Estradiol/Norethindrone Acetate, Transdermal

What are other names for this medicine?

Type of medicine: hormone

Generic and brand names: estradiol and norethindrone acetate, transdermal; CombiPatch

What is this medicine used for?

This medicine is a patch that you put on your skin to replace hormone levels that drop when menopause occurs (when monthly menstrual periods stop). It combines 2 hormones.

It helps with symptoms such as vaginal dryness, itching, and burning, and hot flashes.

Sometimes these patches are prescribed if you need estrogens because your ovaries do not function properly, or your ovaries were surgically removed.

This medicine is taken by women who still have a uterus. This medicine should not be used by women who have had a hysterectomy (surgery to remove the uterus).

What should my healthcare provider know before I take this medicine?

Tell your healthcare provider if you have ever had:

• an allergic reaction to any hormones, medicines, or adhesives
• a heart attack or stroke
• a hysterectomy (removal of the uterus)
• asthma
• blood clots in your legs, lungs, brain, or eyes
• cancer of the breast, uterus, cervix, or vagina
• depression
• diabetes
• endometriosis
• heart, liver, gallbladder or kidney disease
• high blood pressure
• high cholesterol
• lupus
• migraines or headaches along with vomiting, double vision, unsteadiness, weakness, or personality changes
• porphyria (nerve pain or sensitivity to sunlight)
• problems with calcium levels in the blood
• seizures
• thyroid problems
• unexplained vaginal bleeding
• yellowing of the eyes or skin (jaundice) during pregnancy or during past use of birth control pills

Tell your healthcare provider if you have recently had a long period of bed rest after major surgery or a broken bone in a cast.

Tell your provider if you have a family history of heart disease, heart attack, blood clots, strokes, breast cancer, or other conditions.

Tell your healthcare provider if you smoke. Smoking while you are using this medicine increases the risk of serious side effects such as heart attack, stroke, and blood clots. The risk increases with age and the number of cigarettes smoked a day. Talk to your healthcare provider about ways to quit smoking.

Females of childbearing age: Do not take this medicine if you are pregnant. This medicine has been reported to cause birth defects. Stop taking this medicine at the first sign that you may be pregnant and contact your health care provider right away. Do not breast-feed while using this medicine without your healthcare provider's approval.

How do I use it?

Check the label on the medicine for directions about your specific dose.

1. Wash your hands before using this medicine. Apply the medicine patch as soon as it is removed from the protective pouch. Put the sticky side of the patch on clean, dry skin on the lower abdomen. Hold the patch in place with your hand for at least 10 seconds. Avoid areas where bending or rubbing might occur. Choose a spot with no hair or broken skin. Do not put it where your clothing may might rub it off, such as your waistline. Do not apply the patch to broken or irritated skin or to your breasts. Do not place the patch where it would be exposed to sunlight. Make sure all the edges of the patch are firmly attached.
2. Apply the patch to a different place on your skin each time you apply a new patch. Wait at least a week before using that place again. Change the patch on the same day of each week.
3. If the patch comes off, try to put it back on. If it won't stick, put on a new patch but follow your original schedule. Do not use more than 1 patch at a time. Wash your hands after handling a patch.
4. Remove the patch slowly and carefully to avoid irritating your skin. Gently rub the area with cream or lotion to remove any medicine that remains on your skin after removing the patch.
5. Fold used patches so that they stick to themselves with the medicine inside. Then dispose of them safely away from children and pets.

Use this medicine exactly as your healthcare provider prescribes. Do not use more of it or use it longer than prescribed.

Read the information sheet that comes in the medicine package. Follow these directions carefully. If you do not understand how to use this medicine, ask your healthcare provider or pharmacist to explain.

What if I miss a dose?

If you miss a dose, use it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and use the next one as directed. Do not use double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

An acute overdose of this medicine is not likely to cause life-threatening symptoms. If you think that you or anyone else may have taken too much of this medicine, call the poison control center at 800-222-1222.

What should I watch out for?

Hormone therapy, also known as hormone replacement therapy (HRT) offers both benefits and risks. Estrogen has previously been prescribed to help prevent bone loss (osteoporosis). This is no longer advised because it may be harmful. Combined estrogen/progestin therapy may reduce the risk of colorectal cancer. However, estrogen/progestin therapy increases the risk of heart disease, stroke, breast cancer, blood clots in the lungs and legs, gallbladder disease, and possibly dementia.

Most experts now recommend short-term use if hormone therapy is needed. You should take hormones only when you need them, at the lowest effective dosage, and only for as long as you need them. The risk of medical problems such as stroke or cancer increases further with higher doses and longer treatments. Talk with your healthcare provider about this.

You need to see your provider regularly (every 6 months) for checkups to find out if this medicine is still needed and if you are having any side effects. Keep all your appointments. Do not take this medicine for longer than 1 year without a complete physical exam.

