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<DOCUMENT author="perl program" datec=020199 title="leaflet" book="ABPI" edition="1996-97" section="company">
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What you need to know about Estrapak 50  
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Please read this carefully before you start to use Estrapak.  This leaflet does not contain the complete information about your medication.  If you have any questions or are not sure about anything ask your doctor or pharmacist.
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Estrapak is made up of patches containing oestrogen and tablets containing progestogen.  Oestrogen and progestogen belong to the <CB n=1> group of medicines known as Hormone Replacement Therapy (HRT).  HRT is used to relieve symptoms of the menopause (change of life), such as hot flushes and night sweats.  Your doctor may also prescribe this product for the prevention of osteoporosis (thinning of the bones).
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Things to remember about Estrapak 50
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Make sure it is safe for you to use this medication (read the section inside this leaflet called "Before using your medication").
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Instructions for using Estrapak are given in this leaflet.  Please follow them carefully.
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Whilst you are using Estrapak you will probably have a 'period' each month starting on about day 24-26.  This is quite normal.
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Estrapak 50 is NOT a contraceptive.  If you need advice about family planning, talk to your doctor.
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This treatment may cause unwanted effects in some people.
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You can find information about them inside this leaflet (look in the section called "After using your medication").
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Keep your medication in a cool place, out of the reach of children.  When you take off a patch, fold it in half with the sticky side inwards and throw it away carefully.  Even used patches will still contain some active medication so make sure that your <PB n=5> <CB n=2> <FIGURE></FIGURE> <CB n=1> patches are always kept well away from children.
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What’s in your medication?
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Estrapak 50 is made up of:
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8 Estraderm 50 patches.  These are round, transparent patches containing 4mg of oestradiol.  Your body will absorb about 50 micrograms of oestradiol each <PB n=6> <CB n=2> day whilst you are wearing your Estraderm patch.
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12 tablets each containing l mg of norethisterone acetate.  These tablets also contain lactose.
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Before using your medication
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Have you ever been treated for a thrombosis (blot)d clot) of any kind?
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Do you have any serious liver, kidney or heart disease?
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Have you ever had treatment for a breast lump, or any serious disease of your womb?
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Have you had any bleeding between periods or since your last period, if your periods have stopped?
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Is there any chance that you may he pregnant?
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If the answer to any of these questions is YES, talk to your doctor or pharmacist before using Estrapak.
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Have you ever suffered from hearing loss during pregnancy or when taking oestrogens, for example, oral contraceptives?
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Do you suffer from epilepsy (fits) or migraine?
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If the answer to either of these questions is YES, tell your doctor or pharmacist.
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Using your medication
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Always use this product as directed by your doctor.
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If you are still having fairly regular periods, start using Estrapak within 5 days of the start of bleeding.  If you have no periods or irregular periods, you can start using Estrapak at any time.
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You may find it helpful to stick the 'day of the week' sticker beginning with your first day of treatment in the space on the inside cover of the carton. This then shows the <CB n=2> two days each week when you should change your patch.
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Throw the other stickers away.
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Whilst you are using Estrapak you need to wear a patch all the time, changing it twice a week as shown on the calendar.  Each patch can be left in place for 3 to 4 days.  It is best to change your patch on the same two days each week.
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You also need to take one tablet a day for 12 consecutive days as shown on the calendar.  We recommend taking the tablets from Day 15 through to Day 26.
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You may find that you have some irregular bleeding or spotting during the first month or so of treatment.  Once your treatment has become settled, you will probably have a 'period' each <CB n=1> month starting on about day 24- 26.  This is quite normal.  If, however, you continue to have irregular bleeding or spotting, tell your doctor.
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When you finish an Estrapak pack, start the next pack straightaway.  There is no need to have a break between packs.
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Putting on a patch
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Remove the sachet from the box and tear it open at the notch. Use your fingers because cutting with scissors might damage the patch inside. You must 
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never
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Take out the transparent patch and loosen the backing by rubbing the edge of the patch between your thumb and forefinger.  The stiff protective liner will peel away from the flexible, sticky patch.
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Stick the patch onto a hairless area of skin below the waist.  Most patients find that the buttock is the best place and that skin irritation is less likely to occur at this site.  You could also try the lower back, hip, abdomen or upper thigh.  
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Never put a patch on or near the breasts. 
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 Choose a clean, dry area of skin. Avoid skin which is red or irritated.
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Never powder or oil your skin before putting on a patch as it may not stick properly.
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Place the sticky patch on the area of skin you have chosen and press it firmly into position with the palm of your hand while you count up to 10.  Pressing for a few seconds will make it stick securely.  Run your finger around the edge of the patch to make sure that the edges stick.
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Provided that you have applied the patch correctly, you can bathe, shower or swim with little risk of the patch coming off.
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If the patch does come off in the bath or shower, just shake it to remove any water, dry the skin thoroughly and put it on again in the usual way.
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When the time comes to change your patch, take off the old one, <PB n=15> <CB n=2> fold it in half with the sticky side inwards, and throw it away carefully out of the reach of children. Remember, it will still contain some medication.
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Always place your new patch on a fresh area of skin.
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If you forget to change the patch at the right time, you should change it as soon as possible.  Then change to your next patch on the normal day.
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Taking the tablets
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Take one tablet a day for 12 consecutive days as shown on the calendar.
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Try to take the tablet at roughly the same time each day.
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You should always take all 12 tablets each month. If you forget <PB n=16> <CB n=2> to take one or more tablets, keep the missed tablets and take them at the end of the 12 day course. Do not take more than one tablet a day.
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After using your medication
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This treatment sometimes causes unwanted effects in some people:
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Headaches, nausea or breast tenderness.
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Cramping pains in the calf.
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Feeling slightly bloated.
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Slight redness and itching of the skin where a patch has been.  This usually disappears within 3-4 days of taking off the patch.
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These effects are often mild and may wear off after a few weeks' treatment.  If they are very troublesome and do not improve tell your doctor.
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Very rarely, a more severe skin reaction can occur. If this happens, tell your doctor.
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You should also tell your doctor if you have irregular bleeding or spotting after the first month or so of treatment.
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Other useful information
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 Sunbathing - always make sure <CB n=2> your patch is covered by clothing.
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Using a sun bed - either cover up your patch as above or take it off and put it back on after your shower when your skin is completely cool and dry.
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Swimming - you can wear your patch beneath your swimming costume during swimming.
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Never stick on a patch straight <PB n=18> <CB n=1> after a hot bath or shower. Wait a while for the skin to become completely cool and dry.
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Precautions
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Whilst you are receiving Estrapak you should have regular check-ups with your doctor.  He or she will tell you how often this should be done.
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REMEMBER:
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 this medicine is for 
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YOU
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.  Only a doctor can prescribe it for you. Never give it to someone else.  It may harm them even if they have the same symptoms as you.
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This leaflet is produced in accordance with guidance issued by the Association of the British Pharmaceutical Industry.  The information in it applies only to Estrapak 50.
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This leaflet has been prepared for patients as part of our 'Partners in
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Health Care' theme by:
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Ciba Laboratories Horsham, West Sussex,
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England.
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PL 0001/0121 Supplied by Ciba-Geigy Limited, Basle, SwitzerlandCopyright Ciba-Geigy PLC MARCH 1993
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C  I  B  A
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