Vivelle-Dot
Vivelle-Dot (estradiol patch) is a twice-weekly hormonal patch used to treat menopause symptoms and low estrogen levels. It also helps prevent bone loss (osteoporosis) in people who have gone through menopause. The patch is a form of hormone replacement therapy. The usual dose is one patch applied to the lower stomach or buttocks twice a week, or every 3 to 4 days. Side effects include headache, breast pain, and sinus swelling.
This twice weekly patch is also available as a generic called Dotti.
What is Vivelle-Dot (estradiol patch)?
What is Vivelle-Dot (estradiol patch) used for?
- Hot flashes, night sweats, and flushes caused by menopause
- Vaginal dryness and irritation caused by menopause
- Low estrogen levels due to certain conditions
- Prevention of osteoporosis after menopause
How Vivelle-Dot (estradiol patch) works
Vivelle-Dot (estradiol patch) is an estrogen replacement. It replaces the natural estrogen your body loses during menopause or if you have low estrogen levels due to certain conditions. Replacing estrogen helps to prevent bone loss and relieves menopause symptoms like hot flashes, night sweats, and vaginal dryness.
Drug facts
More on Vivelle-Dot (estradiol patch) essentials
Side effects of Vivelle-Dot (estradiol patch)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache (up to 50%)
- Common cold symptoms (up to 20%)
- Breast tenderness (up to 17%)
- Sinus swelling (up to 13%)
- Bleeding in-between periods (up to 11%)
- Depression (up to 11%)
- Back pain (up to 11%)
- Sinus headache (up to 10%)
- Indigestion (up to 9%)
- Weight gain (up to 9%)
- Joint pain (up to 9%)
Less Common Side Effects
- Constipation
- Flu-like symptoms
- Pain in arms or legs
- Neck pain
- Other pain in body
- Anxiety
- Trouble sleeping
- Nausea
- Vomiting
- Stomach cramps
- Migraine
- Dizziness
Vivelle-Dot (estradiol patch) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: chest pain or tightness, pain that radiates up to your shoulder, arm, neck, or jaw
- Stroke: sudden trouble talking, trouble walking, numbness on one side of your body or face, severe headache, confusion
- Deep vein thrombosis (blood clot in the leg): leg cramp, swelling, pain, muscle tightness
- Pulmonary embolism (blood clot in the lung): cough, chest pain, trouble breathing, racing heart
- Cancer: lumps, pain, swelling, or changes in the breasts; swollen lymph nodes, unusual or heavy vaginal bleeding, bloating, extreme tiredness, stomach-area pain
- Gallbladder problems: stomach pain, nausea or vomiting that doesn't go away, fever, yellowing of the skin and eyes (jaundice)
- Severe allergic reaction: hives, swelling in the face or throat, trouble breathing, stomach pain, vomiting
The following Vivelle-Dot (estradiol patch) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Abdominal or stomach cramps or pain
acid or sour stomach
backache
belching
blistering, peeling, or loosening of the skin
blurred vision
breast tenderness, enlargement, pain, or discharge
change in vaginal discharge
changes in skin color
changes in vision
chest pain or discomfort
chills
clay-colored stools
clear or bloody discharge from the nipple
confusion
convulsions
darkening of the urine
difficulty with breathing
difficulty with swallowing
dimpling of the breast skin
dizziness or lightheadedness
double vision
fainting
fast heartbeat
fluid-filled skin blisters
full or bloated feeling or pressure in the stomach
headache
headache, severe and throbbing
indigestion
inverted nipple
irregular heartbeat
itching of the vagina or genital area
joint or muscle pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
light-colored stools
loss of appetite
loss of bladder control
lump in the breast or under the arm
migraine headache
mood or mental changes
muscle cramps in the hands, arms, feet, legs, or face
muscle spasm or jerking of all extremities
noisy breathing
numbness and tingling around the mouth, fingertips, or feet
pain during sexual intercourse
pain in the ankles or knees
pain or discomfort in the arms, jaw, back, or neck
pain or feeling of pressure in the pelvis
pain, redness, or swelling in the arm, foot, or leg
painful, red lumps under the skin, mostly on the legs
pains in the stomach, side, or abdomen, possibly radiating to the back
