Depo estradiol injection site

Depo estradiol injection site DEFAULT

WARNINGS

Endogenous estrogens are largely responsible for the development and maintenance of the female reproductive system and secondary sexual characteristics. Although circulating estrogens exist in a dynamic equilibrium of metabolic interconversions, estradiol is the principal intracellular human estrogen and is substantially more potent than its metabolites, estrone and estriol, at the receptor level.

The primary source of estrogen in normally cycling adult women is the ovarian follicle, which secretes 70 to mcg of estradiol daily, depending on the phase of the menstrual cycle. After menopause, most endogenous estrogen is produced by conversion of androstenedione, secreted by the adrenal cortex, to estrone by peripheral tissues. Thus, estrone and the sulfate conjugated form, estrone sulfate, are the most abundant circulating estrogens in postmenopausal women.

Estrogens act through binding to nuclear receptors in estrogen-responsive tissues. To date, two estrogen receptors have been identified. These vary in proportion from tissue to tissue.

Circulating estrogens modulate the pituitary secretion of the gonadotropins, luteinizing hormone (LH) and follicle stimulating hormone (FSH), through a negative feedback mechanism. Estrogens act to reduce the elevated levels of these hormones seen in postmenopausal women.

Absorption

When conjugated with aryl and alkyl groups for parenteral administration, the rate of absorption of oily preparations is slowed with a prolonged duration of action, such that a single intramuscular injection of estradiol valerate or estradiol cypionate is absorbed over several weeks.

Distribution

The distribution of exogenous estrogens is similar to that of endogenous estrogens. Estrogens are widely distributed in the body and are generally found in higher concentrations in the sex hormone target organs. Estrogens circulate in the blood largely bound to sex hormone binding globulin (SHBG) and albumin.

Metabolism

Exogenous estrogens are metabolized in the same manner as endogenous estrogens. Circulating estrogens exist in a dynamic equilibrium of metabolic interconversions. These transformations take place mainly in the liver. Estradiol is converted reversibly to estrone, and both can be converted to estriol, which is the major urinary metabolite. Estrogens also undergo enterohepatic recirculation via sulfate and glucuronide conjugation in the liver, biliary secretion of conjugates into the intestine, and hydrolysis in the gut followed by reabsorption. In postmenopausal women, a significant proportion of the circulating estrogens exist as sulfate conjugates, especially estrone sulfate, which serves as a circulating reservoir for the formation of more active estrogens.

Excretion

Estradiol, estrone, and estriol are excreted in the urine along with glucuronide and sulfate conjugates.

Drug Interactions

In vitro and in vivo studies have shown that estrogens are metabolized partially by cytochrome P 3A4 (CYP3A4). Therefore, inducers or inhibitors of CYP3A4 may affect estrogen drug metabolism. Inducers of CYP3A4 such as St. John's Wort preparations (Hypericum perforatum), phenobarbital, carbamazepine, and rifampin may reduce plasma concentrations of estrogens, possibly resulting in a decrease in therapeutic effects and/or changes in the uterine bleeding profile. Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects.

Estrogen drug products administered by non oral routes are not subject to first-pass metabolism, but also undergo significant hepatic uptake, metabolism, and enterohepatic recycling.

Clinical Studies

Women's Health Initiative Studies

The Women's Health Initiative (WHI) enrolled a total of 27, predominantly healthy postmenopausal women to assess the risks and benefits of either the use of mg conjugated estrogens (CE) per day alone or the use of oral mg conjugated estrogens plus mg medroxyprogesterone acetate (MPA) per day compared to placebo in the prevention of certain chronic diseases. The primary endpoint was the incidence of coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome studied. A "global index" included the earliest occurrence of CHD, invasive breast cancer, stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, or death due to other cause. The study did not evaluate the effects of CE or CE/MPA on menopausal symptoms.

