Prefest
Prefest (estradiol / norgestimate) is a combination medication that works well to relieve menopausal symptoms and prevent bone loss, but the directions on the package might be a little tricky to follow when you first start it.
What is Prefest (estradiol / norgestimate)?
What is Prefest (estradiol / norgestimate) used for?
Hot flashes, night sweats, and flushes caused by menopause
Vaginal dryness and burning caused by menopause
Prevention of postmenopausal osteoporosis (not a first-choice)
How Prefest (estradiol / norgestimate) works
Prefest (estradiol / norgestimate) is a combination of two medications.
Estradiol (an estrogen) replaces the estrogen your body loses during menopause and relieves hot flashes, relieves vaginal dryness, and strengthens bones.
Norgestimate (a progestin) protects the uterus from damage and helps prevent uterine cancer.
Drug Facts
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What are the side effects of Prefest (estradiol / norgestimate)?
Common Side Effects
- Headaches (23%)
- Cold- or flu-like symptoms (up to 21%)
- Breast pain (16%)
- Stomach or back pain (12%)
- Vaginal bleeding (9%)
- Joint pain (9%)
- Menstrual cramps (8%)
- Sinus pain or swelling (8%)
Other Side Effects
- Vaginal pain
- Sore throat
- Depression
- Fatigue
- Dizziness
- Muscle aches
- Gas
Serious Side Effects
- Allergic reactions
- Heart attack: chest pain or tightness, pain that radiates up to your shoulder, arm, neck, or jaw
- Stroke: sudden trouble talking, walking, or numbness on one side of your body or face
- Shortness of breath
- Sudden, severe headaches
- Breast lumps or pain
- Unusual or heavy vaginal bleeding
Source: FDA
The following side effects have also been reported
Women rarely have severe side effects from taking estrogens to replace estrogen. Discuss these possible effects with your doctor:
The prolonged use of estrogens has been reported to increase the risk of endometrial cancer (cancer of the lining of the uterus) in women after menopause. This risk seems to increase as the dose and the length of use increase. When estrogens are used in low doses for less than 1 year, there is less risk. The risk is also reduced if a progestin (another female hormone) is added to, or replaces part of, your estrogen dose. If the uterus has been removed by surgery (total hysterectomy), there is no risk of endometrial cancer, and no need to take an estrogen and progestin combination.
It is not yet known whether the use of estrogens increases the risk of breast cancer in women. Although some large studies show an increased risk, most studies and information gathered to date do not support this idea.
Check with your doctor immediately if any of the following side effects occur:
Check with your doctor as soon as possible if any of the following side effects occur:
More common
Breast pain or tenderness
dizziness or light-headedness
headache
rapid weight gain
swelling of feet and lower legs
vaginal bleeding
Rare
Breast lumps
change in vaginal discharge
discharge from nipple
pains in chest, groin, or leg, especially calf
pains in stomach, side, or abdomen
pain or feeling of pressure in pelvis
severe or sudden headache
sudden and unexplained shortness of breath
sudden loss of coordination
sudden slurred speech
sudden vision changes
weakness or numbness in arm or leg
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Prefest (estradiol / norgestimate)
Pros
Only needs to be taken once a day
Relieves multiple menopausal symptoms
Includes a medication that helps protect your uterus
Lowers your risk of fractures by keeping your bones healthy
Cons
Not safe if you have liver problems
Brand-name only — might be expensive
Directions might be a little complicated for some people
Raises your risk of certain cancers, blood clots, and strokes
Pharmacist tips for Prefest (estradiol / norgestimate)
You can take Prefest (estradiol / norgestimate) with or without food. Nausea is a possible side effect, so if this happens to you, try taking your dose with something to eat. For the most consistent results, take this medication at the same time every day.
Prefest (estradiol / norgestimate) comes in a pack that contains 30 tablets. The dose of the medication you receive changes every 3 days. You must take the tablets in the correct order for it to work properly. To prevent taking this medication in the wrong order, don't remove a tablet from the pack until you are ready to take your dose.
If you are only taking Prefest (estradiol / norgestimate) for vaginal symptoms, there are vaginal creams and rings available that have fewer side effects. Speak to your provider if you are interested in switching.
It might take up to 3 months for you to feel the full effects of Prefest (estradiol / norgestimate), although many people feel some relief sooner than that. Let your provider know if you don't feel any better after using this medication for 3 months.
