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Estradiol Transdermal

Climara

Climara is a hormone (estrogen), approved by the FDA for use by women to alleviate menopausal symptoms like hot flashes, burning, vaginal dryness, and irritation, which result from decreased estrogen production in the body. If this medication is being used specifically to treat vaginal symptoms, consider topical products applied directly inside the vagina before using oral, skin-absorbed, or injected medications. Additionally, this medication may benefit women unable to produce sufficient estrogen, for example, due to hypogonadism or primary ovarian failure. So, if you want to buy Climara online to treat menopausal symptoms, you need to get a prescription from your doctor.

Climara Overview

Climara is an FDA-approved estrogen hormone patch designed primarily to alleviate various menopausal symptoms in women, such as hot flashes, vaginal dryness, irritation, and burning. These symptoms arise from the decreased production of estrogen during menopause. Climara is particularly recommended for those experiencing severe vasomotor symptoms (like hot flashes) and symptoms of vulvar and vaginal atrophy. Besides menopause relief, Climara is also beneficial for women with hypoestrogenism due to conditions like castration, hypogonadism, or primary ovarian failure.

The Climara patch is available in multiple strengths, including 25 mg, 50 mg, 75 mg, and 100 mg. The typical starting dose is 0.025 mg per day, administered once weekly, with adjustments made based on the patient’s response and symptoms. Regular assessment every 3 to 6 months is advised to decide whether to continue or adjust the dosage. The application involves placing the patch on a clean, dry area of the lower abdomen or buttocks, avoiding the waistline and breasts, and it should be replaced weekly, rotating sites to avoid skin irritation. However, there are several risks associated with Climara. It may increase the risk of endometrial cancer, particularly in women with a uterus who do not take progestin. 

Cardiovascular risks, such as strokes and deep vein thrombosis, have also been documented, especially in older postmenopausal women. Moreover, Climara could potentially increase the risk of breast and ovarian cancers. Common side effects include skin irritation where the patch is applied, abdominal pain, and headaches. More severe side effects might involve symptoms of blood clots, severe allergic reactions, and changes in liver function. Patients are advised to consult healthcare providers regularly to monitor and manage these risks effectively. Climara should not be used by individuals with certain conditions like unexplained vaginal bleeding, estrogen-dependent tumors, severe liver disease, and those at high risk for thromboembolic events. 

Uses of Climara

  • Climara is primarily used to treat symptoms associated with menopause, such as hot flashes, night sweats, and vaginal issues like:
    • Dryness 
    • Irritation 
    • Burning
  • This patch is used to prevent osteoporosis in postmenopausal women by providing estrogen replacement, which is essential after the natural decline of estrogen production due to menopause.
  • It can be used to manage conditions that result from low estrogen levels.

Climara Dosage

Climara is available in patch form and has 4 strengths:

  • Climara 25 mg 
  • Climara 50 mg
  • Climara 75 mg
  • Climara 100 mg

Recommended Climara Dosage for Different Patients

Treatment of Moderate to Serious Vasomotor Symptoms Because of Menopause:

  • Initial Therapy: Begin with a dose of 0.025 mg per day, applied to the skin once weekly.
  • Dose Adjustment: Therapy should start at the lowest effective dose and for the shortest duration that aligns with treatment goals.
  • Tapering/Discontinuation: Attempts to taper or discontinue the medication should be made every 3 to 6 months, assessing the patient’s response and symptom control.

Treatment of Moderate to Serious Symptoms of Vulvar & Vaginal Atrophy Because of Menopause:

  • Initial Therapy: Start with a dose of 0.025 mg per day, applied to the skin once weekly.
  • Dose Adjustment: Therapy should begin at the lowest effective dose and continue for the shortest duration that meets treatment objectives.
  • Tapering/Discontinuation: Evaluate the need to taper or discontinue the medication every 3 to 6 months, based on symptom management and patient response.

