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In the WHI estrogen-alone substudydaily CE0.625 mgalone versus placebothere was a higher relative risk of stroke in women greater than 65 years of agesee WARNINGS AND PRECAUTIONSand Clinical Studies

The minimum effective dose is 0.625mg daily for most patientssee section 5.1

PREMARIN Vaginal Cream is administered intravaginally in a cyclic regimendaily for 21 days and then off for 7 daysGenerallywomen should be started at the 0.5 g dosage strengthDosage adjustments0.5 to 2 gmay be made based on individual responsesee Dosage Forms And Strengths

The metabolism of estrogens may be increased by concomitant use of substances known to induce drug-metabolising enzymesspecifically cytochrome P450 3A4CYP3A4enzymesThereforeinducers or inhibitors of CYP3A4 may affect estrogen drug metabolismInducers of CYP3A4such as StJohn’s wortHypericum perforatumpreparationsphenobarbitalphenytoincarbamazepinerifampicinrifabutinnevirapineefavirenz and dexamethasonemay reduce plasma concentrations of estrogenspossibly resulting in a decrease in therapeutic effects and/or changes in the uterine bleeding profileInhibitors of CYP3A4such as cimetidineerythromycinclarithromycinketoconazoleitraconazoleritonavirnelfinavir and grapefruit juicemay increase plasma concentrations of estrogens and may result in side effects.

Take this medication regularly to get the most benefit from itTo help you remembertake it at the same time(seach day as directedFollow your dosing schedule carefullyDo not increase your dose or take this medication more often or for a longer time than directed.

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