Let your provider know if you experience unusual vaginal bleeding, lumps in your breast, changes to your vision, or severe headaches after starting Prefest (estradiol / norgestimate). These are not typical side effects and could be a sign of more serious problems.
Frequently asked questions about Prefest (estradiol / norgestimate)
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What are the risks and warnings for Prefest (estradiol / norgestimate)?
Prefest (estradiol / norgestimate) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
BREAST CANCER
Risk factors: Personal or family history of breast cancer | Long-term use of Prefest (estradiol / norgestimate)
There is a higher risk of developing breast cancer when taking medications containing both estrogen and progestin, such as Prefest (estradiol / norgestimate). The longer you take this medication, the higher your risk is. That's why it's best to use Prefest (estradiol / norgestimate) only for the shortest amount of time needed. Talk to your provider about ways to protect yourself, especially if you or someone in your family has or has had breast cancer.
BLOOD CLOTS, HEART ATTACKS, AND STROKES
Risk factors: Personal or family history of blood clots | High blood pressure | Diabetes | High cholesterol | Smoking | People who are overweight | Systemic lupus erythematosus (SLE)
Prefest (estradiol / norgestimate) can raise your risk of blood clots, which can be very dangerous and lead to a heart attack, a stroke, or a pulmonary embolism (life-threatening blood clot in the lungs). While there are several conditions that can raise this risk even further, smoking and a history of blood clots are two of the biggest risk factors. Be sure to discuss all your past and present medical conditions with your provider before starting Prefest (estradiol / norgestimate). If you need to have surgery while using this medication, you might need to temporarily stop it for a few weeks before the procedure. Ask your provider when to stop and restart Prefest (estradiol / norgestimate) to lower your risk of blood clots after surgery. Call 911 or seek immediate medical attention if you have pain in your legs or arms, chest pain, sudden, severe headaches, trouble breathing, or sudden changes in your speech or vision. Prefest (estradiol / norgestimate) should not be used to prevent any heart-related problems or conditions.
DEMENTIA
Risk factors: Age 65 or older
Women taking Prefest (estradiol / norgestimate) might have a higher risk of developing dementia. While experts aren't sure why this happens, your risk is highest if you start using Prefest (estradiol / norgestimate) for the first time at the age of 65 or older. Talk to your provider if this worries you.
ENDOMETRIAL CANCER
Risk factors: Using Prefest (estradiol / norgestimate) for more than one year
Vaginal bleeding after menopause can be a warning sign of endometrial cancer (cancer of the lining of the uterus), so let your provider know if you notice any unusual bleeding. Using estrogen-containing medications like Prefest (estradiol / norgestimate) for more than a year can raise your risk of this. Even though this medication contains a progestin to help protect your uterus, endometrial cancer is still a possible risk.
GALLBLADDER PROBLEMS
Prefest (estradiol / norgestimate) can cause you to have problems with your gallbladder. Some people have even needed to have their gallbladder removed after starting this medication. If you experience stomach pain, nausea or vomiting that doesn't go away, fever, or a yellowing of the skin and eyes (jaundice), speak with your provider or seek medical attention.
HIGH BLOOD CALCIUM LEVELS
Risk factors: History of or current breast or bone cancer
Prefest (estradiol / norgestimate) can raise the levels of calcium in your body, especially if you have or have had breast or bone cancer. When calcium levels are too high, it can be dangerous and lead to heart problems or a coma. You might have to have regular blood tests done while taking Prefest (estradiol / norgestimate) to make sure your calcium levels are healthy. Let your provider know if you experience lower appetite, unexplainable nausea and vomiting, constipation, extreme tiredness, muscle weakness, or confusion at any time after you start using this medication.
VISION PROBLEMS
Prefest (estradiol / norgestimate) can cause blood clots in or around the eye. This is a medical emergency and can lead to permanent vision loss or blindness. Seek immediate care or call 911 if you experience a sudden loss of vision, severe double vision, or you notice your eyeball starts to bulge out of its socket.
Prefest (estradiol / norgestimate) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 30 tablets | 3 packages | $587.18 | $195.73 |
Typical dosing for Prefest (estradiol / norgestimate)
There are 2 different colored tablets in the package that alternate every 3 days. Take 1 pink tablet by mouth once a day for 3 days. Then, take 1 white tablet by mouth once a day for 3 days. Repeat this pattern every 3 days.
The pink tablet contains 1 mg of estradiol. The white tablet contains 1 mg of estradiol and 0.09 mg of norgestimate.