Treatment of Hypoestrogenism Because of Castration, Hypogonadism, or Primary Ovarian Failure:

  • Initial Therapy: Start with a dose of 0.025 mg per day, applied to the skin once weekly.
  • Dose Adjustment: Adjust the dose as necessary to manage symptoms effectively. The lowest effective dose should guide the administration of the transdermal system, particularly in women with an intact uterus.
  • Monitoring: Regularly assess clinical responses to ensure symptom relief and adjust the dose accordingly.

Prevention of Postmenopausal Osteoporosis:

  • Initial Therapy: Begin with a dose of 0.025 mg per day, applied to the skin once weekly.
  • Dose Adjustment: Maintain the therapy at the lowest effective dose to prevent osteoporosis while considering the overall treatment goals and patient needs.

By following this dosing guide, the treatment can be tailored to achieve the desired therapeutic outcomes while minimizing potential risks and side effects.

[Note: These recommendations mentioned above can vary from person to person. Discuss it with your doctor or pharmacist, and they will customize your Climara dosage accordingly.]

How to Take Climara?

  • Before starting this medication, read the Patient Information Leaflet provided by your pharmacist and refer to it each time you get a refill. Consult your doctor or pharmacist if you have any questions.
  • To apply the patch, first peel off the backing. Choose a clean, dry area on your lower stomach or the top of your buttocks. Avoid the breast area, as well as oily, broken, or irritated skin.
  • Press the patch firmly for about 10 seconds to ensure it adheres properly. Do not place the patch near the waistline or other areas where clothing may rub it off.
  • Follow your doctor’s instructions regarding usage. Typically, the patch should be worn for one week before replacement.
  • Adhere to the prescribed dosing schedule precisely.
  • Change the patch weekly, applying each new one to a different area than the previous one. Avoid reusing the same spot for at least one week.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Climara Work?

Climara is a medicated adhesive patch designed to deliver estradiol directly through the skin into the bloodstream. This method of delivery mimics the natural, continuous, and controlled release of estrogen by the ovaries before menopause. By administering the medication transdermally, Climara bypasses the digestive system and liver, allowing for a significantly lower dosage of estrogen than would be required if taken orally in tablet form. The estradiol provided by Climara serves as a replacement for the estrogen that the body ceases to produce adequately during menopause. As women transition into menopause, the production of estradiol by the ovaries diminishes, which can lead to various uncomfortable and often distressing symptoms associated with this decrease in hormonal levels. By supplementing the body’s hormone levels, Climara aims to prevent or alleviate common menopausal symptoms, which include but are not limited to:

  • Hot flushes and night sweats
  • Sleep disturbances
  • Vaginal dryness
  • Emotional and psychological symptoms such as depression, nervousness, and irritability
  • Physical discomforts like headaches and dizziness

Climara thus provides essential hormone support during menopause, helping to smooth the transition and improve the quality of life during this natural phase of a woman’s life.

Climara Side Effects

Common side effects of Climara may include:

  • Nausea/vomiting
  • Breast tenderness
  • Weight changes
  • Abdominal pain
  • Skin redness/irritation at the application site
  • Bloating
  • Headache

Mild side effects of Climara may include:

  • Mental/mood changes (such as depression, memory loss)
  • Swelling of the hands/ankles/feet
  • Increased thirst/urination
  • Persistent nausea/vomiting
  • Dark urine
  • Severe stomach/abdominal pain
  • Breast lumps
  • Increased or new vaginal irritation/odor/itching/discharge
  • Yellowing of the eyes or skin
  • Unusual vaginal bleeding

Serious side effects of Climara may include:

  • Symptoms of Blood Clots:
    • Sudden vision changes (such as partial/complete blindness)
    • Weakness on one side of the body
    • Unusual sweating
    • Tingling/weakness/numbness in the arms/legs
    • Pain/redness/swelling of legs
    • Trouble speaking
    • Chest/jaw/left arm pain
    • Sudden dizziness/fainting
    • Confusion
    • Sudden severe headache
    • Coughing up blood
    • Trouble breathing
  • Symptoms of Severe Allergic Reactions:
    • Rash
    • Severe dizziness
    • Itching/swelling (especially of the tongue/face/throat)
    • Trouble breathing