The CE/MPA substudy was stopped early because, according to the predefined stopping rule, the increased risk of breast cancer and cardiovascular events exceeded the specified benefits included in the "global index." Results of the CE/MPA substudy, which included 16, women (average age of 63 years, range 50 to 79; % White, % Black, % Hispanic), after an average follow-up of years are presented in Table 1 below:

For those outcomes included in the "global index," the absolute excess risks per 10, person-years in the group treated with CE/MPA were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10, person-years were 6 fewer colorectal cancers and 5 fewer hip fractures. The absolute excess risk of events included in the "global index" was 19 per 10, women-years. There was no difference between the groups in terms of all-cause mortality. (See BOXED WARNINGS, WARNINGS and PRECAUTIONS.)

Women's Health Initiative Memory Study

The Women's Health Initiative Memory Study (WHIMS), a substudy of WHI, enrolled 4, predominantly healthy postmenopausal women 65 years of age and older (47% were age 65 to 69 years, 35% were 70 to 74 years, and 18% were 75 years of age and older) to evaluate the effects of CE/MPA ( mg conjugated estrogens plus mg medroxyprogesterone acetate) on the incidence of probable dementia (primary outcome) compared with placebo.

After an average follow-up of 4 years, 40 women in the estrogen/progestin group (45 per 10, women-years) and 21 in the placebo group (22 per 10, women-years) were diagnosed with probable dementia. The relative risk of probable dementia in the hormone therapy group was (95% CI, to ) compared to placebo. Differences between groups became apparent in the first year of treatment. It is unknown whether these findings apply to younger postmenopausal women. (See BOXED WARNINGS and WARNINGS, Dementia.)

Comparative clinical studies have demonstrated that estradiol cypionate produces estrogenic effects that are qualitatively the same as those produced by other estradiol esters. In menopausal women, the average duration of estrogenic effect (as measured by vaginal smear) following a single injection of 5 mg of estradiol cypionate was found to be approximately 3 to 4 weeks. Relief of vasomotor symptoms was observed to occur within 1 to 5 days and to be maintained for 1 to 8 weeks, with an average of approximately 5 weeks.

Sours: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9afd-fecd-4acc4f-6df

Estrogen Injection

pronounced as (ess' troe jen)

Estrogen increases the risk that you will develop endometrial cancer (cancer of the lining of the uterus [womb]). The longer you use estrogen, the greater the risk that you will develop endometrial cancer. If you have not had a hysterectomy (surgery to remove the uterus), you should be given another medication called a progestin to take with estrogen injection. This may decrease your risk of developing endometrial cancer, but may increase your risk of developing certain other health problems, including breast cancer. Before you begin using estrogen injection, tell your doctor if you have or have ever had cancer and if you have unusual vaginal bleeding. Call your doctor immediately if you have abnormal or unusual vaginal bleeding during your treatment with estrogen injection.Your doctor will watch you closely to help ensure you do not develop endometrial cancer during or after your treatment.

In a large study, women who took estrogen with progestins by mouth had a higher risk of heart attacks, strokes,blood clots in the lungs or legs, breast cancer, and dementia (loss of ability to think, learn, and understand). Women who use estrogen injection alone or with progestins may also have a higher risk of developing these conditions. Tell your doctor if you smoke or use tobacco, if you have had a heart attack or a stroke in the past year, and if you or anyone in your family has or has ever had blood clots or breast cancer. Also tell your doctor if you have or have ever had high blood pressure, high blood levels of cholesterol or fats, diabetes, heart disease, lupus (a condition in which the body attacks its own tissues causing damage and swelling), breast lumps, or an abnormal mammogram (x-ray of the breast used to find breast cancer).

The following symptoms can be signs of the serious health conditions listed above. Call your doctor immediately if you experience any of the following symptoms while you are using estrogen injection: sudden, severe headache; sudden, severe vomiting; speech problems; dizziness or faintness; sudden complete or partial loss of vision; double vision; weakness or numbness of an arm or a leg; crushing chest pain or chest heaviness; coughing up blood; sudden shortness of breath; difficulty thinking clearly, remembering, or learning new things;breast lumps or other breast changes; discharge from nipples; or pain, tenderness, or redness in one leg.