These directions can be confusing when you first start taking Prefest (estradiol / norgestimate). Follow the instructions on your package carefully, and contact your local pharmacist if you are confused on how to take it.
Interactions between Prefest (estradiol / norgestimate) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
- Boceprevir
- Cyclosporine
- Dasabuvir
- Eltrombopag
- Gemfibrozil
- Ombitasvir
- Paritaprevir
- Ritonavir
- Tranexamic Acid
Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Alprazolam
- Amifampridine
- Amiodarone
- Amoxicillin
- Ampicillin
- Amprenavir
- Anagrelide
- Apalutamide
- Aprepitant
- Armodafinil
- Artemether
- Bacampicillin
- Betamethasone
- Bexarotene
- Boceprevir
- Bosentan
- Brigatinib
- Bupropion
- Capmatinib
- Carbamazepine
- Carbenicillin
- Cefaclor
- Cefadroxil
- Cefdinir
- Cefditoren
- Cefixime
- Cefpodoxime
- Cefprozil
- Ceftazidime
- Ceftibuten
- Cefuroxime
- Cenobamate
- Ceritinib
- Clarithromycin
- Clavulanic Acid
- Clobazam
- Cloxacillin
- Clozapine
- Cobicistat
- Colesevelam
- Conivaptan
- Cyclacillin
- Cyclosporine
- Dabrafenib
- Darolutamide
- Darunavir
- Desogestrel
- Dexamethasone
- Dicloxacillin
- Dienogest
- Digoxin
- Donepezil
- Doxycycline
- Drospirenone
- Efavirenz
- Elagolix
- Eliglustat
- Elvitegravir
- Enasidenib
- Encorafenib
- Enzalutamide
- Erdafitinib
- Eslicarbazepine Acetate
- Estradiol
- Ethinyl Estradiol
- Ethynodiol
- Etonogestrel
- Etravirine
- Fosamprenavir
- Fosaprepitant
- Fosnetupitant
- Fosphenytoin
- Fostemsavir
- Gestodene
- Glecaprevir
- Griseofulvin
- Guar Gum
- Idelalisib
- Indinavir
- Isotretinoin
- Itraconazole
- Ivosidenib
- Ketoconazole
- Lasmiditan
- Leflunomide
- Lemborexant
- Lesinurad
- Levonorgestrel
- Lixisenatide
- Lopinavir
- Lorlatinib
- Lumacaftor
- Medroxyprogesterone
- Mestranol
- Midazolam
- Minocycline
- Mitotane
- Modafinil
- Mycophenolate Mofetil
- Mycophenolic Acid
- Nafcillin
- Nefazodone
- Nelfinavir
- Netupitant
- Nevirapine
- Nomegestrol
- Norelgestromin
- Norethindrone
- Norgestimate
- Norgestrel
- Octreotide
- Omeprazole
- Oxacillin
- Oxcarbazepine
- Oxytetracycline
- Paclitaxel
- Paclitaxel Protein-Bound
- Penicillin G
- Penicillin G Procaine
- Penicillin V
- Phenobarbital
- Phenylbutazone
- Phenytoin
- Pibrentasvir
- Piperaquine
- Pitolisant
- Pixantrone
- Posaconazole
- Prednisone
- Primidone
- Red Clover
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rosuvastatin
- Rufinamide
- Saquinavir
- Secobarbital
- Segesterone
- St John's Wort
- Sugammadex
- Sultamicillin
- Tazemetostat
- Telaprevir
- Telithromycin
- Teriflunomide
- Tetracycline
- Theophylline
- Ticarcillin
- Tigecycline
- Tizanidine
- Topiramate
- Troglitazone
- Ubrogepant
- Ulipristal
- Valproic Acid
- Venetoclax
- Voriconazole
How much does Prefest (estradiol / norgestimate) cost?
What are alternatives to Prefest (estradiol / norgestimate)?
Hot flashes, night sweats, and flushes caused by menopause
Vaginal dryness and burning caused by menopause
Prevention of postmenopausal osteoporosis (not a first-choice)
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Moderate-to-severe vaginal symptoms due to menopause, like vaginal dryness and irritation
Prevention of bone loss (osteoporosis) after menopause
Moderate-to-severe vasomotor symptoms (VMS) of menopause, like hot flashes and night sweats
Moderate-to-severe symptoms of vulvar and vaginal atrophy, like vaginal dryness and irritation
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