If you are scheduled to have surgery or will be on bedrest, talk to your healthcare provider. You may need to stop taking hormones at least 4 to 6 weeks before the surgery and bedrest.

Sometimes this medicine causes dark spots to develop on your skin, especially with long exposure to the sun. The spots usually go away when you stop using this medicine. While you are taking this medicine, avoid long exposure to the sun. Wear protective clothing, a hat, and sunscreen lotion when you need to be outdoors. Do not apply sunscreen on top of this medicine because it may affect how much estrogen is absorbed. Talk with your provider about this. Do not use a sunlamp.

If you wear contact lenses and notice a change in your vision or it becomes difficult to wear your lenses, contact your healthcare provider.

This medicine may increase your HDL cholesterol levels, decrease your LDL levels, and increase your blood triglyceride levels. Talk to your healthcare provider about this.

Tell healthcare providers you are taking this medicine before you have lab tests. This medicine may change blood test results such as cholesterol, liver function, and thyroid levels.

Diabetics: This medicine may affect your blood sugar level and change the amount of insulin or other diabetes medicines you may need. Talk to your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you are unable to reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives, itching, rash, trouble breathing, swelling of your lips, tongue and throat); sudden, severe headache; sudden, severe vomiting; sudden partial or complete loss of vision; speech problems; weakness or numbness of an arm or a leg; crushing chest pain or chest heaviness; coughing up blood; sudden shortness of breath; swelling.

Serious (report these to your healthcare provider right away): Unexplained bleeding from your vagina; dizziness, or fainting; breast lumps; redness, warmth, or swelling in your hands, ankles or feet; increased blood pressure; discomfort from contact lenses, vision changes; yellowing of the skin or eyes, especially with fever, tiredness, loss of appetite, dark urine, or light-colored bowel movements.

Other: Changes in menstruation, breast tenderness, nausea, vomiting, acne, hair loss, cramping, minor bloating, depression, anxiety, weight gain or loss, headache, sensitivity to the sun; darkening of skin on the face; irritation where the medicine is applied.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• alcohol
• aminoglutethimide (Cytadren)
• antibiotics such as ciprofloxacin (Cipro), erythromycin (EES, E-mycin, Ery-Ped), and clarithromycin (Biaxin)
• antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral)
• antiseizure medicines such as carbamazepine (Tegretol), primidone (Mysoline), oxcarbazepine (Trileptal), topiramate (Topamax), ethotoin (Peganone), fosphenytoin (Cerebyx), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), valproic acid (Depacon, Depakene, Depakote), tiagabine (Gabitril), and phenytoin (Dilantin)
• barbiturates such as phenobarbital, butabarbital (Butisol), and pentobarbital (Nembutal)
• medicine that reduces the chance of blood clots forming such as warfarin (Coumadin)
• calcium channel blockers such as diltiazem (Cardizem, Tiazac), and verapamil (Isoptin, Calan)
• cholesterol-lowering medicines (statins) such as atorvastatin (Lipitor), lovastatin (Mevacor), and simvastatin (Zocor)
• cimetidine (Tagamet)
• corticosteroids such as cortisone (Cortone), dexamethasone (Dexameth, Dexone, Hexadrol), hydrocortisone (Hydrocortone, Cortef), methylprednisolone (Medrol), prednisolone (Pediapred, Prelone), prednisone (Liquid Pred, Prednisone Intensol), and triamcinolone (Aristocort, Kenacort)
• cyclosporine (Neoral, Sandimmune, Gengraf)
• dantrolene (Dantrium)
• medicines for diabetes such as acarbose (Precose), glipizide (Glucotrol), glyburide (DiaBeta, Micronase, Glynase), metformin (Glucophage), miglitol (Glyset), nateglinide (Starlix), repaglinide (Prandin), pioglitazone (Actos), rosiglitazone (Avandia), and insulin
• medicines to treat HIV such as delavirdine (Rescriptor), saquinavir (Invirase, Fortovase), ritonavir (Norvir), and nelfinavir (Viracept)
• natural remedies such as soy, topical progesterone, black cohosh, red clover, chasteberry, evening primrose oil, dong quai, ginseng, St. John's wort, bloodroot, alfalfa, saw palmetto, and wild yam
• rifampin (Rifadin, Rimactane)
• theophylline (Theo-24, Elixophyllin, T-Phyl, Uniphyl, Quibron-T, Theolair, Theochron) and aminophylline (Truphylline)
• thyroid medicines such as levothyroxine (Levothroid, Synthroid, Unithroid, Levoxyl), thyroid USP (Armor Thyroid, Thyrar, Thyroid Strong), liothyronine (Cytomel, Triostat), and liotrix (Thyrolar)
• tricyclic antidepressants such as amitriptyline, nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), and doxepin (Sinequan)

Do not eat grapefruit or drink grapefruit juice while taking this medicine. Grapefruit affects the way this medicine works and may increase the risk of side effects.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.