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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76 Comments to “Prempak-C Shortage”

  1. Is this prescription available anywhere in Europe, do they have similar perhaps in France?
    Can anyone say where there is a supplier, we are not looking for class A drugs! Just a quality of life which our doctor is quite happy about.
    Kind regards, please advise.

    Comment by Philippa Darcy — October 27, 2018 #
    Reply

    1. It seems that while Prempak-C has been discontinued worldwide, Premarin remains available. This product that is not a direct switch as Prempak-C also contained progestogen tablets to induce a monthly bleed, but a GP may be willing to prescribed Premarin with some progestogen tablets to recreate the Prempak-C cyclical treatment.

      Comment by Matthew Robinson — October 28, 2018 #
      Reply

    2. Hello all...I've just found this website while I was Googling Prempak-C for information on why it has disappeared. I'm amazed to read all of your comments about coming off it and the results. I was on Prempak-C for 20 years or so and just assumed it was initially out of stock; then found out from my GP it wasn't being made any more. He couldn't tell me why. I can only assume it's to do with the risk of cancer. I told my GP several times over the aforesaid 20 odd years that I'd rather get cancer than suffer from the effects of the menopause. It seems like I'm not the only one. I had a break from the pills and then started a short course of something else and didn't really notice much difference so I haven't renewed my prescription. Now I do get sweats but mainly during the day - not so bad but my moods are awful and it did't dawn on me until reading these comments from you all that it was to do with the menopause. I had forgotten...and just assumed I was depressed with everything going on in my life whereas now I think it's caused (partially) by the menopause. I'm up and down - different every day and sometimes hour to hour! I'm contemplating getting another course of HRT but not sure which type I'll ask for. Certainly not the Elleste which seems to have been getting a lot of complaints.

      Comment by SUE BANKS — March 19, 2019 #
      Reply

  2. I have been taking Prempak-C for over 20 years and they definitely improved my quality of life by 100 per cent. I was fit, healthy and very energetic. I was devasted when I was informed Prempak-C was no longer available. I also had an horrendous battle with my GP (the surgery being taken over by another outside very large practice - my original GP retiring - sadly). The first thing this new practice did was introduce me to a very young arrogant young man who obviously had no idea whatsoever of women's issues lecturing me on the negative aspects of this medicine. After a lengthy discussion he then decided in his 'wisdom' to put me on a very low does of Femoston; so low even several chemists that I tried didn't stock it. I did wonder if this had been deliberate. I made another appointment with a GP requesting someone more mature and female. After another horrendous lecture I was eventually put on a bit higher dosage of Femoston, the lowest they do actually make. I tried these for 3 months but my life was hell and I felt suicidal. I went back to another female GP who has now put me on a higher dose of Femoston 1 mg/5mg even these are not as effective as Prempak-C. It would be helpful to know if anyone has found a decent alternative to Prempak-C. This has really been an uphill and stressful experience.

    Comment by Noreen Skinner — February 28, 2018 #
    Reply

    1. Found this website, I need to try it yet but need to see the GP to have my prescription changed, if she'll agree that is. She actually prescribed me the wrong hrt first, Kliofem as an alternative which made me very ill, then the web stated that Elleste Duet was the alternative, which seemed ok but the last few month I've struggled so much with the hot flushes, really low moods etc. It's not fair that we're having to suffer, Prempak-C 1.25 really saved life, now I'm a mess.
      Please let me know how you get on. For me the quality of my life is far important, as in able to function without coming across like a dithering mess & Feeling like one too, all that because of a tablet, it was a God send.
      This is the link:-
      https://www.pharmacy2u.co.uk/prempak-c-1-25-mg-+-0-15-mg-tablets-p10559.html

      Comment by Naz — September 11, 2018 #
      Reply

  3. I was on Prempak-C for 5 yrs and felt amazing, then it was discontinued. I've been put on Elleste Duet and feel worse now than when menapause floored me. I am going back to the doctors to see if they will try another tablet, I cannot go on the way I feel. Seriously, how difficult would it be to start producing Prempak-C again 😠

    Comment by Paula Batley — February 20, 2018 #
    Reply

    1. I feel exactly the same, I have tried Kliovance and Elleste but have put so much weight on. I was on Prempak-C for 20 years and felt so much better than I do now. Why was Prempak-C discontinued when so many ladies feel the same as I do?

      Comment by Gaynor — June 13, 2018 #
      Reply

      1. Came across this website, I need to see gp to change prescription, please let me know how you get on. My life is not the same as before since Prempak-C 1.25 has been discontinued.
        Web address is:-
        https://www.pharmacy2u.co.uk/prempak-c-1-25-mg-+-0-15-mg-tablets-p10559.html

        Comment by Nas — September 11, 2018 #
        Reply

  4. I was originally prescribed Prempak-C before it was discontinued. I tried a couple of different brands, which firstly did not agree with me due to the amount of breakthrough bleeding and secondly another brand was given that again became discontinued.