persistent crusting or scaling of the nipple
poor insight and judgment
problems with memory or speech
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red, irritated eyes
redness or swelling of the breast
sensitivity to the sun
skin thinness
sore on the skin of the breast that does not heal
sores, ulcers, or white spots in the mouth or on the lips
stomach discomfort, upset, or pain
sudden loss of consciousness
sudden shortness of breath or troubled breathing
sweating
swelling
swelling of the abdominal or stomach area
thick, white vaginal discharge with no odor or with a mild odor
tightness in the chest
trouble recognizing objects
trouble thinking and planning
trouble walking
unexpected or excess milk flow from the breasts
unpleasant breath odor
unusual tiredness or weakness
unusually heavy or unexpected menstrual bleeding
vaginal bleeding or spotting
vomiting
vomiting of blood
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:
Incidence not known
Decreased interest in sexual intercourse
hives or welts
inability to have or keep an erection
increased hair growth, especially on the face
increased in sexual ability, desire, drive, or performance
increased interest in sexual intercourse
irritability
leg cramps
loss in sexual ability, desire, drive, or performance
loss of scalp hair
mental depression
mood disturbances
patchy brown or dark brown discoloration of the skin
redness of the skin
twitching, uncontrolled movements of the tongue, lips, face, arms, or legs
weight changes
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.
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Pros and cons of Vivelle-Dot (estradiol patch)
Pros
- Typically has fewer side effects than oral estrogen pills
- Relieves multiple menopause symptoms
- Good option if you have trouble swallowing pills
- Available in different strengths, allowing you to customize your dose
Cons
- Commonly causes headache, breast pain, and sinus swelling
- Need to apply a new patch twice a week
- Raises your risk of certain cancers, blood clots, and strokes
- Might need to take it with another hormone called progestin if you have a healthy uterus
Pharmacist tips for Vivelle-Dot (estradiol patch)
- Mark your calendar with the two days per week when you’ll apply Vivelle-Dot (estradiol patch). Change your patch every 3-4 days and remove the old patch before applying a new one.
- Apply Vivelle-Dot (estradiol patch) to your lower stomach or buttocks. But avoid your waistline, since tight clothing can cause it to fall off.
- Use a different area each time you apply a new Vivelle-Dot (estradiol patch) to lower the risk of skin irritation. Wait at least 1 week before using the same spot again.
- When removing Vivelle-Dot (estradiol patch), fold the patch in half with the sticky sides together before throwing it away. This helps prevent exposing others to any medication left on the patches. Don't flush it down the toilet.
- If the adhesive sticks to your skin after removing Vivelle-Dot (estradiol patch), let the area dry for 15 minutes, then gently rub it off with some oil or lotion.
- Showering shouldn't make Vivelle-Dot (estradiol patch) fall off. But if it does, try reapplying it to another area on your lower stomach or buttocks. If it won't stick, use a new patch, but stay on your regular schedule.
- If you forget to apply Vivelle-Dot (estradiol patch), put one on as soon as you remember. Then, continue with your usual schedule.
- Let your prescriber know if you experience unusual vaginal bleeding, lumps in your breast, changes to your vision, or severe headaches after starting Vivelle-Dot (estradiol patch). These are more serious side effects and could be a sign of a bigger health problem.
- Go to your follow-up appointments so you and your prescriber can discuss whether you still need to use Vivelle-Dot (estradiol patch).
How to apply Vivelle-Dot (estradiol patch):
- Open the pouch and peel off half of the protective backing without touching the sticky side.
- Hold the other half of the backing and apply the sticky side to clean, dry, hairless skin on your lower stomach or buttocks. Never apply it to your breasts or broken skin (e.g., cuts, scrapes, wounds).
- While holding the sticky side down, fold the patch back to peel off the second half of the protective liner.
