Prescribing Advice for GPs

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Prempak-C Shortage

The manufacturer of Conjugated Estrogens / Norgestrel (Prempak-C)® has written to clinicians to inform them of stock shortages.

The letter from the Medical Director states that there is a short-term production difficulty that is affecting supplies. They are working urgently to resolve the manufacturing difficulties and they provide a website address for weekly updates.

Prempak-C is licensed for hormone replacement therapy (HRT) in oestrogen deficiency and for prevention of osteoporosis in high-risk women who cannot take alternative products. The findings of the Women's Health Initiative have restricted the place of HRT products since many expected benefits of HRT were not demonstrated in real life studies while many of the harms remain.

Action: The shortage of Prempak-C is an opportunity to review the need for treatment. Prescribing should be stopped where the risks now outweigh the benefits of treatment.

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24 Comments to “Prempak-C Shortage”

  1. Ok, no more Prempak-C 125. Now about to start Femoston. Any comments about switch would be helpful, scary business Prempak-C suited me very well.

    Comment by Dori Maydew — August 16, 2017 #
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  2. I've been on Prempak-C for 6 months and it had helped me so much.
    I was only 36 when I started getting menopausal symptoms it took 10 years of so many different things wrong with me and finally a doctor that listened.
    I didn't want any HRT and it took a lot of persuasion then when I took the plunge, it's now off the shelves 😓
    The biggest reason I agreed to taking HRT was for my bones as I have arthritis and doctor said it would help my bones and I went from taking painkillers like sweets to literally nothing.
    I'm so scared as it's no longer available so doctor prescribed me a alternative and guess what guys, it's no longer available either.
    Been 1 week now without it and can already feel the pains returning in my shoulders and hip.
    What to do I'm In limbo.
    Going back to docs tomorrow.

    Comment by Michelle Rawlings — July 26, 2017 #
    Reply

    1. @Michelle

      Hopefully you've had your consultation with your doctor by now about this.

      My understanding of HRT in respect of bone health is that treatment improves bone mineral density, which is a measure of bone strength, while you are on treatment and things fairly rapidly return to 'normal' on stopping HRT. Given that HRT is not intended to be a long term treatment it's not usually recommended as a treatment for bone health as the effects diminish rapidly on stopping treatment.

      I can't think of a reason why it would improve joint pain but if it has then that's got to be a good thing for you.

      Comment by Matthew Robinson — August 2, 2017 #
      Reply

  3. Today I was to pick up my repeat prescription for Prempak-C 0.625 but instead I have an appointment to see Doctor on Monday. Now I know why. I have, over the years, tried every alternative to no avail. Life without Prempak is unbearable. Therefore on Monday I shall ask for the 1.25 dose from doctor, failing this since available on line I shall buy from there. My intention is to take half a tablet daily which will give me the same dose. I have to cut in half prednisone plus cut in quarter Furosemide plus half Vetmedin for my sick Dog, he is thriving on his meds. So if half tablets work for my Dog that is good enough for me. Quality of life on Prempak 25 years excellent.

    Comment by Christina Upton — July 21, 2017 #
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  4. Prempak-C has been discontinued by Pfizer (no reason given). That is why doctors cannot prescribe it. I agree with everyone above. All the alternatives have much higher doses of progesterone and less than half the oestrogen. I tried Premique but was up all night with severe RLS caused by the high progesterone. I loved Prempak-C and am distraught. Maybe Pfizer can be persuaded to reintroduce it.
    Elleste and other brands are much higher doses - I thought low doses were recommended but manufacturers can demand more money from the NHS for higher doses. Disgraceful.
    Will have to look at herbal alternatives.

    Comment by Julie Gould — July 15, 2017 #
    Reply

  5. I have taken Prempak-C 1.25 for about 30 years - marvellous! Am now distraught at the thought of my manageable life falling to bits! Have NEVER had over-heating et al and SO want to find a similar pill. Can I buy it online perhaps. I have been prescribed Elleste and Femoston - and am about to finish last of the Prempak-C and on to one of these others. Have not read brilliant comments on these - depressing!!! Doctors are very kind but seem keen to have me stop taking HRT........happy to if it won't affect my life........but I have a horrible feeling that ceasing it, will??

    Comment by Betty Hale — June 28, 2017 #
    Reply

    1. @Betty Hale

      You haven't really said what things you've read about Elleste and Femoston but from a medicines perspective they are pretty much identical to Prempak-C in terms of the ingredients and what they do/. They are all oestrogen pills with cyclical progestogen to induce a monthly bleed pattern.

      If you have been on Prempak-C for 30 years then I suspect it is time to think about stopping. All of these pills come with cardiac risks and an increased risk of blood clots. They also increase the risk of some types of cancer (while decreasing the risk of others). When you stop taking HRT you will basically then go through the menopause, but the time period over which you get symptoms should be shorter than it's normal biological equivalent.