    I’ve been taking Elleste Duet 1mg for the past 3 months and it worked well similar to Prempak-C. However, my dilemma has returned with Elleste Duet 1mg as there seems to be a shortage due to manufacturing problems. I have found this out over the past few days, as I need to hand my prescription in but no local chemists have it in stock or are unable to order it from anywhere.

    I’ve had to travel 20 miles away to hand my script in to a chemist there who only has 1 month to give me and the pharmacist is unsure whether it will be possible to obtain any further supplies.

    Has anyone else having problems getting hold of Elleste Duet 1mg recently?

    Comment by Karen — December 30, 2017 #
    Reply

    1. @Karen

      I'm not aware of any issues with the Elleste product range but I'm not directly involved in the supply chain so there may be an issue. It may be due to an increase in demand now Prempak-C needs to be replaced. It could also be a local thing that one wholesaler is out of supply. I'll post another comment if I hear anything.

      Comment by Matthew Robinson — December 30, 2017 #
      Reply

      1. Have been reading about everyones distress and unhappiness re the withdrawal of Prempak-C.

        I too had been taking this HRT 0.625mg although at a very low dose just every 3rd day. I found my symptoms could be controlled in this way.
        My doctor has prescribed two alternatives. One a continuous preparation which didn't suit at all, just bled continuously. I am now taking Elleste Duet every 3rd day and although it is controlling the night sweats and hot flushes to a degree I am aware that my abdomen is quite distended.

        I am wondering who you are Matthew since you seem to be the most prolific contributor to this site. Do you have medical knowledge beyond a GP?

        Comment by Brenda Grant — April 23, 2018 #
        Reply

        1. @Brenda,

          In answer to who I am - I am the owner and operator of this site! You can read all about me but in summary I'm a pharmacist and independent prescriber with more than 15 years experience of working with doctors in surgeries to guide prescribing.

          Do I have medical knowledge beyond a GP - certainly not, do I have medicines knowledge beyond a GP, well I'd hope that's a yes.

          Comment by Matthew Robinson — April 24, 2018 #
          Reply

          1. OK that's my answer. Thank you Matthew will do a little research into the non HRT alternative you hae mentioned previously as my symptoms are related to body temperature alone.

            Comment by Brenda Grant — April 24, 2018 #

  5. Hi all, Im in the same boat and no other HRT has managed to curtail my symptoms and Ive had 3 different ones. Has anyone had success with any other version of HRT, please share
    Thanks

    Comment by Aideen Ohalloran — December 15, 2017 #
    Reply

  6. I have been taking Prempak-C for 15 years and I felt normal. Since it has been discontinued my doctor has given me several different HRT products to try. My life is falling apart. I am tired, cranky and sweaty. I have body pain and feel ancient and have no quality of life so to speak. My doctor researched Prempak-C and it appears it contains an ingredient that no other HRT has. That is why it suits so many women. Shame on the manufacturers, I hope they suffer a huge loss that rocks the very foundation of their company, I curse each and every one of the people who decided to put profit above giving relief with a medicine that actually works. As I am now consigned to a life of feeling subnormal, I will continue to curse this company until they see the damage their profit seeking does to normal people.

    Comment by Naomi — November 6, 2017 #
    Reply

    1. I'm devastated that Prempak-C has been discontinued. I feel exactly the same as you do. Feel like my life is over and struggling to even get up in the morning and go to work. GP prescribed alternative Premique 0.3mg/1.5mg but its just not the same. Why oh why have Pfizer done this. Destroying womens' health and wellbeing.

      Comment by Caroline Armstrong — November 8, 2017 #
      Reply

    2. Really interesting that its all about the money.
      Maybe all women who are now without their Prempak-C should lay siege to the Pfizer Labs with burning torches and pitch forks or just a baseball bat and mace! 🙂 Only joking...or am I? Be good to make a point though. Ha.
      If this was a Male problem (no offence Matthew) there would be unlimited drugs, research and no expense spared - unfortunately its not, no idea, its all completely natural (just like childbirth) - yeah whatever.
      Rant over - got my 6 months of medication whatever it is!
      And I actually haven't hurt anybody today, its a good day Grrr.

      Comment by Michele Johnson — November 15, 2017 #
      Reply

      1. @Michele

        It may not all be about money and it's interesting you suggest laying siege to Pfizer - I do wonder whether that is some of the reason it's been discontinued but due to another group laying the siege! If this statement confuses you perhaps investigate how conjugated equine oestrogen is produced.

        Interesting you feel male problems get all the money - what about contraception and cancer screen? Those are heavily weight towards women.