- Press the patch firmly onto your skin for 10 seconds with the palm of your hand. Run your finger along the edges to make sure it sticks well.
More on Vivelle-Dot (estradiol patch) tips
Common questions about Vivelle-Dot (estradiol patch)
Yes, Vivelle-Dot (estradiol patch) is bioidentical. Bioidentical hormones are chemically similar to the hormones found naturally in your body.
It's generally not recommended to cut patches like Vivelle-Dot (estradiol patch) in half, because this can change how the medication is released into your body. Vivelle-Dot (estradiol patch) comes in different strengths, so your prescriber can help you to find the right one that works best for you.
It can. In studies, up to 9% of people using Vivelle-Dot (estradiol patch) reported weight gain as a side effect. One reason is that the medication might cause your body to hold onto extra fluid, which can appear as water weight. Keep in mind that weight gain is also common during menopause. If gaining weight gain concerns you, speak with your prescriber.
As soon as you apply Vivelle-Dot (estradiol patch), your estrogen levels will start to rise. But it can take some time before you notice improvement in your symptoms. You might start feeling fewer hot flashes and less vaginal dryness within a few weeks, but it can take several weeks or months to see the full benefits. Changes in bone mineral density can take 6 months to appear. Make sure to attend all of your follow-up appointments so your prescriber can check how well the medication is working for you.
Both Vivelle-Dot (estradiol patch) and Climara are estrogen patches used for hormone replacement therapy. They both help treat menopause symptoms, low estrogen levels, and prevent bone loss after menopause. The main difference is how often you apply them. Vivelle-Dot (estradiol patch) is applied twice per week, while Climara is a once-weekly patch. Talk to your prescriber to learn about other differences between these medications.
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Risks and warnings for Vivelle-Dot (estradiol patch)
Vivelle-Dot (estradiol patch) 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.
Blood clots and related complications (e.g., heart attack, stroke)
- Risk factors: Personal or family history of blood clots | High blood pressure | Diabetes (high blood sugar) | High cholesterol | Tobacco use | Considered obese | Systemic lupus erythematosus (SLE)
Vivelle-Dot (estradiol patch) can raise the risk of blood clots. These clots can block the blood flow to other parts of the body, like the leg, lungs, heart, or brain. Some clots can lead to dangerous complications, like heart attack or stroke.
Get emergency help right away if you have any signs of a blood clot.
- Brain: weakness or numbness in your arms, legs, or face on one side of the body, trouble speaking, blurred vision, dizziness, loss of balance, trouble walking, or confusion
- Eyes: trouble seeing, bulging eye, double vision
- Heart: chest pain, sweating, nausea, or dizziness
- Lungs: trouble breathing, chest pain, or cough
- Legs: cramps, swelling, pain, or muscle tightness
If you need to have surgery, tell your care team you're taking Vivelle-Dot (estradiol patch). They might have you stop taking it 4 to 6 weeks before surgery to lower your risk of blood clots.
Uterine (endometrial) cancer
- Risk factors: Using Vivelle-Dot (estradiol patch) without progestin for people with a uterus | Long-term use of Vivelle-Dot (estradiol patch)
Vaginal bleeding after menopause can be a warning sign of uterine (endometrial) cancer, so let your prescriber know if you notice any unusual bleeding. Using estrogen replacement therapy, like the Vivelle-Dot (estradiol patch), for more than a year can raise your risk of this cancer. If you still have your uterus, taking another hormone called a progestin along with Vivelle-Dot (estradiol patch) can help lower this risk. Progestin works by balancing estrogen's effects and slowing the growth of the uterine lining.
Breast cancer
- Risk factors: Personal or family history of breast cancer | Using estrogen and progestin together | Long-term use of Vivelle-Dot (estradiol patch)
Taking Vivelle-Dot (estradiol patch) with a progestin can raise your risk of breast cancer. The longer you use them, the higher the risk. That's why it's best to use this medication for the shortest time needed. You should have a breast exam every year with a healthcare professional and do monthly self-exams to check for any changes. In addition, check with your prescriber about when to schedule mammograms. Call your prescriber if you notice any abnormal changes or feel lumps, pain, or swelling in your breasts.