You can take steps to decrease the risk that you will develop a serious health problem while you are using estrogen injection. Do not use estrogen injection alone or with a progestin to prevent heart disease, heart attacks, strokes, or dementia. Use the lowest dose of estrogen that controls your symptoms and only use estrogen injection as long as needed. Talk to your doctor every months to decide if you should use a lower dose of estrogen or should stop using the medication.

You should examine your breasts every month and have a mammogram and a breast exam performed by a doctor every year to help detect breast cancer as early as possible. Your doctor will tell you how to properly examine your breasts and whether you should have these exams more often than once a year because of your personal or family medical history.

Tell your doctor if you are having surgery or will be on bedrest. Your doctor may tell you to stop using estrogen injection weeks before the surgery or bedrest to decrease the risk that you will develop blood clots.

Talk to your doctor regularly about the risks and benefits of using estrogen injection.

The estradiol cypionate and estradiol valerate forms of estrogen injection are used to treat hot flushes (hot flashes; sudden strong feelings of heat and sweating) and/or vaginal dryness, itching, and burning in women who are experiencing menopause (change of life; the end of monthly menstrual periods). However, women who need a medication only to treat vaginal dryness, itching, or burning should consider a different treatment. These forms of estrogen injection are also sometimes used to treat the symptoms of low estrogen in young women who do not produce enough estrogen naturally. The estradiol valerate form of estrogen injection is also sometimes used to relieve the symptoms of certain types of prostate (a male reproductive organ) cancer. The conjugated estrogens form of estrogen injection is used to treat abnormal vaginal bleeding that a doctor has decided is caused only by a problem with the amounts of certain hormones in the body. Estrogen injection is in a class of medications called hormones. It works by replacing estrogen that is normally produced by the body.

The estradiol cypionate and estradiol valerate forms of long acting estrogen injection come as a liquid to inject into a muscle. These medications are usually injected by a health care professional once every 3 to 4 weeks. When the estradiol valerate form of estrogen injection is used to treat the symptoms of prostate cancer, it is usually injected by a health care professional once every 1 to 2 weeks.

The conjugated estrogens form of estrogen injection comes as a powder to mix with sterile water and inject into a muscle or vein. It is usually injected by a health care professional as a single dose. A second dose may be injected 6 to 12 hours after the first dose if it is needed to control vaginal bleeding.

If you are using estrogen injection to treat hot flushes, your symptoms should improve within 1 to 5 days after you receive the injection. Tell your doctor if your symptoms do not improve during this time.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using estrogen injection,

  • tell your doctor and pharmacist if you are allergic to estrogen injection, any other estrogen products, any other medications, or any of the ingredients in estrogen injection. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients in the brand of estrogen injection you plan to use.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); certain antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral);aprepitant (Emend); carbamazepine (Carbatrol, Epitol, Tegretol);cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); dexamethasone (Decadron, Dexpak); diltiazem (Cardizem, Dilacor, Tiazac, others); erythromycin (E.E.S, Erythrocin);fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); griseofulvin (Fulvicin, Grifulvin, Gris-PEG); lovastatin (Altocor, Mevacor); medications for human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase); medications for thyroid disease; nefazodone; phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate);sertraline (Zoloft); troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor what herbal products you are taking, especially St. John's wort.
  • tell your doctor if you have or have ever had yellowing of the skin or eyes during pregnancy or during your treatment with an estrogen product, endometriosis (a condition in which the type of tissue that lines the uterus [womb] grows in other areas of the body), uterine fibroids (growths in the uterus that are not cancer), asthma, migraine headaches, seizures, porphyria (condition in which abnormal substances build up in the blood and cause problems with the skin or nervous system), very high or very low levels of calcium in your blood, or thyroid, liver, kidney, gallbladder, or pancreatic disease.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using estrogen injection, call your doctor.

Talk to your doctor about eating grapefruit and drinking grapefruit juice while using this medicine.

