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estrogens, conjugated

C.E.S. (CA), Congest (CA), Premarin, Premarin Intravenous

Pharmacologic class: Estrogen

Therapeutic class: Replacement hormone, antineoplastic, antiosteoporotic

Pregnancy risk category X


Bind to nuclear receptors in responsive tissues (such as female genital organs, breasts, and pituitary gland), enhancing DNA, RNA, and protein synthesis. In androgen-dependent prostate cancer, compete for androgen receptor sites, inhibiting androgen activity. Also decrease pituitary release of follicle-stimulating and luteinizing hormones.


Powder for injection: 25 mg/5 ml

Tablets: 0.3 mg, 0.625 mg, 0.9 mg, 1.25 mg

Vaginal cream: 0.625 mg/g

Indications and dosages

Ovariectomy; primary ovarian failure

Adults: 1.25 mg P.O. daily continuously or in cycles of 3 weeks on and 1 week off

Osteoporosis and menopausal symptoms

Adults: 0.3 to 1.25 mg P.O. daily continuously or in cycles of 3 weeks on and 1 week off

Female hypogonadism

Adults: 0.3 to 0.625 mg P.O. daily, given in cycles of 3 weeks on and 1 week off

Inoperable breast cancer in men and postmenopausal women

Adults: 10 mg P.O. t.i.d. for 3 months or more

Inoperable prostate carcinoma

Adults: 1.25 to 2.5 mg P.O. t.i.d.

Uterine bleeding caused by hormonal imbalance

Adults: 25 mg I.M. or I.V., repeated in 6 to 12 hours if necessary

Atrophic vaginitis, kraurosis vulvae

Adults: 0.5 to 2 g (vaginal cream) intravaginally daily in cycles of 3 weeks on and 1 week off

Moderate to severe dyspareunia

Adults: 0.5 g (vaginal cream) intravaginally daily in cycles of 3 weeks on and 1 week off


• Hypersensitivity to drug or its components

• Thromboembolic disease (current or previous)

• Undiagnosed vaginal bleeding

• Breast or reproductive system cancer (except metastatic disease)

• Estrogen-dependent neoplasms

• Pregnancy


Use cautiously in:

• cardiovascular disease, severe hepatic or renal disease, asthma, bone disease, migraine, seizures, breast disease

• family history of breast or genital tract cancer

• breastfeeding patients.


• Know that drug is compatible with dextrose 5% in water and normal saline solution.

Adverse reactions

CNS: headache, dizziness, lethargy, depression, asthenia, paresthesia, syncope, cerebrovascular accident (CVA), seizures

CV: hypertension, chest pain, myocardial infarction (MI), thromboembolism

EENT: contact lens intolerance, worsening of myopia or astigmatism, otitis media, sinusitis, rhinitis, pharyngitis

GI: nausea, vomiting, diarrhea, abdominal cramps, bloating, enlarged abdomen, dyspepsia, flatulence, gastritis, gastroenteritis, hemorrhoids, colitis, gallbladder disease, anorexia, pancreatitis

GU: urinary incontinence, dysuria, urinary tract infection, amenorrhea, dysmenorrhea, endometrial hyperplasia, vaginal candidiasis, leukorrhea, vaginal hemorrhage, genital eruptions, gynecomastia, breast tenderness, breast enlargement or secretion, reduced libido, erectile dysfunction, testicular atrophy, increased risk of breast cancer, endometrial cancer, hemolytic uremic syndrome

Hepatic: cholestatic jaundice, hepatic adenoma

Metabolic: hyperglycemia, hypercalcemia, sodium and fluid retention, reduced carbohydrate tolerance

Musculoskeletal: leg cramps, back pain, skeletal pain

Respiratory: upper respiratory tract infection, bronchitis, pulmonary embolism

Skin: acne, oily skin, pigmentation changes, urticaria, pruritus, erythema nodosum, hemorrhagic eruption, skin hypertrophy, hirsutism, alopecia, erythema multiforme

Other: edema, weight changes, increased appetite, hypersensitivity reaction, angioedema


Drug-drug. Corticosteroids: enhanced corticosteroid effects

CYP450 inducers (such as barbiturates, rifampin): decreased estrogen efficacy Hypoglycemics, warfarin: altered requirement for these drugs

Phenytoin: loss of seizure control

Tamoxifen: interference with tamoxifen effects

Tricyclic antidepressants: reduced antidepressant effects

Drug-diagnostic tests. Antithrombin III, folate, low-density lipoproteins, pyridoxine, total cholesterol, urine pregnanediol: decreased values

