Medicine co-pack containing one pack of Estrogel ®( estradiol hemihydrate) plus one pack of Prometrium ®( micronised progesterone) for women with a uterus

PBS information: General Benefit Estrogel Pro, Estrogel & Prometrium are listed on the PBS.

Estrogel ® Pro, as well as Estrogel ® and Prometrium ®, are now available on the PBS for your post-menopausal patients, giving greater access to a hormone therapy that treats her range of menopause symptoms. 3, 4

Please review the Product Information before prescribing, accessible at besins-healthcare. com. au / PI or 1800 BESINS( 237 467), or by scanning the QR code:

Minimum Product Information Estrogel( estradiol hemihydrate) gel. Indications: Hormone replacement therapy( HRT) for estrogen deficiency symptoms in postmenopausal women. Prevention of osteoporosis in postmenopausal women at high risk of future fractures who are intolerant of, or contraindicated for, other medicinal products approved for the prevention of osteoporosis. The lowest effective dose should be used for the shortest duration. Contraindications: Known, past or suspected breast cancer; Known or suspected estrogen-dependent malignant tumours( e. g. endometrial cancer); Undiagnosed genital bleeding; Untreated endometrial hyperplasia; Previous or current venous thromboembolism( e. g. deep venous thrombosis, pulmonary embolism); Known thrombophilic disorders( e. g. protein C, protein S, or antithrombin deficiency); Active or recent arterial thromboembolic disease( e. g. angina, myocardial infarction); Acute liver disease, or a history of liver disease as long as liver function tests have failed to return to normal; Known or suspected pregnancy; Lactation; Known hypersensitivity to the active substances or to any of the excipients; Porphyria. Precautions: Appraisal of the risks and benefits should be undertaken at least annually. Refer to full Product information( PI) for conditions which require supervision during treatment with Estrogel. Treatment should be withdrawn if the following occur, jaundice or deterioration in liver function; significant increase in blood pressure; new onset of migraine type headache; pregnancy. Caution: endometrial hyperplasia and carcinoma, breast cancer, ovarian cancer, venous thromboembolism, coronary artery disease( CAD), ischaemic stroke, thyroid function, elderly, ALT elevations, paediatric use( see full PI). Interactions: use of concomitant skin medications, surface active agents or strong skin cleansers and detergents should be avoided at site of application, metabolism of estrogens may be increased by concomitant use of inducers of hepatic enzymes such as anticonvulsants( phenobarbital, phenytoin, carbamezapine) and anti-infectives( rifampicin, rifabutin, nevirapine, efavirenz, ritonavir and nelfinavir) and some herbal preparations( St John’ s wort) reducing the effectiveness of estrogen. Estrogel as a transdermal administration might be less affected than other oral hormones by enzyme inducers. Concomitant use of estrogens with lamotrigine may decrease lamotrigine plasma concentrations. Caution is warranted for co-administration with hepatitis C virus( HCV) combination regimens ombitasvir / paritaprevir / ritonavir with or without dasabuvir and the regimen glecaprevir / pibrentasvir may cause greater than usual ALT elevations. Pregnancy Category B3; not for use in lactation. Adverse Effects: headache, nausea, abdominal pain, breast swelling / pain, breast enlargement, dysmenorrhea, menorrhagia, metrorraghia, leucorrhoea, endometrial hyperplasia, weight gain( increase or decrease), water retention with peripheral edema( see full PI). Dosage and Administration: Estrogel should be used daily on a continuous basis. Estrogel as an estrogen only product is indicated only for women without a uterus. In women with an intact uterus it is recommended to add a progestogen for at least 12 days of each month. Although some women will respond to 1.25 g daily( 1 pump), the usual starting dose is 2.5 g per day( 2 pumps). If after one month of treatment, effective relief of menopausal symptoms is not obtained the dosage may be increased to a maximum of 5 g( 4 pumps)( see full PI). The lowest effective dose should be used for maintenance therapy. The optimal daily maintenance dose needs to be reevaluated regularly( e. g. annually). Estrogel should only be continued for as long as the benefit outweighs the risk. The correct dose of gel should be dispensed and applied to clean, dry, intact areas of skin e. g. on the arms and shoulders, and / or inner thighs. The area of application should be as large as possible. Refer to Full Product Information before prescribing. Minimum Product Information Prometrium( oral, micronised progesterone) Indications: menstrual irregularities; adjunctive use with an estrogen in postmenopausal women with an intact uterus. Contraindications: known allergy / hypersensitivity to progesterone or excipients; severe hepatic dysfunction; undiagnosed vaginal bleeding; known missed abortion / ectopic pregnancy; mammary / genital tract carcinoma; thromboembolic disorders; thrombophlebitis; cerebral haemorrhage; porphyria. Clinically Significant Precautions: not a treatment for premature labour; not a contraceptive; discontinue if unexplained visual loss / changes, proptosis, diplopia, papilloedema, retina vascular lesions or migraine; use caution in conditions affected by fluid retention and history of depression, diabetes, hepatic dysfunction, migraine, photosensitivity and during lactation; increased risk of breast cancer and venous thromboembolism with estrogen concomitant therapy( refer estrogen PI); may cause drowsiness; may affect laboratory test results. Clinically Significant Interactions: caution with P450 enzyme inducers and inhibitors; may increase antidiabetic medication; bioavailability may be reduced by smoking and increased by alcohol abuse. Very Common and Common Adverse Effects: menstrual disturbances; headache. d1 – d25. Secondary amenorrhoea: 400mg / d for 10d. Ovulation disorders / anovulation: 200 – 300mg for 10d( d17 – d26, inclusive).