Ovarian cancer
- Risk factors: Using estrogen and progestin together
Taking Vivelle-Dot (estradiol patch) with a progestin might raise your risk of ovarian cancer. If you're concerned about this risk, talk to your prescriber. Let your prescriber or gynecologist know if you have unusual vaginal bleeding, vaginal discharge, or pelvic pain, as these could be signs of ovarian cancer.
Dementia
- Risk factors: Older adults
Taking estrogen alone or with progestin might raise the risk of dementia, especially in older adults. Talk to your prescriber if you have concerns about memory problems or dementia while taking this medication.
Gallbladder and liver problems
- Risk factors: History of liver problems or jaundice
Vivelle-Dot (estradiol patch) can cause gallbladder problems, and some people have even needed to have their gallbladder removed after starting this medication. If you have stomach pain, nausea or vomiting that won't go away, fever, or yellowing of the skin and eyes (jaundice), tell your prescriber right away or get medical attention.
Since Vivelle-Dot (estradiol patch) is broken down by your liver, you might have more side effects if your liver isn’t working properly. If you have or have had any problems with your liver, including liver issues during pregnancy, you shouldn't use this medication.
Vision problems
Although very rare, some people taking estrogens had vision problems from a blood clot in the eye. Stop taking Vivelle-Dot (estradiol patch) right away and tell your prescriber if you have sudden vision loss, bulging eyes, double vision, or migraines.
High triglycerides
- Risk factors: High levels of triglycerides
Estrogens like Vivelle-Dot (estradiol patch) can raise your blood fat levels (triglycerides), which can lead to heart problems or inflammation of the pancreas. If you experience sudden stomach or back pain, nausea, vomiting, sudden weight loss, or a fast heart rate, contact your prescriber or get medical care right away.
Low thyroid hormone levels (hypothyroidism)
- Risk factors: Low thyroid hormone levels
Vivelle-Dot (estradiol patch) can affect thyroid hormone levels in your blood. If your thyroid is healthy, your body can adjust and keep your hormone levels normal. But if you take thyroid medication, you may need a higher dose while using Vivelle-Dot (estradiol patch). Your prescriber will monitor your thyroid levels during treatment to make sure they stay in a healthy range.
Fluid Retention
- Risk factors: History of heart or kidney problems
Using estrogen products like Vivelle-Dot (estradiol patch) might cause fluid retention, or edema. The risk is higher if you have heart conditions, like congestive heart failure, or kidney damage. If you notice unusual swelling in any part of your body or sudden weight gain, let your prescriber know. If fluid retention becomes a serious problem, your prescriber might stop your treatment with Vivelle-Dot (estradiol patch).
Severe allergic reactions
A few people using Vivelle-Dot (estradiol patch) have had severe allergic reactions (anaphylaxis), including hives, itching, and swelling of the lips, tongue, or face. Some also had trouble breathing, stomach pain, or vomiting. Angioedema, which causes swelling of the eyes, face, throat, tongue, hands, legs, or fingers, has also been reported. In serious cases, swelling of the tongue or throat can block your airway, making it hard to breathe. If you have swelling or signs of a severe allergic reaction, get medical help right away.
Worsening of other health conditions
Tell your prescriber about all the medical conditions you have before taking Vivelle-Dot (estradiol patch). This medication can make some health conditions worse. This includes asthma, diabetes, epilepsy, migraine, and lupus, among others. It can also affect people with hypoparathyroidism or hereditary angioedema.
More on Vivelle-Dot (estradiol patch) warnings
Vivelle-Dot (estradiol patch) dosage
Carton| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 8 twice-weekly patches of 0.025mg/day | 1 carton | $27.91 | $27.91 |
| 8 twice-weekly patches of 0.0375mg/day | 3 cartons | $73.22 | $24.41 |
| 8 twice-weekly patches of 0.05mg/day | 3 cartons | $77.88 | $25.96 |
| 8 twice-weekly patches of 0.075mg/day | 3 cartons | $77.95 | $25.98 |
| 8 twice-weekly patches of 0.1mg/day | 3 cartons | $87.24 | $29.08 |
Typical dosage for Vivelle-Dot (estradiol patch)
Your dose will depend on the reason you're taking Vivelle-Dot (estradiol patch). Apply 1 patch to the skin on your lower stomach or buttocks twice a week, or every 3 to 4 days.
