How to use
Premarin should be taken orally, once a day, with or without food. You can take this medication after your evening meal or just before bedtime to prevent nausea and stomach upsets. Take the pills exactly as directed by your doctor, even if this differs from the the usually prescribed dosage. Read the label carefully.

Take Premarin regularly and at regular intervals to enjoy its maximum benefits. This ensures there is a constant level of medication in your blood stream.

Overdose
The following are potential syptoms of a Premarin overdose:

• Severe nausea or vomiting
• Unusual vaginal bleeding

If you suspect you have taken too much of this medication, you should contact your local poison control center or the emergency medical services immediately.

Missed dose
If you missed a dose of Premarin, take it as soon as you remember. If you are close to your next scheduled dosage time, you should skip the missed dose, then continue with your regular schedule. Do not attempt to double up on this medication to make up for a missed dose.

Notes
Do not share this medication with others, since they may have a problem that is not effectively treated by Premarin.

Storage
Store Premarin at room temperature between 59 and 86 degrees F (15-30 degrees C ) and keep away from light and moisture. KEEP THIS AND ALL MEDICATIONS OUT OF REACH OF CHILDREN.

Important note
The above information is intended to supplement, not substitute for, the expertise and judgement of your physician, pharmacist or other healthcare professional. It should not be construed that the taking of this medication is safe, appropriate or effective for you.

 * Illustrations are for graphic purposes only and the ordered medication may differ in appearance.

Precautions
Before taking Premarin, you should discuss your medical history with your doctor. Especially mention:

• Any allergies
• Vaginal bleeding of unknown cause
• Certain cancers (e.g. breast cancer, cancer of the uterus or ovaries)
• Blood clots
• History of strokes or heart attacks
• Liver diseases
• Family medical history of breast lumps or cancer
• Asthma
• Diabetes
• Seizures
• Migraine headaches
• Heart diseases (e.g. high blood pressure, congestive heart failure)
• Kidney diseases
• Underactive thyroid (hypothyroidism)
• A certain hormone problem (hypoparathyroidism)
• Mineral imbalance (low calcium blood level)
• Mental or mood disorders (e.g. dementia, depression)
• High blood pressure during pregnancy (toxemia)
• Yellowing of the eyes or skin (cholestatic jaundice) during pregnancy or with past estrogen use
• Uterus problems (e.g. uterine fibroids, endometriosis)
• High blood cholesterol or fat (triglyceride) levels
• Gallbladder disease
• Obesity
• Certain blood disorder (porphyria)
• Lupus

If you currently suffer or ever have suffered from any of the above conditions, you may not be able to take Premarin or you may need a dosage adjustment.

Premarin may cause patchy darkening of the skin on the face (melasma). This may be worsened by darkening. Avoid prolonged sun exposure or artificial sunlight, such as sunlamps and tanning booths. Use an effective sunscreen or protective clothing when exposed to sunlight outdoors.

The combination of estrogens and smoking may increase your risk of strokes, blood clots, high blood pressure and heart attacks, especially in women over the age of 35. Talk to your doctor about an effective smoking cessation programme.

Caution is advised when this medication is taken by children as it may affect their growth and development.

Premarin is classed as Pregnancy Category X by the FDA, which means it is known to cause birth defects in unborn babies. It is not recommended to take this medication when pregnant. Talk to your doctor before taking these pills if you are currently pregnant or planning to become pregnant during treatment.

Premarin passes into breast milk and could potentially harm a nursing infant. Talk to your doctor before taking this medication if you are currently breastfeeding a baby.

Drug Interactions
Before taking Premarin, make sure to tell your doctor if you are currently also taking any of the following medications:

• Anastrozole
• Exemestane
• Blood thinners (anticoagulants such as Warfarin)
• Corticosteroids (e.g. Prednisone)
• Raloxifene
• Tamoxifen
• Medicines affecting liver enzymes that remove estrogens from your body (such as St. John's Wort, Phenobarbital, Phenytoin, Rifamycins including rRifabutin, Azole antifungals including Itraconazole, Macrolide antibiotics including Erythromycin, certain anti-seizure medications including Carbamazepine)

This is only a partial list and other medications may interact with Premarin. Inform your doctor of all prescription and non-prescription you are currently using, including vitamins, dietary supplements, herbal pills and medication prescribed by other doctors. Do not start or stop taking any medication without discussing this with your doctor first.

The following common side effects of Premarin may occur:

• Dizziness
• Lightheadedness
• Headache
• Stomach upset
• Bloating
• Nausea
• Weight  changes
• Increased or decreased interest in sex
• Breast tenderness

These symptoms are usually mild and should disappear over time. If any of these side effects persist or worsen, notify your doctor immediately.

Inform your doctor straightaway if you notice any of the following unlikely but serious side effects:

• Mental or mood changes (e.g. severe depression, memory loss)
• Breast lumps
• Swelling of the hands or feet
• Unusual vaginal bleeding (e.g. spotting, breakthrough bleeding, prolonged or recurrent bleeding)
• Unusual vaginal discharge, itching or odor
• Yellowing of the eyes or skin (jaundice)
• Stomach or abdominal pain
• Persistent nausea or vomiting
• Dark urine
• Worsening of seizures
• Signs of worsening diabetes control (e.g. increased thirst and urination)

Infrequently, Premarin may cause serious problems, such as heart attacks, strokes or blood clots. Seek emergency medical attention if you experience any of the following symptoms:

• Pain in the chest, jaw or left arm
• Sudden severe headache
• Weakness on one side of the body
• Confusion
• Slurred speech
• Sudden vision changes (e.g. double vision, loss of vision)
• Pain, redness or swelling of legs
• Trouble breathing
• Coughing up blood
• Sudden dizziness or fainting

In very unlikely cases, you may experience an allergic reaction to this medication. Seek immediate medical attention if you notice any of the following symptoms:

• Rash
• Itching or swelling (especially of the face, tongue or throat)
• Severe dizziness
• Trouble breathing

This is only a partial list of potential side effects of Premarin and others may occur. Notify your doctor if you experience any other side effects than the ones mentioned above, especially if they are bothersome.