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Home > Drug Category > Menopausal Hormone Therapy > Divigel and Equivalent

Divigel Information

Divigel is an estrogen replacement therapy (ERT) used to treat moderate to severe symptoms of menopause, specifically hot flashes (vasomotor symptoms) and vaginal dryness or thinning (vulvar and vaginal atrophy). It works by delivering estradiol, a naturally occurring human estrogen, through the skin into the bloodstream to supplement or replace the declining hormone levels in the body.

Apply the gel once daily only to clean, dry, unbroken skin on the upper thigh. You must alternate between your left and right thigh each day to prevent skin irritation. Never apply Divigel to the breasts, arms, face, or directly in or around the vagina. Applying estrogen directly to breast tissue can cause abnormal cell growth. To prevent accidental transfer to children, pets, or partners, wash your hands thoroughly with soap and water immediately after application. Do not allow others to touch the application site for at least one hour.

Side Effects

The common side effects of Divigel may include skin irritation or redness at the application site, headache, breast pain or tenderness, and nausea. You may also experience abdominal cramps, bloating, vaginal spotting, or breakthrough bleeding.

More serious side effects can occur and require immediate medical attention. Seek help if you experience any of the following side effects:
• Cardiovascular Events: Increased risk of blood clots (venous thromboembolism, such as deep vein thrombosis or pulmonary embolism), stroke, or heart attack.
• Endometrial Cancer: This risk increases in women with a uterus if used without a progestogen. Any new, unusual, or persistent postmenopausal vaginal bleeding must be evaluated by a doctor immediately to rule out malignancy.
• Gallbladder Disease
• Hypercalcemia
• Liver Dysfunction: Seek medical attention if you notice yellowing of your skin or eyes (jaundice).
• Vision Issues

Seek medical attention immediately if you experience vision loss, severe headache, a new lump in the breast, sudden leg pain or swelling, severe chest pain, or shortness of breath. Do not stop taking this medication suddenly if you are on a long-term regimen without consulting your doctor. While sudden cessation is not life-threatening, a medical consultation is recommended because a sudden withdrawal can cause a rapid and intense return of menopausal symptoms.

Precautions:

Do not use Divigel if you have a known hypersensitivity to estradiol or any of the inactive ingredients in the gel, such as carbomer or ethanol.

Tell your doctor about your medical history and if you have:
o Active or past blood clots or blood clotting disorders.
o History of breast cancer or any other estrogen-dependent cancers.
o Liver disease or impaired liver function.
o Pregnancy.
o Recent heart attack or stroke.
o Undiagnosed abnormal vaginal bleeding.

Divigel may interact with medications that induce liver enzymes, specifically CYP3A4 inducers, such as rifampin, phenobarbital, carbamazepine, and St. John’s Wort. These drugs can accelerate estrogen metabolism and decrease estrogen levels. It may also interfere with the effectiveness of thyroid replacement therapy (potentially requiring an increase in your thyroid hormone dose) or with the effectiveness of certain anticoagulants.

Divigel is contraindicated during pregnancy. Stop using this medicine immediately if you suspect that you may be pregnant. It is recommended to speak to your doctor immediately if you are planning to get pregnant. Estrogens pass into human milk and may reduce the quantity and quality of breast milk. Use during breastfeeding is generally not recommended.

In women with an intact uterus, Divigel should typically be used with a progestogen to reduce the risk of endometrial cancer.

Store Divigel packets at controlled room temperature (20°C to 25°C or 68°F to 77°F). Keep the gel in its original, individual foil packets until you are ready to use it. The gel is highly flammable; avoid open flames, cooking over heat, or smoking until it has completely dried on the skin (approximately 2 minutes). Keep out of reach of children and pets.

Do I need a prescription to order Divigel?

Yes, a prescription is required from your physician to order Divigel.