        Comment by Matthew Robinson — November 15, 2017 #
        Reply

        1. So, equine oestrogen. Yes, many of us have recently become aware of the bad conditions the horses are kept in etc and I for one have decided to stop taking Prempak-C but coming off it immediately is not a good idea and I like many other women am struggling to get through the day. Withdrawal can even make you feel suicidal but it's hard for anyone to imagine that. To have a drug readily available to take long term then to take it off the market with no proper explanation or decent substitute is very bad for the consumer. Also Matthew women do have a lot of organs which can easily become cancerous due to fluctuations in hormones, men not so many but yes they get cancer too sadly.

          Comment by Joanne Kalel — February 27, 2018 #
          Reply

          1. @Joanne,

            I am aware of how difficult it is for many women to stop HRT and have already commented on exactly that issue.

            UK based data (more recent data set from 2015) shows that men are more likely to be diagnosed with cancer and are also more likely to die from cancer. One could conclude therefore that being female is better in terms of cancer risk.

            Last point, you will not that this post was made in 2006 when Prempak-C was in short supply. I do not work for the manufacturer nor have I ever worked in the drug industry. The decision to discontinue the product was nothing at all to do with me. I'm not sure if your comment was meant to sound like a personal attack but it certainly read that way before I edited it.

            Comment by Matthew Robinson — February 27, 2018 #

    3. Hi, I too have been on prempak C 1.25mg for approximately 15 years and it has suited me perfectly. I am absolutely devastated to find out it has been discontinued. I have been on Elleste 1mg for the past 2 months and it isn't helping at all. I have called the manufacturer of Prempak, Pfizer and was informed it was a business decision. I asked them why and they wouldn't tell me, they only gave me the address of their legal department. I advised them I wasn't prepared to let this go, as it is affecting millions of women and we need answers. Therefore, I am wondering if quite a few of us who are affected got in touch with their legal department and see what we can do, my email is annenorris@hotmail.co.uk

      Comment by Anne Norrisw — December 7, 2017 #
      Reply

      1. I also felt wonderful on Prempak! Never felt better except when pregnant. I had a huge tussle with my GP who made me come off HRT altogether. It also kept my singing voice. I was broken hearted and deliberately kept on and on over several months. Finally I was allowed to go on HRT again, sadly not Prempak.

        Comment by Lucinda St.John — September 3, 2018 #
        Reply

      2. Hi there
        I was on the same strength as you, GP put me on kliofem, it made me so ill. Now have been on Elleste Duet since August 2017 & I'm suffering the sweats, low moods etc. I'm so so devastated about Prempak-C 1.25mg withdrawal, I was perimenopausal at 42. However I just fount this website, apparently our hrt can be purchased, https://www.pharmacy2u.co.uk/prempak-c-1-25-mg-+-0-15-mg-tablets-p10559.html
        I'll need to speak with my GP to see if they will change my prescription. My quality is so poor since Prempak-C was discontinued. I pray it returns, I feel so worthless, its been a struggle.

        Comment by Naz — September 11, 2018 #
        Reply

        1. Regarding the web page saying that you can get Prempak-c 1.25 from Pharmacy2U on Sept 11th 2018. I saw it as well but thought it must be wrong then reading your post I wondered if you spoke to your Dr and if you got them.

          Comment by Veronica Tattum — February 25, 2019 #
          Reply

    4. I am in exactly the same position as you. After suffering for some 12 years, in January 2017 I was prescribed Prempak-C and what a difference it has made to my life. No more horrendous hot flushes day and night which are totally debilitating and exhausting. I was drinking pints of water a day and not going to the toilet once, which can't do your kidneys any good. Couldn't go for long walks with my husband or look after the grandchildren without feeling totally exhausted, housework was exhausting to name just a few!!! Prempak-C gave me life and I want that back. I am now taking Nuvelle Continuous but it doesn't seem to be working, most doctors are not interested and I've had 4 doctors who have told me they won't prescribe anything at all to help. I am 64 and have paid into the NHS all my life so I think I should be able to get something that will help me. I understand there are risks but there are risks to everything in life and surely it should my decision at the end of the day. I am seeing another doctor mid January the earliest appointment I could get!

      Comment by Sandy — December 31, 2017 #
      Reply

      1. @Sandy

        I partially agree with you. If you have understood the risks of a treatment then it is partially your decision to take the treatment or not. However, what a lot of people forget is that risk is shared with the person prescribing the treatment. Clinicians are often the subject of spurious complaints and litigation when things go wrong despite having explained risks so I can also understand why many are reluctant to prescribe in higher risk groups.

        Comment by Matthew Robinson — January 8, 2018 #
        Reply

    5. I have taken Prempak-C for the last 22 years and I have never had any problems, but I am suffering the same as you.

      Comment by Annie Mottram — February 15, 2018 #
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    6. I don't think the company will care one way or the other. I've looked online but I think they have run out of supplies too. After wonderful Prempak-C I was put onto Premique for nine months and then that went away. Now they are giving me Elleste Duet. I'm also having problems with another prescription thats under threat.

