Estratest (Oral)

Esterified estrogens and methyltestosterone combination is used to treat menopause symptoms in patients who did not find relief from estrogens alone. These symptoms may include hot flashes, which are feelings of heat, sweating, and warmth in the face, neck, or chest; and vaginal dryness, burning, and itching.

Esterified estrogens are a synthetic mix of estrogens. Estrogen is a hormone that the body produces in higher amounts in females. It is essential for normal sexual development in females and for regulating the menstrual cycle during childbearing years. Methyltestosterone is a synthetic form of testosterone, a hormone produced in larger amounts in males and smaller amounts in females. Menopause symptoms happen when the hormone balance shifts in the female body. This combination of hormones helps relieve menopause symptoms by increasing hormone levels in the body.

This medicine is available only with your doctor's prescription.

It is very important for your doctor to check your progress at regular visits to ensure the medicine is working properly and to determine if you should keep taking it. These visits should happen every 6 to 12 months or as directed by your doctor.

It is unlikely that a postmenopausal woman may become pregnant. However, you should be aware that using this medicine while pregnant could harm your unborn baby. If you think you may be pregnant while using the medicine, inform your doctor immediately.

Very rarely, this medicine can cause serious side effects such as a heart attack or stroke. You are much more likely to experience these side effects if you smoke cigarettes, are overweight, or have diabetes, high blood pressure, or high blood cholesterol. Discuss with your doctor if you think you may be at risk.

Using large doses of estrogen alone for a long time may increase the risk of some types of cancer (e.g., endometrial cancer). Talk with your doctor about this risk. If you experience vaginal bleeding while on this medicine, contact your doctor immediately.

This medicine may increase the risk of developing breast cancer. It is very important to regularly check your breasts for any unusual lumps or discharge and to have breast x-rays every year as directed by your doctor. These exams are crucial if you have a family history of breast cancer. Discuss this risk with your doctor.

This medicine may increase the risk of dementia in elderly women (those over 65 years of age). Talk with your doctor if this is a concern for you.

Contact your doctor right away if you experience blurred vision, difficulty reading, or any other changes in vision during or after treatment. Your doctor may want you to see an ophthalmologist (eye doctor) for an eye exam.

Using large doses of methyltestosterone for a long time may increase the risk of serious liver problems (e.g., peliosis hepatis or liver cancer). Discuss this risk with your doctor.

Before undergoing any medical tests, inform the medical doctor in charge that you are taking this medicine. Some test results may be affected by this medicine. Additionally, you may need to stop taking this medicine for a few weeks before and after surgery, or if you are inactive for a long time.

Do not take other medicines unless discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

In deciding to use a medicine, it is important to consider the risks and benefits together with your doctor. For this medicine, consider the following:

Allergies

Inform your doctor if you have ever had any unusual or allergic reactions to this medicine or any other medicines. Also let your healthcare professional know if you have other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

The combination of esterified estrogens and methyltestosterone is not recommended for children.

Geriatric

Current studies have not shown any specific problems for older adults that would limit the use of the combination of esterified estrogens and methyltestosterone in the elderly. However, older patients are at a higher risk for developing dementia and age-related issues with the kidneys, liver, or heart, which may require caution and an adjustment in the dose for patients taking this medicine.

Breast Feeding

There are no adequate studies in women to determine the risk to infants when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Some medicines should not be used together at all, while others may be used together even if interactions might occur. In these situations, your doctor may need to adjust the dose or take other precautions. It is very important for your healthcare professional to know if you are taking any of the medicines listed below. The following interactions are significant but not all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be necessary in some cases. If both are prescribed together, your doctor may change the dose or how often you take one or both of the medicines.

• Amifampridine
• Anisindione
• Bupropion
• Dicumarol
• Donepezil
• Phenprocoumon
• Somatrogon-ghla

Using this medicine with any of the following medicines may increase the risk of certain side effects, but using both may be the best treatment for you. If both are prescribed together, your doctor may change the dose or how often you take one or both of the medicines.

• Ginseng
• Levothyroxine
• Licorice
• Tipranavir
• Warfarin

Interactions with Food/Tobacco/Alcohol

Some medicines should not be used around the time of eating food or certain types of food due to potential interactions. Using alcohol or tobacco with certain medicines may also cause interactions. Discuss with your healthcare professional about using this medicine with food, alcohol, or tobacco.

Other Medical Problems

Other medical problems may affect the use of this medicine. Be sure to inform your doctor if you have any other medical issues, especially:

• Abnormal vaginal bleeding, undiagnosed or
• Blood clotting problems (e.g., deep vein thrombosis, pulmonary embolism), history of or
• Breast cancer, or history of or
• Heart attack, recent or history of or
• Liver disease, severe or
• Stroke, recent or history of—Should not be used in patients with these conditions.

