides Decrease: serum folate, serum triglycer- ide, T3 resin uptake test, glucose tolerance test, antithrombin III, metyrapone test False positive: LE prep, antinuclear antibodies
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DOSAGE AND ROUTES Estrogens conjugated Vasomotor symptoms (menopause) • Adult: PO 0.3-1.25 mg/day 3 wk on, 1 wk off Prevention of osteoporosis • Adult: PO 0.3 mg/day or in cycle Atrophic vaginitis • Adult: VAG CREAM 0.5 g/day × 21 days, off 7 days, repeat Prostatic cancer • Adult: PO 1.25-2.5 mg tid Advanced inoperable breast cancer • Adult: PO 10 mg tid × ≥3 mo Abnormal uterine bleeding • Adult: IV/IM 25 mg q6-12hr Castration/primary ovarian failure • Adult: PO 1.25 mg/day 3 wk on, 1 wk off Hypogonadism • Adult: PO 0.3 or 0.625 mg daily (3 wk on, 1 wk off), adjust to response Estrogens conjugated synthetic B Vasomotor symptoms (menopause) • Adult: PO 0.625 mg/day initially; may increase based on response Dyspareunia (moderate to severe); menopausal-cyclic regimen: • Adult: INTRAVAGINALLY 0.5 g daily × 21 days, then off 7 days; continuous regimen INTRAVAGINALLY 0.5 g bid
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Available forms: Tablets 0.3, 0.45, 0.625, 0.9, 1.25, 2.5 mg; injection 25 mg/vial; vag cream 0.625 mg/g; syn- thetic B: tablets 0.625, 1.25 mg
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Administer: Titrated dose; use lowest effective dose PO route • Give with or immediately after food to reduce nausea IM route • Reconstitute after withdrawing 5 mL of air from container, inject sterile dilu- ent on vial side, rotate to dissolve; give injection deep in large muscle mass, as- pirate before injection Vaginal route • Use applicator provided, wash after use Direct IV route • IV, after reconstituting as for IM, inject into distal port of running IV line of D5W, 0.9% NaCl at ≤5 mg/min Y-site compatibilities: Heparin, hydro- cortisone, potassium chloride, vitamin B/C
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Assess:
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Evaluate: • Therapeutic response: absence of breast engorgement, reversal of meno- pause symptoms, decrease in tumor size with prostatic cancer
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid breastfeeding; product is ex- creted in breast milk • To weigh weekly; to report gain >5 lb
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PHARMACOKINETICS PO/IM/IV: Degraded in liver, excreted in urine, crosses placenta, excreted in breast milk
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• Adult: PO 0.3-1.25 mg/day 3 wk on, 1 wk off Prevention of osteoporosis
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• Adult: PO 0.3 mg/day or in cycle Atrophic vaginitis
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• Adult: VAG CREAM 0.5 g/day × 21 days, off 7 days, repeat Prostatic cancer
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• Adult: PO 1.25-2.5 mg tid Advanced inoperable breast cancer
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• Adult: PO 10 mg tid × ≥3 mo Abnormal uterine bleeding
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• Adult: IV/IM 25 mg q6-12hr Castration/primary ovarian failure
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• Adult: PO 1.25 mg/day 3 wk on, 1 wk off Hypogonadism
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• Adult: PO 0.3 or 0.625 mg daily (3 wk on, 1 wk off), adjust to response Estrogens conjugated synthetic B Vasomotor symptoms (menopause)
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• Adult: PO 0.625 mg/day initially; may increase based on response Dyspareunia (moderate to severe); menopausal-cyclic regimen:
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• Adult: INTRAVAGINALLY 0.5 g daily × 21 days, then off 7 days; continuous regimen INTRAVAGINALLY 0.5 g bid
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