If you miss an appointment to receive a dose of estrogen injection, call your doctor as soon as possible.

Your doctor will store the medication in his or her office.

In case of overdose, call the poison control helpline at Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at

Symptoms of overdose may include:

  • upset stomach
  • vomiting
  • vaginal bleeding

Keep all appointments with your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are using estrogen injection.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

  • Delestrogen®
  • DEPO-Estradiol®
  • Premarin® I.V.
  • estradiol cypionate
  • estradiol valerate
  • conjugated estrogens
Last Reviewed - 09/01/

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by FOLX Health

Thu Nov 12

Subcutaneous injections and intramuscular injections in hormone replacement therapy achieve the same result but slightly vary in method & equipment

For many, hormone replacement therapy (HRT) involves needles: this can be daunting or it might leave someone totally unfazed. All of these feelings are valid! Some people feel they notice faster changes using injectable hormones than other methods such as patches, pills, or gels (more on those routes for estrogen here and testosterone here).

There are two methods for delivering testosterone or estrogen with needles: subcutaneously or intramuscularly. This can be done by the person taking the hormones, or with the help of a friend or family member. Whatever the feeling about needles or hormones being taken, there are ways to make the process simple and safe!

FOLX clinicians can offer training for how to do this and be there to answer any questions!

Subcutaneous injections (or SubQ or SC, if you like)

Sours: https://www.folxhealth.com/library/hrt-subcutaneous-intramuscular-injections

Estradiol (By injection)

Learn More

Brand Name(s)

Delestrogen, Depo-Estradiol

There may be other brand names for this medicine.

Drugs and Foods to Avoid

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

How to Store and Dispose of This Medicine

  • If you store this medicine at home, keep it at room temperature, away from heat and direct light. Do not allow the medicine to get cold.
  • Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.
  • Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any leftover medicine, containers, and other supplies. Throw away old medicine after the expiration date has passed.
  • Keep all medicine out of the reach of children. Never share your medicine with anyone.

How to Use This Medicine

Injectable

  • Your doctor will prescribe your exact dose and tell you how often it should be given. This medicine is given as a shot into one of your muscles. You may receive this medicine once a week, once every 2 weeks, or once every 4 weeks.
  • If you have not had your uterus removed (hysterectomy), you may need to use another hormone medicine together with estradiol. Carefully follow your doctor's instructions about all medicines you are using.
  • A nurse or other health provider will give you this medicine.
  • You may be taught how to give your medicine at home. Make sure you understand all instructions before giving yourself an injection. Do not use more medicine or use it more often than your doctor tells you to.
  • Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
  • Use a new needle and syringe each time you inject your medicine.

If a dose is missed:

  • Call your doctor or pharmacist for instructions.

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at FDA

Introduction

Estradiol (es-tra-DYE-ol)

Treats hot flashes and other symptoms of menopause. Also treats prostate cancer in men, and treats lack of estrogen caused by a disorder of the ovaries in women.

Possible Side Effects While Using This Medicine

Call your doctor right away if you notice any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
  • Blistering, peeling, red skin rash.
  • Breast changes or lumps.
  • Chest pain, or coughing up blood.
  • Dark-colored urine or pale stools, yellowing of your skin or the whites of your eyes.
  • Nausea, vomiting, loss of appetite, pain in your upper stomach.
  • Numbness or weakness in your arm or leg, or on one side of your body.
  • Pain in your lower leg (calf).
  • Shortness of breath, cold sweat, and bluish-colored skin.
  • Sudden or severe headache, problems with vision, speech, or walking.
  • Swelling in your hands, ankles, or feet.
  • Vaginal bleeding or spotting.

If you notice these less serious side effects, talk with your doctor:

  • Joint pain.
  • Breast pain or tenderness, discharge from your nipples.
  • Hair loss, increased hair growth, or skin changes.
  • Mood changes or depression.
  • Problems or discomfort when wearing contact lenses.
  • Vaginal itching or discharge.
  • Weight gain or loss.

