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estrogen/progesterone combinations

estrogen/progesterone combinations

Restricted Medications Non-Formulary

Drug Name	Form	Strength	Non-Formulary	Restricted	TX Sub	Notes
oral contraceptives (various brands)
Premphase
Prempro

Display Contraceptives, Estrogens, Progestins Class : 681200, 681604, 683200

Medication comments:

USP <800> Hazardous Drug Assessment of Risk (AOR)
Per policy, these drugs are exempt from USP <800> handling requirements under normal circumstances. The following outlines must be followed.
generic (Brand) Route [Packaging: Manufacturer ⇒ Dispense]	Activities
estrogen / progesterone combinations (oral contraceptives (various brands)) PO [n/a]	tablets	Stock @ IDBH? N NIOSH Table 1^A↑
Pharmacy: Receiving / Storage / Preparation Exposure Risk: minimal	• Handling/preparation PPE Requirements: n/a
	• Receiving from Distributor: N/A
	• Pharmacy Storage Area: Patient Bin
	• Packaging/Reconstitution Location: N/A
	• Compounding (Non-Sterile/Sterile) Location: N/A
	• Omnicell Load: No
Transport	• Transport (dose is placed inside a plastic sealable bag): Standard
Nursing: Storage / Administration Exposure Risk: minimal	• Handling/administration PPE Requirements: Single pair of CX approved gloves. Wash hands after handling
	• Storage of Finished dose in Nursing Area/Procedural Area: Patient Med Drawer
	• Signage on Patient Door Required: No
	• Manipulation of Dosage Form: Standard
	• Special Manipulation for Administration: N/A
Disposal / Spills	• Disposal of Drug Waste: Full- blue bin Trace/packaging- trash
	• Disposol of Used PPE: yellow bin
	• Spill management:

2023 American Geriatrics Society Beers Criteria^® for potentially inappropriate medication use in older adults.
Medication:	estrogen/progesterone combinations (Prempro, Premphase)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Drug(s)	estrogens with or without progestins (includes natural and synthetic estrogen preparations)
Rationale	Evidence of carcinogenic potential (breast and endometrium); lack of cardioprotective effect and cognitive protection in older women. For women who start HRT at age 60 and older, the risks of HRT are greater than the benefits, as HRT is linked to a higher risk of heart disease, stroke, blood clots, and dementia. Evidence indicates that vaginal estrogens for the treatment of vaginal dryness are safe and effective; women with a history of breast cancer who do not respond to nonhormonal therapies are advised to discuss the risks and benefits of low-dose vaginal estrogen (e.g., dosages of estradiol <25 mcg twice weekly) with their healthcare provider.
Recommendation	Do not initiate systemic estrogen (e.g., oral tablets or transdermal patches). Consider deprescribing among older women already using this medication. Vaginal cream or vaginal tablets: acceptable to use low-dose intravaginal estrogen for the management of dyspareunia, recurrent lower urinary tract infections, and other vaginal symptoms.
Quality of evidence: Oral and patch: high Vaginal cream or vaginal tablets: moderate, Strength of Recommendation: Oral and patch: strong Topical vaginal cream or tablets: weak

Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome	estrogen, oral and transdermal (excludes intravaginal estrogen) ⇄ Urinary incontinence (all types) in women
Rationale	Lack of efficacy.
Recommendation	Avoid in women. See also recommendation on estrogen (Table 2)
Quality of evidence: High, Strength of Recommendation: Strong

Last updated: Nov. 3, 2025

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Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556

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