      I think you need to have a very open and honest discussion with your doctor in order to agree what you do next.

      Comment by Matthew Robinson — July 6, 2017 #
      Reply

  6. I have been taking Prempack-C lower dose, my doctor has prescribed a different type now it has been discontinued. You mentioned in previous post about non-hormonal alternatives.

    There are so many to choose from, do you know of anything that works?

    Comment by Sandra Champion — May 16, 2017 #
    Reply

    1. @Sandra

      There are quite a few options including progestogen alone, SSRI and so on. It's worth visiting your doctor to discuss the options as some of these may not be suitable for you.

      Comment by Matthew Robinson — May 16, 2017 #
      Reply

      1. Thank you for your reply

        Comment by Sandra Champion — May 23, 2017 #
        Reply

  7. I've been switched from Prempak to Elleste Duet which I was originally on and it didn't work. Don't understand why my doctor has put me back on this one when when it didn't work the first time, surely there must be one similar to prempak? I'm now suffering from night sweats and hot flushes during the day. Is there anything close to prempak?

    Comment by Emma M — May 9, 2017 #
    Reply

    1. @Emma M

      There isn't really anything directly like Prempak but there are alternatives other than Elleste. If you are struggling with symptoms as you are, get back into the doctor and ask for something different.

      Update: On checking today it would seem that Prempak-C has been discontinued.

      Comment by Matthew Robinson — May 11, 2017 #
      Reply

  8. Can you please advise has anyone got any Prempak-C 0.625mg/0.15mg coated tablets

    Comment by Susan Lea — May 5, 2017 #
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  9. I have been on Prempak-C 0.625mg for many years. When my Doctor stopped prescribing them to me I ordered online now I'm worried as I can't seem to get them. I can only get the higher does 1.25mg, so I don't know what I can do. Any advice?

    Comment by Linda — February 26, 2017 #
    Reply

    1. @Linda

      It might be wise to speak to your doctor, there are risks associated with long term use and that may be why your doctor stopped prescribing. There are non-hormonal options that might be suitable for you.

      Comment by Matthew Robinson — February 27, 2017 #
      Reply

    2. I have been on Prempak-C 0.625mg. My Doctor stopped giving me them so I've been getting them online. I am now 65 and I don't want to stop them but it's impossible to get them. I've got some higher dose at 1.25mg but I don't know if I should try them? Anyone in the same boat?

      Comment by Linda — February 27, 2017 #
      Reply

      1. @Linda

        You really need to discuss this with your doctor, there are likely to be good reasons why your doctor stopped prescribing these. If you have been buying them yourself and now can't get them any more you need to seek medical advise about what to do next rather than guessing at a dose or an alternative.

        Comment by Matthew Robinson — February 28, 2017 #
        Reply

      2. I have 3 months supply and can't take it. I bought them online a while ago. Would you like to buy them from me. Sue

        Comment by Sue — April 27, 2017 #
        Reply

        1. Yes Sue, I would like to buy them please.

          Comment by Lynn — April 28, 2017 #
          Reply

          1. My email is adreama1@hotmail.com. Email me your address and I will send them. Shall we say £20?

            Comment by Sue Nunn — May 3, 2017 #

    3. I too am in the same situation and struggling with Estelle, I loved Prempak-C and have tried to fined it in other European countries, but only the higher dose is available. Why do they have to change such a good thing? Have you had any more luck?

      Comment by Alison Milthorp — May 16, 2017 #
      Reply

      1. I've been on Prempak-C for 15 years and I'm now 66. It's been great with no side effects. Ok the monthly bleed is a bit annoying but better than spotting which I had when I tried a no bleed alternative. Like most of you on here I am now devastated to find Pfizer has discontinued production. I get free prescriptions but would happily pay for Prempak-C if I could find it somewhere. I've been prescribed Elleste Duet. After taking one pill I suddenly discovered my breasts were really tender which is not exactly conducive to sex! I'm anticipating more side effects as the month goes on. Does anyone know why Pfizer is messing with so many women's wellbeing? Also has anyone found a decent alternative?

        Comment by Viv — August 15, 2017 #
        Reply

  10. I was taking prempak-c 0.625 for 3 months but stopped taking them due to me having a terrible pain down the whole side of my face..Ive been off them for 10 days now and still suffering..Can you give me any advise please. Thank you

    Comment by Lyn Ogden — April 28, 2012 #
    Reply

    1. @Lyn,

      Without more details it's difficult to say for sure but this sounds like something called trigeminal neuralgia. This is probably unrelated to the Prempak-C but either way you need to see your doctor to be checked over.

      Comment by Matthew Robinson — April 28, 2012 #
      Reply

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