      Comment by Ireneholley2017@hotmail.com — February 15, 2018 #
      Reply

    7. My doctor researched Prempak-C and it appears it contains an ingredient that no other HRT has.
      This comment was made by Naomi in 2017. I've only just seen it. I'm having trouble finding an HRT that suits me after Prempak-C has stopped being made. Does anyone know what the ingredient was that is in no other HRT?

      Comment by Pauline — January 12, 2019 #
      Reply

      1. @Pauline,

        As I recall Prempak-C and Premarin are the only HRT products to contain conjugated equine oestrogen.

        Comment by Matthew Robinson — January 13, 2019 #
        Reply

  7. I called Pfizer to find out why they have discontinued Prempak-C and they said it was a business decision. I have been taking Prempak-C for 16 years and never had a problem. I am now on Elleste Duet and it doesn't feel the same. It all boils down to money at the end of the day. Not fair on us.

    Comment by Charmain — October 9, 2017 #
    Reply

    1. Me too. I have not been prescribed any other HRT treatment, instead I was offered ANTIDEPRESSANTS & SLEEPING TABLETS! WTH? I refused them, but I a really suffering, I have gone straight into the change AGAIN, mood swings, emotional and sad. My life feels joyless.

      Comment by HELEN THOMPSON — October 21, 2017 #
      Reply

      1. @Helen

        It is a concern that I have that so many women who are given HRT are seemingly not told that this treatment will alleviate and delay the symptoms of the menopause until the treatment is stopped. Many women in my experience seem unaware that when the treatment is stopped they WILL get menopausal symptoms due to withdrawal of the treatment. I fear this is a failing of healthcare professionals to inform women that this is the case.

        Things like antidepressants have been shown to help alleviate these symptoms without the same withdrawal issues as HRT.

        Comment by Matthew Robinson — October 22, 2017 #
        Reply

        1. Hi my sister was on Prempak-C for over 10 years and gave her life back. A new Doctor took her off it a year ago and she did not get the major menopause back just minor but she swears by how it made her able to live a normal life so just wanted to let women know that! I need HRT now and I don't know what to do or take? I am suffering terribly just like my sister did until she went on Prempak-C. Doctor suggested clonidine but this won't help my awful emotional symptoms will it?

          Comment by Fiona — March 6, 2018 #
          Reply

          1. @Fiona,

            Clonidine is not a hormonal treatment so is unlikely to be as effective with the emotional side of your symptoms. It should help with the sweats and flushing more but in relieving them you may feel you can cope more with the emotional symptoms, and of course you may not. It's worth a try to see how well it works for you and if it doesn't really help you can always see the doctor again and discuss the alternatives.

            Comment by Matthew Robinson — March 6, 2018 #

  8. Can anyone provide me with a few months supply of Prempak-C 0.625, full price guaranteed.
    Thanks Phil

    Comment by Philippa Dacy — September 23, 2017 #
    Reply

    1. Mee too.
      If anyone could give me a pack of Prempak C I I would pay of course, and I would be very greatful. Or could telll me where I can buy withouth any hassels.
      Thank you.

      Comment by Mary — November 3, 2017 #
      Reply

  9. Hi Ladies,

    I too am lost without Prempak-C low dose, has anyone got a supply I can buy?

    Comment by Poppy — September 5, 2017 #
    Reply

    1. Why don’t we all get together and do something about Prempak-C being discontinued. If enough of us speak up, they (NHS or Pfizer) will have to listen. I had been on it for over 15 years and life was wonderful and now it’s not good at all. My email annenorris@hotmail.co.uk, lets take some action!

      Comment by Anne Norris — December 17, 2017 #
      Reply

  10. I've been on Prempak-C 1.25 for 29 years. Two months ago my Gp changed my script to Elleste Duet Conti and life has been awful. I am having night sweats, very disturbed sleep and joint pain. Please don't talk about the risks of long term HRT-as a health professional I am very aware. A friend who is a senior professor in oncology has done a detailed risk assessment and said I should continue on HRT-quality of life is important. So I am going back to my GP and hope that she will suggest another medication because after 2 months on Elleste I feel dreadful.

    Comment by Sharon Chinappen — August 31, 2017 #
    Reply

    1. @Sharon Chinappen,

      I do hope your GP can find you a useful alternative too but I also hope you are not as dismissive of the discussion about risks of treatment, just because you understand the risk and have had a risk assessment does not mean the conversation is over - risks change with time, both in terms of the available evidence base and from the perspective of the individual.

      Comment by Matthew Robinson — September 3, 2017 #
      Reply

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