Cortisol; factors VII, VIII, IX, and X; glucose; high-density lipoproteins; phospholipids; prolactin; prothrombin; sodium; triglycerides: increased values

Metyrapone test: false decrease

Thyroid function tests: false interpretation

Drug-food. Caffeine: increased caffeine blood level

Drug-herbs. Black cohosh: increased risk of adverse reactions

Red clover: interference with estrogen effects

Saw palmetto: antiestrogenic effects St. John's wort: decreased drug blood level and effects

Drug-behaviors. Smoking: increased risk of adverse cardiovascular reactions

Patient monitoring

• Monitor liver function test results and assess abdomen for enlarged liver.

• Evaluate patient for breast tenderness and swelling. As needed, give analgesics and apply cool compresses.

• Monitor fluid intake and output, and weigh patient daily.

Know that drug increases risk of thromboembolism, CVA, and MI.

• Be aware that exogenous estrogens may induce or exacerbate symptoms of angioedema, particularly in women with hereditary angioedema.

• Check serum phosphatase level in patients with prostate cancer.

• Monitor calcium, glucose, and folic acid levels.

• Evaluate bone density annually.

Patient teaching

Teach patient to recognize and report signs and symptoms of thromboembolism.

Caution patient not to take drug if she is or plans to become pregnant.

• Tell patient to report breakthrough vaginal bleeding.

• Recommend that patient have routine breast examinations.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.


v. con·gested, con·gesting, con·gests
Medicine To cause the accumulation of excessive blood or tissue fluid in (a vessel or organ).
To become congested.

con·ges′tion n.
con·ges′tive adj.

Patient discussion about congest

Q. What Is the Treatment for Congestive Heart Failure? My mother is 76 years ols and has been suffering from a heart disease for many years. Lately she has developed congestive heart failure. How is this situation treated?

A. In addition to everything else, she might try CoQ10, a supplement available at most nutrition stores.

"Congestive heart failure has been strongly correlated with significantly low blood and tissue levels of CoQ10 ....

[In numerous studies] treatment with CoQ10 significantly improved heart muscle function while producing no adverse effects or drug interactions."

Q. congestive heart failure how it works is it to do with fluid built up in your body

A. Congestive heart failure (CHF), or heart failure, is a condition in which the heart can't pump enough blood to the body's other organs. The "failing" heart keeps working but not as efficiently as it should. People with heart failure can't exert themselves because they become short of breath and tired.
As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down.
Heart failure also affects the kidneys' ability to dispose of sodium and water. The retained water increases the edema.

Q. describe the symptoms of congestive heart failure

A. From my own expierience, EM24 gave an accurate answer. My edema also affects my hands as well as ankles. I was given a Xopenex HFA inhaler to use if lungs are affected.

More discussions about congest
References in periodicals archive ?
(97.) See Barnes, supra note 94, at 588 (defining a good as congestible if simultaneous users interfere with each other's consumption); see also id.
This pollutable (congestible) space can be physical, as in the case of toxic or noise pollution, but it can also be symbolic space, as in the case of cultural, religious, or spiritual pollution.
This Article's congestible resource analysis also has possibly unexpected implications for an analysis of proposals to disestablish marriage.
Besides, if the rivalry in the case of the semi-public input is generated through congestion, it follows that before congestion takes place, i.e., (G/[n.sub.x]) > (G/[n.sub.x])[.sub.c], a semi-public input is non-rival (but in principle congestible) on the firm level.
"A Tax Competition Analysis of Congestible Public Inputs," Journal of Urban Economics, 48, 2000, pp.
because they share some characteristics with the tragic congestible
congestible commons, subject to overconsumption and tragedy, but also as
[T]he current empirical evidence suggests competitive local governments can provide an efficient level of congestible (local) public goods....
(And it is not entirely clear which argument Lessig supports.) (129) Common access to a congestible resource only makes sense if other characteristics of the resource make it so commons-worthy as to outweigh the "tragedy of the commons" factor.
He argues persuasively for public funding of some Internet infrastructure, (130) and suggests measured sharing of bandwidth through technical protocols--much like the system of traffic laws which enable us peaceably to share another congestible commons, the public streets.
As long as the Internet's nonrivalrous superstructure of information--code and content--rests on a finite, congestible, physical base, tension between these logical and policy imperatives will likely affect legal allocation of access rights over elements of the communications network.
One seemingly minor concern arising from the physical, congestible nature of the Internet's substrate relates to Lessig's innovation argument in particular.