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Climara Warnings

Endometrial Cancer Risk: Unopposed estrogen use increases the risk of endometrial cancer in women with a uterus. This risk arises because estrogen alone can cause the lining of the uterus (endometrium) to grow excessively, which may lead to endometrial hyperplasia. Endometrial hyperplasia is considered a precursor to endometrial cancer. To mitigate this risk, adding progestin is recommended as it counteracts estrogen’s effect on the endometrium by causing it to shed through a process similar to menstrual bleeding, thus reducing the likelihood of hyperplasia and subsequent cancer.

Cardiovascular and Dementia Risks: Studies from the Women’s Health Initiative (WHI), particularly the estrogen-alone substudy, have shown that postmenopausal women aged 50 to 79 years treated with daily oral conjugated estrogens (0.625 mg) alone have an increased risk of stroke and deep vein thrombosis (DVT) compared to those receiving a placebo. Additionally, the WHI Memory Study (WHIMS) found that this same group of women had a higher risk of developing probable dementia when treated with estrogen alone. These findings indicate that estrogen therapy, especially without progestin, may raise certain cardiovascular and neurological risks. The applicability of these risks to other doses or forms of estrogen, and to younger postmenopausal women, is uncertain. Nonetheless, in the absence of specific data, these risks are generally assumed to be similar across different estrogen therapies.

Breast Cancer: The combined use of estrogen and progestin has been linked to an increased risk of invasive breast cancer. This risk was highlighted in the WHI estrogen plus progestin substudy, which observed more cases of invasive breast cancer in women using combined hormone therapy compared to those on a placebo. This finding emphasizes the need for careful consideration and discussion of hormone therapy’s potential risks versus its benefits, particularly in the context of breast cancer risk.

Ovarian Cancer Risk: There is some evidence from observational studies indicating a modestly elevated risk of ovarian cancer among women who have used hormone replacement therapy (HRT) compared to those who have not. Specifically, the risk appears to be somewhat higher in women who are currently on HRT. However, the findings regarding HRT use and ovarian cancer risk are not consistent across all studies, and thus, no definitive conclusions can be drawn. Furthermore, while there is no conclusive evidence linking the duration of HRT use to an increased risk of ovarian cancer, prolonged use over several years might carry a greater risk. Given these uncertainties, it is important for women using HRT to discuss their individual risk factors with their healthcare provider.

Liver Tumors: Regarding the use of hormone-containing products like Climara, there have been rare instances of benign liver tumors and even rarer cases of malignant liver tumors. On occasion, these tumors have led to significant bleeding into the abdominal cavity. Although such complications are infrequent, they underscore the importance of vigilance. Women experiencing persistent upper abdominal pain should consult their doctor promptly to rule out the possibility of liver tumors. This proactive approach is crucial for early detection and management of any potential liver-related issues associated with hormone treatments.

Thyroid Disease: Climara can influence the body’s utilization of thyroid hormones. If you are prescribed thyroid medication to manage an underactive thyroid gland, it is crucial to consult with your healthcare provider. Discuss how this medication could potentially impact your existing medical condition, and conversely, how your condition might influence the dosing and efficacy of the medication. Additionally, inquire whether special monitoring is necessary to ensure the medication’s effectiveness and safety in relation to your thyroid health.

Seizures: Climara has been found to potentially elevate the risk of experiencing seizures. Suppose you suffer from a seizure disorder or have a history of seizures. In that case, it is imperative to have a detailed discussion with your doctor regarding the use of medications containing estrogens. You should discuss how such medications might impact your seizure condition, how your condition may influence the appropriate dosing and effectiveness of the estrogen medication, and determine if there is a need for specialized monitoring to manage and mitigate any potential risks effectively.

