What is Prempak-C?
Prempak-C tablets are available in two strengths: 0.625mg/0.15mg and 1.25mg/0.15mg.
Each pack contains two active ingredients: conjugated oestrogens (either 0.625mg or 1.25mg per tablet), and 0.15mg norgestrel. Conjugated oestrogens replace the oestrogen that is found naturally in the body, and relieve menopausal symptoms. Norgestrel is a synthetic form of progesterone (a “progestogen” hormone found in the body) and this protects the lining of the uterus (womb).
Prempak-C tablets are only intended for women who have a uterus (that is women who have not had a hysterectomy). For women who do not have a uterus, a form of hormone replacement therapy (HRT) that does not contain a progestogen should be used, such as Premarin.
Prempak-C is a form of HRT, and is prescribed to women after the menopause to replace the oestrogen that is no longer being produced. This helps to relieve the symptoms of the menopause, and restores the protective effect oestrogen has against the risk of cardiovascular disease.
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How to take Prempak-C
You should read the enclosed leaflet carefully before commencing use of Prempak-C tablets.
You should start with the lower strength (Prempak-C 0.625 tablets), and the doctor will consider the higher strength if your symptoms are not controlled.
The oestrogen is taken every day, and the norgestrel is taken during days 17 to 28 of each 28-day cycle. The two ingredients are contained in separate tablets. The blister packaging of Prempak-C makes it easy to take the right tablets on the right days. Each pack provides enough tablets for 28 days, and each blister is marked with a number from one to 28. Simply start with blister number one on day one, and take the contents of the next blister each subsequent day until you’ve finished the pack. You’ll then start a new pack straight away. Blisters one to 16 contain an oestrogen tablet, and blisters 17 to 28 also contain the norgestrel tablet.
Is Prempak-C suitable for me?
In some circumstances, Prempak-C, like all medicines, should be used with caution or won’t be recommended at all. This may apply, for example, to women who are aged 65 or above, or those who have cancer or a history of cancer, undiagnosed genital bleeding or liver or kidney problems. Untreated endometrial hyperplasia (excessive growth of tissue in the womb) and current or previous venous thromboembolism (deep vein thrombosis, or pulmonary embolism) will also need to be discussed and may mean Prempak-C isn’t suitable for you. This may also apply to women with disorders of blood clotting, current or previous circulation problems including heart disease, angina, or a heart attack and porphyria. People who are allergic to any of the active or inactive ingredients are likely to be advised against the use of Prempak-C.
In addition, it is important to mention to the online doctor if you have now, or have had in the past, any of the following conditions: endometriosis or risk factors for thromboembolic disorders (for example prolonged immobilisation, major surgery, obesity, cancer, smoking and excessive drinking). You should also be clear if you have, or have previously had, risk factors for oestrogen dependent tumours (including first-degree heredity for breast cancer, for example), hypertension or liver or kidney problems. The doctor will also need to be made aware if you have a history of diabetes mellitus with or without vascular involvement, cholelithiasis, migraines or severe headaches, systemic lupus erythematosus (SLE), endometrial hyperplasia, epilepsy, asthma, or otosclerosis.
Please tell the online doctor if you are taking any other medicines, either prescribed by your doctor or bought over the counter without a prescription. Prempak-C can cause problems if used at the same time as certain other medicines, so we need to know if you’re taking any medicines for epilepsy, or for infections (for example rifampicin, rifabutin, nevirapine, efavirenz). We’ll also need to know if you’re taking some medicines for HIV/AIDS, warfarin and other anticoagulants, or St John's Wort.
We need to be confident we have the full picture of your general health. The doctor needs to have all the information to assess the suitability of Prempak-C for you.
What are the side effects of Prempack-C?
There is always the potential for Prempak-C tablets to cause side effects, although not everybody gets them.
You should be aware, however, that some side effects are potentially serious. If you experience any of the following, you should stop using Prempak-C and tell your local doctor immediately:
- Unexpected vaginal bleeding
- Painful menstrual cramps
- Redness of the legs and swelling
- Sharp chest pain
- Difficulty in breathing
- Chest pain that spreads to the arm or neck
- Yellow tinge to the eyes and face (jaundice)
- An increase in blood pressure
- Migraine-like headaches
- Any changes in the breasts, including dimpling of the skin, changes in the nipple, and any unusual lumps that you can see or feel.
Other reported side effects include breast pain, vaginal discharge, headache and dizziness. You may also experience increased libido, depression, increased blood pressure, palpitations, fluid retention, nose bleeds, indigestion and other type of stomach discomfort. Plus, itching, skin rashes, hair loss, weight gain, sweating, and feeling faint following mealtimes are also side effects associated with Prempak-C.
You should be aware that HRT increases the risk of thrombosis, stroke, breast cancer, and ovarian cancer. Oestrogen-only HRT has an increased risk of endometrial cancer, but the norgestrel in Prempak-C helps to protect you from this extra risk. For women who begin HRT more than 10 years after the onset of the menopause, there is an increased risk of heart disease. This is why the minimum effective dose of HRT should be prescribed and used, for the shortest length of time.
Before you begin a course of Prempak-C, please be sure to read the patient information leaflet provided in the pack. This will give you the extensive list of potential side effects and any other important information you need to be aware of. The leaflet can also be viewed online here.