- Menopause symptoms or low estrogen levels: The typical starting dose is one 0.0375 mg/day patch applied twice a week. Your prescriber might raise your dose based on how well it works for you.
- For people with a uterus: Use the patch on a cycle, such as 3 weeks on, followed by 1 week off.
- For people without a uterus: Use the patch continuously without breaks.
- Prevention of osteoporosis after menopause: The typical starting dose is one 0.025 mg mg/day patch applied twice a week.
- For people with a uterus: Use the patch on a cycle, such as 3 weeks on, followed by 1 week off.
- For people without a uterus: Use the patch continuously without breaks.
More on Vivelle-Dot (estradiol patch) dosage
Interactions between Vivelle-Dot (estradiol patch) 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 this medicine, 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 this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine 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
- Amifampridine
- Amoxicillin
- Ampicillin
- Amprenavir
- Apalutamide
- Aprepitant
- Armodafinil
- Artemether
- Bacampicillin
- Betamethasone
- Bexarotene
- Bosentan
- Brigatinib
- Bupropion
- Carbamazepine
- Carbenicillin
- Cefaclor
- Cefadroxil
- Cefdinir
- Cefditoren
- Cefixime
- Cefpodoxime
- Cefprozil
- Ceftazidime
- Ceftibuten
- Cefuroxime
- Cenobamate
- Ceritinib
- Clavulanic Acid
- Clobazam
- Cloxacillin
- Colesevelam
- Conivaptan
- Cyclacillin
- Cyclosporine
- Dabrafenib
- Darunavir
- Dexamethasone
- Dicloxacillin
- Donepezil
- Doxycycline
- Efavirenz
- Elagolix
- Elvitegravir
- Encorafenib
- Enzalutamide
- Eslicarbazepine Acetate
- Etravirine
- Fosamprenavir
- Fosaprepitant
- Fosnetupitant
- Fosphenytoin
- Griseofulvin
- Guar Gum
- Isotretinoin
- Ivosidenib
- Lesinurad
- Lixisenatide
- Lorlatinib
- Lumacaftor
- Minocycline
- Mitotane
- Modafinil
- Mycophenolate Mofetil
- Mycophenolic Acid
- Nafcillin
- Nelfinavir
- Netupitant
- Nevirapine
- Octreotide
- Oxacillin
- Oxcarbazepine
- Oxytetracycline
- Penicillin G
- Penicillin G Procaine
- Penicillin V
- Phenobarbital
- Phenylbutazone
- Phenytoin
- Pitolisant
- Pixantrone
- Prednisone
- Primidone
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rufinamide
- Secobarbital
- St John's Wort
- Sugammadex
- Sultamicillin
- Tazemetostat
- Telaprevir
- Tetracycline
- Theophylline
- Ticarcillin
- Tigecycline
- Tizanidine
- Topiramate
- Ulipristal
- Valproic Acid
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Atazanavir
- Diazepam
- Ginseng
- Lamotrigine
- Levothyroxine
- Licorice
- Lorazepam
- Prednisolone
- Selegiline
- Tacrine
- Temazepam
- Tipranavir
- Triazolam
- Troleandomycin
- Voriconazole
- Warfarin
How much does Vivelle-Dot (estradiol patch) cost?
Vivelle-Dot (estradiol patch) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Vivelle-Dot (estradiol patch) will not be safe for you to take.
- Abnormal vaginal bleeding
- History of breast cancer
- Cancer that depends on estrogen for growth
- Blood clots or blood clotting conditions
- History of stroke or heart attack
- Liver problems
What are alternatives to Vivelle-Dot (estradiol patch)?
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