• Asthma or
• Cancer (e.g., breast, cervix, liver, vagina) or
• Depression, history of or
• Diabetes or
• Edema (fluid retention) or
• Endometriosis (problem with the lining of the uterus) or
• Epilepsy or
• Eye or vision problems (e.g., retinal vascular thrombosis) or
• Gallbladder disease or
• Hepatitis (including cholestatic jaundice), history of or
• Hypercalcemia (high calcium in the blood) or
• Hypocalcemia (low calcium in the blood) or
• Hypothyroidism (underactive thyroid) or
• Migraine headaches, history of or
• Porphyria (enzyme problem) or
• Systemic lupus erythematosus—Use with caution. May make these conditions worse.

• Heart or blood vessel disease or
• Hypercholesterolemia (high cholesterol in the blood) or
• Hypertension (high blood pressure) or
• Hypertriglyceridemia (high triglycerides or fat in the blood) or
• Venous thromboembolism (clot in the veins), history of—May increase risk for more serious side effects.

Along with its necessary effects, a medicine may cause some unwanted effects. Not all of these side effects may happen, but if they do, they might need medical attention.

Check with your doctor right away if any of the following side effects occur:

More common

• Absent, missed, or irregular menstrual periods
• acne or oily skin
• decreased breast size
• enlarging clitoris
• hoarseness or deepening of the voice
• menstrual changes
• stopping of menstrual bleeding
• unnatural hair growth or loss

Rare

• Continuing nausea
• cough
• dark-colored urine
• difficulty with swallowing
• dizziness
• fast heartbeat
• fever
• hives
• itching
• light-colored stools
• loss of appetite
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• purple or red-colored spots on the body or inside the mouth or nose
• shortness of breath
• skin rash
• sore throat
• tightness in the chest
• unusual tiredness or weakness
• vomiting
• wheezing

Incidence not known

• Abdominal or stomach bloating, cramps, or pain
• anxiety
• bleeding from gums or nose
• blistering, peeling, or loosening of the skin
• bloating
• bloody or cloudy urine
• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• change in vaginal discharge
• changes in skin color, pain, or tenderness
• chest pain or discomfort
• chills
• clay-colored stools
• clear or bloody discharge from nipple
• confusion
• constipation
• convulsions
• darkening of urine
• decrease in amount of urine
• diarrhea
• difficult, burning, or painful urination
• difficulty with breathing
• difficulty with moving
• difficulty with speaking
• dimpling of the breast skin
• dizziness or lightheadedness
• double vision
• eye pain
• fainting
• fever
• fluid-filled skin blisters
• frequent urge to urinate
• headache
• heavy bleeding
• inability to move the arms, legs, or facial muscles
• inability to speak
• indigestion
• inverted nipple
• irregular heartbeats
• 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
• lump in the breast or under the arm
• mood or mental changes
• muscle cramps in the hands, arms, feet, legs, or face
• muscle pain or stiffness
• nausea
• noisy, rattling breathing
• numbness and tingling around the mouth, fingertips, or feet
• pain
• 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 pelvis
• painful, red lumps under the skin, mostly on the legs
• pains in the stomach, side, or abdomen, possibly radiating to the back
• pelvic pain
• persistent crusting or scaling of the nipple
• pinpoint red or purple spots on the skin
• poor insight and judgment problems with memory or speech
• red, irritated eyes
• redness or swelling of the breast
• ringing in the ears
• sensitivity to the sun
• shortness of breath
• skin thinness
• slow speech
• sore on the skin of the breast that does not heal
• sore throat
• sores, ulcers, or white spots in the mouth or on the lips
• stomach pain
• sudden shortness of breath or troubled breathing
• sweating
• swelling
• swelling of the fingers, hands, feet, or lower legs
• tenderness of the breast
• thick, white curd-like vaginal discharge without odor or with mild odor
• tiredness
• tremor
• trouble recognizing objects
• trouble thinking and planning
• trouble walking
• troubled breathing at rest
• unexpected or excess milk flow from breasts
• unpleasant breath odor
• vaginal bleeding
• vision changes
• vomiting of blood
• weakness
• weight gain
• 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

• Blemishes on the skin
• brown, blotchy spots on the exposed skin
• decreased interest in sexual intercourse
• depression
• headache, severe and throbbing
• inability to have or keep an erection
• increase or decrease in weight
• 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 hair
• mental depression
• pimples
• redness of the skin
• swelling or inflammation of the mouth
• twitching, uncontrolled movements of the tongue, lips, face, arms, or legs

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.

In the U.S.

• Covaryx
• Covaryx HS
• Essian
• Estratest
• Menogen
• Syntest D.S.
• Syntest H.S.

Available Dosage Forms:

• Tablet

Therapeutic Class: Estrogen/Androgen Combination

Pharmacologic Class: Estrogen

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine comes with a patient information insert. Read and follow the instructions in the insert carefully. Ask your doctor if you have any questions.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):For treatment of menopause symptoms: Adults—One to two tablets once a day. Children—Use is not recommended.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.