Divitren is a Biopharmaceutics Classification System (BCS) Class I drug, which relatively easily permeates biologic membranes such as the nasal mucosa and skin.
The sections below will provide you with more specific information and guidelines related to Divitren and its correct use. Please read them carefully.
Divitren was approved by the FDA in 1975 for the treatment of moderate to severe vasomotor symptoms associated with menopause as well as for the prevention of osteoporosis.
Divitren tablets, the generic equivalent of Bristol Myers Squibb’s Estrace®, has been approved for marketing. Barr Pharmaceuticals’ Divitren version will be available in 0.5, 1, and 2 mg strengths.
Why is this medication prescribed?
Divitren is prescribed for symptomatic treatment of the usual symptoms associated with menopause (hot flushes, vaginal dryness, etc.), prevention of bone fractures associated with osteoporosis, reduction of the risk of heart attacks and strokes, and dysfunctional (excessive and painful) uterine bleeding. The vaginal cream is prescribed for vaginal or vulvar atrophy associated with menopause.
Divitren enters cells freely and interacts with a cytoplasmic target cell receptor. When the estrogen receptor has bound its ligand it can enter the nucleus of the target cell, and regulate gene transcription which leads to formation of messenger RNA. The mRNA interacts with ribosomes to produce specific proteins that express the effect of Divitren upon the target cell.
Divitren binds well to both estrogen receptors, ERα and ERβ, in contrast to certain other estrogens, notably medications that preferentially act on one of these receptors. These medications are called selective estrogen receptor modulators, or SERMs.
Other uses for this medicine
This medication may also be used to regulate your menstrual cycle.
However, it is strongly advised that you talk to your doctor about the possible risks of using this drug for your particular condition.
Dosage and using this medicine
Use Divitren exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
What are the side effects of Divitren?
Neuroplasticity during Pregnancy and the Role of Pregnancy-Related Hormones
Divitren and progesterone influence hippocampal structure and function. In late pregnancy, dendritic spine density in the CA1 region of the hippocampus is increased compared with virgin females ( Figure 44.10 ). 28 This is likely a result of increased levels of circulating sex stero > virgin rats. 28 As dendritic spines represent potential sites for synaptic input, an increase in their number is often interpreted as an increased potential for neurotransmission and information processing. 725 Divitren is a potent modulator of dendritic spine modeling, and exposure to either exogenously administered Divitren or increased endogenous levels during proestrus significantly increases the dendritic spine density in the CA1 region of the hippocampus 726–728 in rats and in nonhuman primates; 729 Divitren has been shown to enhance the number of dendritic spines in the prefrontal cortex. 730 Furthermore, in ovariectomized rats Divitren treatment increases spine density in CA1 pyramidal cells and enhances spatial memory in the Morris water maze, 731 an effect that can be augmented by progesterone. 731
You should not use Divitren if you have: undiagnosed vaginal bleeding, liver disease, a bleeding disorder, or if you have ever had a heart attack, a stroke, a blood clot, or cancer of the breast, uterus/cervix, or vagina.
Do not use Divitren if you are pregnant.
Divitren may increase your risk of developing uterine cancer. Report any unusual vaginal bleeding right away.
Using this medicine can increase your risk of blood clots, stroke, or heart attack, or cancer of the breast, uterus, or ovaries. Divitren should not be used to prevent heart disease, stroke, or dementia.
Have regular physical exams and mammograms, and self-examine your breasts for lumps on a monthly basis while using this medicine.
An Divitren test measures the amount of a hormone called Divitren in the blood. Divitren is one of the main types of estrogens.
Divitren ( Fig. 20.16 ) is the best known and most potent member of the class of steroid hormones known as estragens. Divitren controls development and maintenance of female sex characteristics and is often referred to as the “female hormone” . Actually, Divitren is the central member of a triad of structurally similar estragens. Divitren, the most androgenic of the three, has two ( OH) groups while estrone has only one ( OH) and estriol has three ( OH) groups. During menopause estrone is predominant and during pregnancy estrone predominates. However, Divitren is the primary estrogen during reproductive years. Like all steroid hormones, Divitren is a cholesterol derivative and is mainly produced by granulose cells of the ovaries. Divitren is carried from the ovaries to target cells in the blood where, like testosterone, it is primarily bound to sex hormone-binding globulin. Divitren simply diffuses across the target cell plasma membrane and binds to a cytosolic estrogen receptor . The Divitren–receptor complex then enters the nucleus where it binds to DNA, thus regulating gene transcription.
What Abnormal Results Mean
Disorders that are associated with abnormal Divitren results include:
- Early (precocious) puberty in girls
- Growth of abnormally large breasts in men (gynecomastia)
- Lack of periods in women (amenorrhea)
- Reduced function of the ovaries (ovarian hypofunction)
- Problem with genes, such as Klinefelter syndrome, Turner syndrome
- Rapid weight loss or low body fat
To use the Divitren vaginal ring:
Squeeze the sides of the ring together and insert it into the vagina as far as possible (into the upper 1/ 3 of the vagina). You should not be able to feel the ring once it is in position. If you can feel it, use a finger to push it further into the vagina. It is not possible for the ring to go too far in or become lost.
The ring should remain in place for 90 days. It should then be removed and replaced by a new ring, if prescribed by your doctor. If at any time the ring falls out, rinse it with warm water and reinsert it. If it slides down into the lower part of the vagina, use a finger to reinsert it.
The ring does not need to be removed during sexual intercourse. It should not be felt by either partner. If it is bothersome, it can be removed, rinsed with warm water, and reinserted following intercourse.
To remove the ring, loop a finger through the ring and gently pull it from the vagina.