Warnings While Using This Medicine

  • It is unlikely that you will become pregnant while you are going through menopause. But, you should know that using this medicine while you are pregnant could harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away. If you have recently had an infant, tell your doctor if you are breast feeding.
  • Make sure your doctor knows if you have asthma, epilepsy, migraine headaches, heart disease, or kidney disease. Also tell your doctor if you have endometriosis, gallbladder disease, liver disease, lupus, porphyria, or an underactive thyroid.
  • This medicine should not be used to treat or prevent heart disease or stroke. In fact, hormone therapy can increase your risk of certain heart or blood vessel problems. Tell your doctor if you have a history of heart attack, stroke, high blood pressure, congestive heart failure, blood clots, or circulation problems.
  • Your risk of heart disease or stroke from this medicine is higher if you smoke. Your risk is also increased if you have diabetes or high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. If you have diabetes, keep it under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level.
  • This medicine may also increase your risk of other medical problems, including certain types of cancer. Talk with your doctor about how these risks might affect you.
  • Tell any doctor or dentist who treats you that you are using this medicine. You may need to stop using this medicine several days before you have surgery or medical tests. This medicine may also affect the results of certain medical tests.

When This Medicine Should Not Be Used

You should not use this medicine if you have had an allergic reaction to hormone medicines. Do not use this medicine if you are pregnant, or if you have abnormal vaginal bleeding that has not been checked by a doctor. You should not use this medicine if you have a history of cancer of the breast, ovary, or uterus. Do not use if you have liver disease or a history of heart attack, stroke, or blood clots.

Sours: https://account.allinahealth.org/library/content/45/

Site depo estradiol injection

1. Obtain one dose of injectable, needle, and syringe
Needle with bottle
  • 25 mg MPA/estradiol cypionate or 50 mg NET-EN/estradiol valerate, intramuscular injection needle, and 2 ml or 5 ml syringe. (NET-EN/estradiol valerate is sometimes available in prefilled syringes.)
  • For each injection use a disposable auto-disable syringe and needle from a new sealed package (within expiration date and not damaged), if available.
2. Wash
  • Wash hands with soap and water, if possible.
  • If injection site is dirty, wash it with soap and water.
  • No need to wipe site with antiseptic.

If using a prefilled syringe, skip to step 5.

3. Prepare vial
  • MPA/estradiol cypionate: Gently shake the vial.
  • NET-EN/estradiol valerate: Shaking the vial is not necessary.
  • No need to wipe top of vial with antiseptic.
  • If vial is cold, warm to skin temperature before giving the injection.
4. Fill syringe
  • Pierce top of vial with sterile needle and fill syringe with proper dose.
5. Inject formula
  • Insert sterile needle deep into the hip (ventrogluteal muscle), the upper arm (deltoid muscle), the buttocks (gluteal muscle, upper outer portion), or outer (anterior) thigh, whichever the woman prefers. Inject the contents of the syringe.
  • Do not massage injection site.

Four spots for giving injections

6. Dispose of disposable syringes and needles safely

Nurse disposing of syringe and needle in Sharps Box

  • Do not recap, bend, or break needles before disposal.
  • Place in a puncture-proof sharps container.
  • Do not reuse disposable syringes and needles. They are meant to be destroyed after a single use. Because of their shape, they are very difficult to disinfect. Therefore, reuse might transmit diseases such as HIV and hepatitis.
  • If reusable syringe and needle are used, they must be sterilized again after each use (see Infection Prevention in the Clinic).
Sours: https://www.fphandbook.org/giving-injection
Delestrogen (estradiol valerate) IntraMuscular Injection - The Reproductive Medicine Group

The skirt was pulled up, the blouse and bra were on the floor. First, they entered Zhanna from behind, then someone else appeared in front of her nose. She began to lick this rapidly expanding flesh, and after a minute, someone thrust the barrel right into the very throat. Jeanne trembled: the long-awaited orgasm was inexorably approaching.

The vagina was already compressed by spasms, the clitoris was trembling.

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