References: 1. Hailes J. Menopause has gone mainstream: What does this mean for women today? [ Internet ]. [ accessed 2025 Feb 17 ]. Available from: https:// www. jeanhailes. org. au / news / menopause-has-gone-mainstream-what-does-this-mean-for-women-today 2. Parliament of Australia. Menopause [ Internet ]. Senate Community Affairs Committee. [ accessed 2025 Feb 17 ] Available from: https:// www. aph. gov. au / Parliamentary _ Business / Committees / Senate / Community _ Affairs / Menopause 3. Estrogel ®( estradiol hemihydrate) Product Information, updated 18 December 2023. 4. Prometrium ®( micronised progesterone) Product Information, updated 1 Feb 2022. MHT: Menopausal Hormone Therapy Estrogel ® and Prometrium ® are registered trademarks of Besins Healthcare. Besins Healthcare Australia Pty Ltd ABN 68 164 882 062. Suite 5.02, 12 Help Street, Chatswood NSW 2067. Office phone( 02) 9904 7473. For medical information call 1800 BESINS( 237 467). www. besins-healthcare. com. au EPR-EST-PRM-2338 March 2025

Antony Scholefield QUEENSLAND pharmacists have conducted 1350 consults for medical conditions such as shingles, impetigo and reflux in their first year of prescribing S4 medicines.

So far, some 118 of the state’ s 7800 pharmacists have received approval to diagnose and prescribe, having undergone 12 months’ training, which includes a period where they shadow another prescriber.

The approval allows them to independently prescribe S4 drugs for 16 separate conditions( see examples below).

Queensland Health has still refused to provide a breakdown of the conditions treated or the drugs prescribed, but the State Government has now made the pilot a permanent program despite the final evaluation report being due in 2026.

Depending on the consultation length, patients must pay $ 19.50, $ 36.70 or $ 70.50, plus private fees for all medicines and pathology tests.

The fees are set by the State Government, although all fees are out of pocket given the lack of state or Medicare subsidies.

Consult numbers grew from 415 in the first six months as more pharmacists completed the mandatory training.

However, Queensland Health said 631 consultations had occurred in Cairns and 209 in the Whitsundays region but just nine in Brisbane.

Queensland pharmacist prescribing program

• Gastro-oesophageal reflux

• Acute nausea and vomiting

• Rhinitis

• Impetigo

• Shingles

• Atopic dermatitis

• Acne

• Wound management

• Otitis media

• Asthma( collaborative prescribing)

• COPD( collaborative prescribing)