estrogens esterified/methyltestosterone (Rx)

Brand and Other Names:Covaryx, Estratest, more...Estratest H.S.
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

estrogens esterified/methyltestosterone

tablet

  • 0.625mg/1.25mg
  • 1.25mg/2.5mg
more...

Menopausal Vasomotor Symptoms

Treatment of moderate-to-severe vasomotor symptoms associated with menopause in patients not improved by estrogens alone

Use lowest dose that will control symptoms

Typical dosage range: 0.625 mg/1.25 mg PO qDay up to 1.25 mg/2.5 mg qDay

Administration should be cyclic (eg, 3 weeks on and 1 week off)

Attempts to discontinue or taper medication should be made at 3-6 month intervals

Not indicated

Next:

Interactions

Interaction Checker

and estrogens esterified/methyltestosterone

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            Frequency Not Defined

            Edema

            Headache

            Acne, alopecia

            Breast soreness,

            Menstrual irregularities

            Bloating

            Nausea

            Hypercalcemia

            Hypercholesterolemia

            Cholestatic hepatitis

            Vomiting

            Anaphylaxis

            Suppression of clotting factors II, V, VII

            Polycythemia

            Paresthesia

            Previous
            Next:

            Warnings

            Black Box Warnings

            Estrogens Increase Risk of Endometrial Cancer

            • Close clinical surveillance of all women taking estrogens is important
            • Adequate diagnostic measures, including endometrial sampling when indicated, should be undertaken to rule out malignancy in all cases of undiagnosed persistent or recurring abnormal vaginal bleeding
            • There is no evidence that the use of "natural" estrogens results in a different endometrial risk profile than synthetic estrogens at equivalent estrogen doses

            Cardiovascular Risks

            • Estrogens with & without progestins should not be used to prevent cardiovascular disease
            • Estrogens plus progestins: Women’s Health Initiative (WHI) Estrogen Plus Progestin substudy reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, & deep vein thrombosis (DVT) in postmenopausal women (aged 50-79 yr) during 5.6 yr of treatment w/ daily PO conjugated estrogens (CE 0.625 mg) combined w/ medroxyprogesterone acetate (MPA 2.5 mg) compared w/ placebo
            • Estrogens alone: A substudy of the WHI Study reported increased risk for stroke & DVT in postmenopausal women (aged 50-79 yr) during 6.8 yr of treatment w/ oral conjugated estrogens (0.625 mg/day) alone compared w/ placebo
            • Unopposed estrogen in women with intact uterus is assocated with increased risk of endometrial cancer

            Dementia Risks

            • Estrogens with & without progestins should not be used to prevent dementia
            • Women's Health Initiative Memory Study (WHIMS), a substudy of the WHI study, reported increased risk of developing probable dementia in postmenopausal women aged 65 yr or older during 4 yr of treatment w/ daily CE 0.625 mg combined w/ MPA 2.5 mg, compared w/ placebo
            • Estrogens alone: A substudy of the WHIMS reported an increased risk of developing probable dementia in postmenopausal women aged 65 yr or older during 5.2 yr of treatment w/ conjugated estrogens 0.625 mg alone compared w/ placebo
            • Unknown whether these findings apply to younger postmenopausal women

            Dose & Duration

            • In the absence of comparable data, these risks should be assumed to be similar for other doses of CE and MPA & other combinations & dosage forms of estrogens & progestins
            • Because of these risks, estrogens w/ or without progestins should be prescribed at lowest effective dose & for shortest duration consistent w/ treatment goals and individual risks

            Contraindications

            Pregnancy, lactation

            Estrogen-dependent neoplasia

            Breast cancer

            Estrogen dependent tumor

            Liver dysfunction or disease

            Undiagnosed abnormal vaginal bleeding

            Active/history of DVT/PE

            Active/recent thromboembolic disease

            Hypersensitivity

            Cautions

            Cardiac disease, renal disease, DM, endometriosis, hyperlipidemias, HTN, hypothyroidism

            Increased risk of VTE

            Fluid retention may exacerbate asthma, epilepsy, migraines, & cardiac or renal dysfunction

            Increased risk of ovarian and endometrial cancer

            Concomitant warfarin, oral anticoagulants: may need to incr anticoagulant dose

            Estrogen may cause retinal vascular thrombosis; discontinue if migraine, proptosis, loss of vision, diplopia, or other vision abnormalities occur

            Women with thrombophilias may experience increased risk of venous thromboembolism

            Use caution in patients with familial defects of lipoprotein metabolism; triglycerides and HDL cholesterol may increase while LDL cholesterol may decrease

            See also individual monographs:

            • Estrogens, esterifed
            • Methyltstosterone
            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy Category: X

            Lactation: Excreted into breast milk; contraindicated

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Esterified estrogen: reduces LHRH release from hypothalamus, reduces gonadotropin release from pituitary; incr synthesis of DNA, RNA, & various proteins in target tissues

            Methyltestosterone: synthetic testosterone derivatives with predominantly anabolic & minor androgenic activity; promoting growth & development of male sex organs & maintaining secondary sex characteristics in androgen-deficient males

            Pharmacokinetics

            Half-Life: Methyltestosterone: 10-100 min (PO)

            Protein bound: 50-80% (esterified estrogens); 98% (methyltestosterone)

            Excretion

            • Esterified estrogens: Urine as conjugates, most estrogens are also excreted in bile & undergo enterohepatic recycling
            • Methyltestosterone: Urine (90%); feces (6%)

            Metabolism

            • Esterified estrogens: Liver, undergoes extensive first-pass metabolism to less active products such as estriol; kidneys, gonads, & muscle tissues may be involved in metabolism to some extent
            • Methyltestosterone: Hepatic
            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous