Prochieve

Tell your healthcare provider:

• If you are pregnant or breastfeeding.
• About all of your medical problems. Your healthcare provider may need to check you more carefully if you have certain conditions, such as asthma (wheezing), epilepsy (seizures), diabetes, migraine, endometriosis, lupus, problems with your heart, liver, thyroid, or kidneys, or have high calcium levels in your blood.
• About all the medicines you take.

Capsules:

• Prevention of Endometrial Hyperplasia: A postmenopausal woman with a uterus who is taking estrogens should take a single daily dose of 200 mg progesterone at bedtime for 12 continuous days per 28-day cycle.
• Secondary Amenorrhea: Progesterone may be given as a single daily dose of 400 mg at bedtime for 10 days.

Store Prometrium capsules at room temperature 15° to 30°C (59° to 86°F). Protect from excessive moisture (keep out of bathroom).

Keep this and all medicines out of the reach of children.

You should not use this medicine if you have: a history of stroke or blood clot, circulation problems, liver disease, breast or uterine cancer, abnormal vaginal bleeding, or if you have recently had a tubal pregnancy or an incomplete abortion.

Some forms of vaginal progesterone may contain plant-based oils. Tell your doctor if you have any type of food allergy.

Do not use if you are pregnant, unless you are using progesterone as part of your fertility treatment.

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Do not take by mouth. Progesterone vaginal is for use only in the vagina.

Insert this medicine directly into the vagina using only the applicator provided. Use a disposable applicator only once and then throw it away.

Progesterone vaginal suppositories are made at the pharmacy and provided in a special container. Your pharmacist can show you how to remove a suppository from the container. Avoid handling the suppository too long or it will begin to melt in your hand.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Use this medicine at bedtime if it causes dizziness or drowsiness.

Progesterone vaginal is sometimes given for only 6 to 12 days at a time. When used as part of fertility treatment, progesterone vaginal may be given for up to 12 weeks into a pregnancy. Follow your doctor's dosing instructions very carefully.

Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using progesterone vaginal.

If you need surgery or medical tests or if you will be on bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using progesterone vaginal.

It is normal to have vaginal discharge for several days after using this medicine. Talk with your doctor if you have concerns about any vaginal discharge.

Store progesterone vaginal inserts or gel at room temperature away from moisture, heat, and light.

Progesterone vaginal suppositories should be stored in a refrigerator. Follow the instructions provided with your medicine.

Progestins are hormones. They are used by both men and women for different purposes.

Progestins are prescribed for several reasons:

• To properly regulate the menstrual cycle and treat unusual stopping of the menstrual periods (amenorrhea). Progestins work by causing changes in the uterus. After the amount of progestins in the blood drops, the lining of the uterus begins to come off and vaginal bleeding occurs (menstrual period). Progestins help other hormones start and stop the menstrual cycle. .
• To help a pregnancy occur during egg donor or infertility procedures in women who do not produce enough progesterone. Also, progesterone is given to help maintain a pregnancy when not enough of it is made by the body.
• To prevent estrogen from thickening the lining of the uterus (endometrial hyperplasia) in women around menopause who are being treated with estrogen for ovarian hormone therapy (OHT). OHT is also called hormone replacement therapy (HRT) and estrogen replacement therapy (ERT).
• To treat pain that is related to endometriosis, a condition where the endometrial tissue which lines the uterus becomes displaced in other female organs.
• To treat a condition called endometriosis, to help prevent endometrial hyperplasia, or to treat unusual and heavy bleeding of the uterus (dysfunctional uterine bleeding) by starting or stopping the menstrual cycle.
• To help treat cancer of the breast, kidney, or uterus. Progestins help change the cancer cell's ability to react to other hormones and proteins that cause tumor growth. In this way, progestins can stop the growth of a tumor.
• To test the body's production of certain hormones such as estrogen.
• To treat loss of appetite and severe weight or muscle loss in patients with acquired immunodeficiency syndrome (AIDS) or cancer by causing certain proteins to be produced that cause increased appetite and weight gain.

Progestins may also be used for other conditions as determined by your doctor.

Depending on how much and which progestin you use or take, a progestin can have different effects. For instance, high doses of progesterone are necessary for some women to continue a pregnancy while other progestins in low doses can prevent a pregnancy from occurring. Other effects include causing weight gain, increasing body temperature, developing the milk-producing glands for breast-feeding, and relaxing the uterus to maintain a pregnancy.

Progestins can help other hormones work properly. Progestins may help to prevent anemia (low iron in blood), too much menstrual blood loss, and cancer of the uterus.

Progestins are available only with your doctor's prescription.

Prochieve® (progesterone gel) is a bioadhesive vaginal gel containing micronized progesterone in an emulsion system, which is contained in single use, one piece polyethylene vaginal applicators. The carrier vehicle is an oil in water emulsion containing the water swellable, but insoluble polymer, polycarbophil. The progesterone is partially soluble in both the oil and water phase of the vehicle, with the majority of the progesterone existing as a suspension. Physically, Prochieve® has the appearance of a soft, white to off-white gel.

The active ingredient, progesterone, is present in either a 4% or an 8% concentration (w/w). The chemical name for progesterone is pregn-4-ene-3,20-dione. It has an empirical formula of C21H30O2 and a molecular weight of 314.5.

The structural formula is:

Progesterone exists in two polymorphic forms. Form 1, which is the form used in Prochieve®, exists as white orthorhombic prisms with a melting point of 127-131°C.

Each applicator delivers 1.125 grams of Prochieve® gel containing either 45 mg (4% gel) or 90 mg (8% gel) of progesterone in a base containing glycerin, mineral oil, polycarbophil, carbomer 934P, hydrogenated palm oil glyceride, sorbic acid, purified water and may contain sodium hydroxide.

Progesterone is a naturally occurring steroid that is secreted by the ovary, placenta, and adrenal gland. In the presence of adequate estrogen, progesterone transforms a proliferative endometrium into a secretory endometrium. Progesterone is essential for the development of decidual tissue, and the effect of progesterone on the differentiation of glandular epithelia and stroma has been extensively studied. Progesterone is necessary to increase endometrial receptivity for implantation of an embryo. Once an embryo is implanted, progesterone acts to maintain the pregnancy. Normal or near-normal endometrial responses to oral estradiol and intramuscular progesterone have been noted in functionally agonadal women through the sixth decade of life. Progesterone administration decreases the circulatory levels of gonadotropins.

Pharmacokinetics

Due to the sustained release properties of Prochieve®, progesterone absorption is prolonged with an absorption half-life of approximately 25-50 hours, and an elimination half-life of 5-20 minutes. Therefore, the pharmacokinetics of Prochieve® are rate-limited by absorption rather than by elimination.

The bioavailability of progesterone in Prochieve® was determined relative to progesterone administered intramuscularly. In a single dose crossover study, 20 healthy, estrogenized postmenopausal women received 45 mg or 90 mg progesterone vaginally in Prochieve® 4% or Prochieve® 8%, or 45 mg or 90 mg progesterone intramuscularly. The pharmacokinetic parameters (mean ± standard deviation) are shown in Table 1.

The multiple dose pharmacokinetics of Prochieve® 4% and Prochieve® 8% administered every other day and Prochieve® 8% administered daily or twice daily for 12 days were studied in 10 healthy, estrogenized postmenopausal women in two separate studies. Steady state was achieved within the first 24 hours after initiation of treatment. The pharmacokinetic parameters (mean ± standard deviation) after the last administration of Prochieve® 4% or 8% derived from these studies are shown in Table 2.

Progesterone is extensively bound to serum proteins (~96-99%), primarily to serum albumin and corticosteroid binding globulin.

The major urinary metabolite of oral progesterone is 5β-pregnan-3α, 20α-diol glucuronide which is present in plasma in the conjugated form only. Plasma metabolites also include 5β-pregnan-3α-ol-20-one (5β-pregnanolone) and 5α-pregnan-3α-ol-20-one (5β-pregnanolone).

Progesterone undergoes both biliary and renal elimination. Following an injection of labeled progesterone, 50-60% of the excretion of progesterone metabolites occurs via the kidney; approximately 10% occurs via the bile and feces, the second major excretory pathway. Overall recovery of labeled material accounts for 70% of an administered dose, with the remainder of the dose not characterized with respect to elimination. Only a small portion of unchanged progesterone is excreted in the bile.

Assisted Reproductive Technology

Prochieve® 8% is administered vaginally at a dose of 90 mg once daily in women who require progesterone supplementation. Prochieve® 8% is administered vaginally at a dose of 90 mg twice daily in women with partial or complete ovarian failure who require progesterone replacement. If pregnancy occurs, treatment may be continued until placental autonomy is achieved, up to 10-12 weeks.

Secondary Amenorrhea

Prochieve® 4% is administered vaginally every other day up to a total of six doses. For women who fail to respond, a trial of Prochieve® 8% every other day up to a total of six doses may be instituted.

It is important to note that a dosage increase from the 4% gel can only be accomplished by using the 8% gel. Increasing the volume of gel administered does not increase the amount of progesterone absorbed.

SEE Prochieve® PATIENT INFORMATION SHEET - HOW TO USE Prochieve®.
Note: The PATIENT INFORMATION SHEET contains special instructions for using the applicator at altitudes above 2500 feet in order to avoid a partial release of Prochieve® before vaginal insertion.

Applies to progesterone: oral capsule, oral capsule liquid filled

Along with its needed effects, progesterone (the active ingredient contained in Prochieve) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking progesterone:

• Chest pain
• chills
• cold or flu-like symptoms
• cough or hoarseness
• fever
• problems with urination

• Clear or bloody discharge from the nipple
• dimpling of the breast skin
• inverted nipple
• lump in the breast or under the arm
• persistent crusting or scaling of the nipple
• redness or swelling of the breast
• sore on the skin of the breast that does not heal

• Abdominal or stomach pain
• bloating
• blurred vision
• change in vaginal discharge
• clay-colored stools
• cleft lip or palate
• confusion
• constipation
• darkened urine
• diarrhea
• difficult or labored breathing
• difficulty with swallowing
• difficulty with walking
• dizziness
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• fainting
• fast, pounding, or irregular heartbeat or pulse
• headache
• hives
• indigestion
• irregular heartbeat
• irritation
• itching
• joint pain, stiffness, or swelling
• lightheadedness
• loss of appetite
• nausea
• nervousness
• noisy breathing
• numbness or tingling in the face, arms, or legs
• pain or feeling of pressure in the pelvis
• pains in the stomach, side, or abdomen, possibly radiating to the back
• pounding in the ears
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• rash
• redness of the skin
• shortness of breath
• slow heartbeat
• spontaneous abortion
• stomach or pelvic discomfort, aching, or heaviness
• sweating
• swelling of the eyelids, face, lips, hands, or feet
• tightness in the chest
• trouble speaking, thinking, or walking
• unpleasant breath odor
• unusual tiredness or weakness
• vaginal bleeding
• vomiting
• vomiting of blood
• wheezing
• yellow eyes or skin

Some side effects of progesterone may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

• Breast pain or tenderness
• depression
• muscle or joint pain
• white or brownish vaginal discharge
• worry

• Attack, assault, or force
• blurred or loss of vision
• change in walking and balance
• changes in behavior
• changes in patterns and rhythms of speech
• choking
• clumsiness or unsteadiness
• confusion about identity, place, and time
• continuing ringing or buzzing or other unexplained noise in the ears
• decreased awareness or responsiveness
• difficulty with moving
• disturbed color perception
• double vision
• drowsiness
• extreme dizziness or drowsiness
• feeling drunk
• feeling of constant movement of self or surroundings
• feeling of unreality
• hair loss or thinning of the hair
• halos around lights
• hearing loss
• hives or welts
• longer or heavier menstrual periods
• loss of consciousness
• muscle cramps
• muscle stiffness
• night blindness
• normal menstrual bleeding occurring earlier, possibly lasting longer than expected
• overbright appearance of lights
• redness of the skin
• relaxed and calm
• sensation of spinning
• sense of detachment from self or body
• severe sleepiness
• sleepiness
• slurred speech
• swollen tongue
• thoughts of killing oneself
• tunnel vision
• weight changes