Climara Precautions

  • Do not use Climara if you are allergic to estradiol (the active ingredient) or any other ingredients listed in the product leaflet. Symptoms of an allergic reaction include wheezing, shortness of breath or difficulty breathing, swelling of the lips, face, tongue, or other parts of the body, and skin reactions such as rash, itching, or hives.
  • Avoid using Climara if you have severe uncontrolled high blood pressure.
  • Do not use it if you have severe liver disease, signs of liver problems like jaundice, or persistent itching from a previous pregnancy.
  • Do not use it if you have known or suspected tumors influenced by sex hormones, including tumors in the uterus, ovaries, or breast.
  • Avoid it if you have endometriosis or a history of blood clots in the blood vessels.
  • Do not use it if you have recently had a heart attack or stroke or if you are at high risk of venous or arterial thrombosis.
  • Avoid it if you have severe diabetes, sickle-cell anemia, disturbances in fat metabolism, or a history of herpes during pregnancy.
  • Do not use it if you experience worsening hearing loss (otosclerosis) during pregnancy.
  • Avoid use if you have undiagnosed abnormal vaginal bleeding.
  • If you have not had a hysterectomy, do not use Climara unless prescribed a progestogen by your doctor, as using estrogens alone can lead to excessive development of the womb lining and increase cancer risk.
  • Do not use Climara if you are pregnant or breastfeeding. The active ingredient can pass into breast milk and may affect the baby.

Climara Contraindications

Climara should not be used by women who have any of the following conditions:

  • Unexplained abnormal bleeding from the genitals
  • Current, suspected, or past breast cancer
  • Estrogen-dependent tumors, whether current or suspected
  • Active deep vein thrombosis (DVT), pulmonary embolism (PE), or a history of these conditions
  • Active arterial thromboembolic disease, such as stroke and myocardial infarction (MI), or a history of these diseases
  • Previous severe allergic reactions or angioedema triggered by Climara
  • Existing liver impairment or disease
  • Deficiencies in protein C, protein S, or antithrombin, or other known clotting disorders
  • Known or suspected pregnancy

Climara Missed Dose

If you miss the scheduled time to replace your patch, apply a new patch as soon as you remember. It is important to only wear one patch at a time; do not apply more than one patch to try to make up for the missed application. After replacing the missed patch, continue with your regular dosing schedule as usual.

[Note: If you have missed a dose of your medication and are still determining when to take the next one, immediately consult your doctor or pharmacist.]

Climara Overdose 

Ingesting or chewing the medication patch can be harmful. If an overdose occurs, it’s important to remove the patch immediately, if possible. In cases where serious symptoms occur, such as unconsciousness or difficulty breathing, immediate medical intervention is crucial. Call 911 or seek emergency medical help without delay to address these critical conditions effectively.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

Climara Storage

  • Store the patches in their original pack until ready for use.
  • Do not remove the patch from its protective pouch until you are prepared to apply it.
  • Keep the patches in a cool, dry place where the temperature stays below 30°C.
  • Avoid storing the patches in the bathroom, near a sink, or on a window sill to prevent exposure to dampness and direct sunlight.
  • Do not leave patches in the car where heat can degrade the medication.
  • Fold the used patch in half so the sticky sides meet, and throw it away in a trash can. 
  • Ensure it’s placed where children and pets cannot access it. 
  • Avoid flushing the patch down the toilet.
  • A locked cupboard at least one-and-a-half meters above the ground is recommended for storing medicines safely.
  • If advised by your doctor to stop using the patches or if they are past their expiry date, consult your pharmacist regarding proper disposal.
  • Return any unused or expired patches to your pharmacist for safe disposal.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Climara Interactions

Interaction with CYP3A4 Inhibitors: Research has indicated that the metabolism of estrogens involves the enzyme cytochrome P450 3A4 (CYP3A4). Consequently, any substances that act as inducers or inhibitors of CYP3A4 can significantly alter how estrogen is metabolized in the body. For instance, inducers of CYP3A4, including phenobarbital, carbamazepine, St. John’s Wort (Hypericum perforatum) preparations, and rifampin, have the potential to lower plasma concentrations of estrogens. This reduction may lead to diminished therapeutic effects of estrogen-based treatments and could also cause variations in the pattern of uterine bleeding.

On the other hand, inhibitors of CYP3A4, such as erythromycin, ketoconazole, clarithromycin, itraconazole, ritonavir, and even grapefruit juice, may increase the plasma concentrations of estrogens. Elevated levels of estrogen could consequently lead to an increase in adverse reactions. Given these interactions, it is essential for individuals using estrogen-based medications to consult healthcare professionals about their use of any known CYP3A4 inducers or inhibitors to properly manage and adjust their medication and to monitor for potential side effects effectively.

Interaction with Blood Thinners (e.g., Warfarin): Using Climara with blood thinners like warfarin can alter the effects of blood thinners, potentially increasing the risk of bleeding. Estrogens can affect how liver enzymes metabolize blood thinners, thus requiring adjustments in dosages to maintain the desired anticoagulant effect.

It’s crucial for individuals taking Climara to consult with their healthcare provider before starting any new medications, supplements, or herbal products like St. John’s Wort to avoid potential interactions that could impact the effectiveness of their treatment or lead to adverse effects.

[Note: This isn’t a complete list, and there could be other drugs that interact with Climara. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Climara Alternatives

  • Premarin (conjugated estrogens)
  • Vivelle-Dot (estradiol)
  • Estrace (estradiol)
  • Divigel (estradiol)
  • Minivelle (estradiol patch)
  • Femring (estradiol acetate)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions For Climara

Is Climara the same as Estradot?

Climara, Estraderm, and Estradot are all hormone replacement therapy patches that contain estrogen. They function in similar ways but differ in size. Climara and Estraderm patches are generally larger than Estradot patches. If you have been prescribed a specific dosage, such as Estradot 50 mg, you can typically substitute it with Climara or Estraderm at the same dosage. For example, a Climara 50 mg or an Estraderm 50 mg patch can replace an Estradot 50 mg patch. Alternatively, if only a higher dosage patch is available, such as 100 mg, it is possible to cut the patch in half to effectively receive a 50 mg dose. This method allows flexibility in managing dosage when specific patch sizes are not available.

Does vitamin D increase estrogen?

Yes, vitamin D can influence estrogen levels, but its effect is more nuanced. Research has demonstrated that vitamin D plays a role in regulating the expression of the enzyme aromatase within immune cells. Aromatase is responsible for converting testosterone into estrogen. When vitamin D downregulates or reduces the expression of aromatase, this conversion process is less efficient, leading to a potential decrease in estrogen levels in the body. Thus, while vitamin D itself does not directly increase estrogen, its interaction with aromatase can affect the overall levels of estrogen.

Can estrogen increase breast size?

Estrogen plays a significant role in breast development, particularly during puberty when the ovaries begin to produce and release this hormone. As estrogen levels increase, it stimulates the accumulation of fat within the connective tissues of the breasts. This process leads to the enlargement and maturation of breast tissue, contributing to the overall growth of the breasts during adolescence and into early adulthood.

How long do you wear a Climara patch?

When using the Climara patch, the duration of wear is typically one week. According to comprehensive data analysis, the onset of the patch’s effectiveness is generally observed within the first one to two weeks of initiating therapy. Furthermore, the effectiveness of the patch remains consistently maintained throughout the entire 7-day period of wear. However, it is important to note that there is some decrease in effectiveness during the week when the patch is not worn, which corresponds to the treatment-free week in each cycle.

What happens if the Climara patch falls off?

If your Climara patch becomes detached, you don’t need to worry about the impact of water exposure from activities like bathing, showering, or swimming. The patch is designed to withstand such conditions without losing effectiveness. However, if the patch does come off, you should reapply it to a different part of your skin. Make sure the area is clean and dry before application. If the patch fails to adhere properly after falling off, it’s best to replace it with a new one. Despite this, you should continue to follow your usual schedule for patch changes to maintain consistent medication levels in your system.

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