The Dotti patch is a transdermal estradiol delivery system used to manage symptoms associated with menopause and other conditions related to estrogen deficiency. This article provides a detailed overview of the Dotti patch, including its ingredients, effectiveness, potential benefits, risks, and important considerations for its use.
What is the Dotti Patch?
The Dotti patch is a type of hormone replacement therapy (HRT) that delivers estradiol, a form of estrogen, through the skin. It is designed to alleviate symptoms of menopause, such as hot flashes, vaginal dryness, and to prevent bone loss (osteoporosis).
How it Works
The patch is applied to the skin, allowing estradiol to be absorbed directly into the bloodstream. This bypasses the liver, which can reduce some of the risks associated with oral estrogen therapies. Estradiol works by increasing estrogen levels in the body, which helps to reduce the symptoms of menopause by improving vaginal health, reducing bone loss, and helping regulate body temperature.
Ingredients of the Dotti Patch
The active ingredient in the Dotti patch is estradiol. The patch also contains inactive ingredients that help to deliver the medication through the skin and keep the patch adhered to the body.
Before using transdermal estradiol, tell your doctor and pharmacist if you are allergic to any brand of transdermal estradiol, any other estrogen products, any other medications, any adhesives, or any of the ingredients in estradiol transdermal patches. Ask your pharmacist for a list of the ingredients.
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Effectiveness of the Dotti Patch
The Dotti patch is effective in treating several conditions related to estrogen deficiency.
Menopausal Symptoms
The Dotti patch is commonly used to reduce symptoms of menopause, such as hot flashes, night sweats, and vaginal dryness. These symptoms are caused by the body making less estrogen.
Prevention of Osteoporosis
Certain estrogen products, including the Dotti patch, may also be used by women after menopause to prevent bone loss (osteoporosis). However, there are other medications (such as raloxifene, bisphosphonates including alendronate) that are also effective in preventing bone loss and may be safer.
Other Uses
Estradiol transdermal may also be used for other conditions as determined by your healthcare provider.
How to Use the Dotti Patch
To ensure the Dotti patch is used correctly and effectively, follow these guidelines:
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Application
Apply estradiol patches to clean, dry, cool skin in the lower stomach area, below your waistline. Ask your doctor or pharmacist or read the manufacturer's information that comes with your patches to find the best place(s) to apply the brand of patches you have received. Do not apply estradiol patches to the breasts or to skin that is oily, damaged, cut, or irritated. Do not apply estradiol patches to the waistline where they may be rubbed off by tight clothing or to the lower buttocks where they may be rubbed off by sitting. Be sure that the skin in the area where you plan to apply an estradiol patch is free of lotion, powders, or creams.
Changing the Patch
The patch is usually replaced twice a week (every 3 to 4 days). When replacing your patch, make sure to apply the new patch to a different area. Wait at least 1 week before applying a patch to the same area.
Missed Dose
Apply the missed patch as soon as you remember. Then apply the next patch according to your regular schedule. Do not apply extra patches to make up for a missed patch. If you forget to change your patch, change it as soon as you remember or wait until your next scheduled patch change.
What to do if a patch falls off
If a patch falls off, try sticking it back into place. If it does not stick well, put on a new patch on a different skin area and leave it on only for the rest of your wearing time.
Additional Instructions
Each brand of estradiol transdermal patches should be applied following the specific directions given in the manufacturer's information for the patient. Ask your doctor or pharmacist if you have any questions. Do not open the pouch until you are ready to apply the patch.
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Dosage and Administration
Start therapy with DOTTI 0.0375 mg per day applied to the skin twice weekly. Make dosage adjustments based on the clinical response. In women who are currently taking oral estrogens, initiate treatment with DOTTI 1 week after withdrawal of oral hormone therapy, or sooner if menopausal symptoms reappear in less than 1 week. Attempts to taper or discontinue DOTTI at 3 to 6 month intervals. Give DOTTI continuously in a woman who does not have an intact uterus.
Place the adhesive side of DOTTI on a clean, dry area of the trunk of the body (including the abdomen or buttocks). Replace DOTTI twice weekly. Rotate the sites of application, with an interval of at least 1 week allowed between applications to a particular site. Select an area that is not oily, damaged, or irritated. Avoid the waistline, since tight clothing may rub the system off. Apply the system immediately after opening the pouch and removing the protective liner.
In the event that a system falls off, reapply the same system or apply a new system to another location. In either case, continue the original treatment schedule. If a woman has forgotten to apply DOTTI, have her apply a new system as soon as possible. Apply the new system on the original treatment schedule.
Potential Benefits of Using the Dotti Patch
Symptom Relief
The Dotti patch effectively reduces menopausal symptoms such as hot flashes and vaginal dryness.
Bone Health
It helps prevent bone loss and reduces the risk of osteoporosis in postmenopausal women.
Convenience
The twice-weekly application is convenient for many users.
Risks and Side Effects
While the Dotti patch offers several benefits, it is important to be aware of the potential risks and side effects.
Common Side Effects
Transdermal estradiol may cause side effects such as headache, breast pain or tenderness, nausea, vomiting, constipation, gas, heartburn, weight gain or loss, hair loss, redness or irritation of the skin that was covered by the estradiol patch, swelling, redness, burning, irritation or itching of the vagina, vaginal discharge, painful menstrual periods, anxiety, depression, changes in mood, change in sexual desire, back, neck, or muscle pain, runny nose or congestion, darkening of skin on face (may not go away even after you stop using transdermal estradiol), unwanted hair growth, difficulty wearing contact lenses, and joint pain.
Serious Side Effects
Some side effects can be serious. Call your doctor immediately if you experience any of the following: yellowing of the skin or eyes, loss of appetite, fever, stomach tenderness, pain, or swelling, itching, hives, rash, blisters on skin, or other skin changes, swelling, of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs, hoarseness, difficulty breathing or swallowing.
Transdermal estradiol may increase your risk of developing cancer of the ovaries and gallbladder disease that may need to be treated with surgery. Talk to your doctor about the risks of using transdermal estradiol.
Increased Cancer Risk
Using estradiol can increase your risk of blood clots, stroke, heart attack, or cancer of the breast, uterus, or ovaries.
Cardiovascular Risks
Increased risks of stroke and DVT are reported with estrogen-alone therapy. Increased risks of PE, DVT, stroke, and MI are reported with estrogen plus progestin therapy.
Dementia
The WHIMS estrogen-alone ancillary study of the WHI reported an increased risk of developing probable dementia in postmenopausal women 65 years of age and older during 5.2 years of treatment with daily CE (0.625 mg)-alone, relative to placebo.
Gallbladder Disease
Using transdermal estradiol may cause gallbladder problems, including cholecystitis and cholelithiasis (also known as gallstones).
Precautions and Warnings
Before using the Dotti patch, it is essential to consider the following precautions and warnings:
Contraindications
Transdermal estradiol should not be used if you have certain conditions, such as allergies to ingredients, blood clots, breast cancer, estrogen-dependent cancer, stroke or heart attack, unusual vaginal bleeding, thrombophilia, or liver problems.
Medical History
Tell your doctor if you have or have ever had a bleeding disorder; asthma; seizures; migraine headaches; endometriosis; uterine fibroids; yellowing of the skin or eyes, especially during pregnancy or while you were using an estrogen product; very high or very low levels of calcium in your blood; porphyria; angioedema; or gallbladder, thyroid, pancreas, liver or kidney disease.
Family History
Tell your doctor if you smoke or use tobacco, if you have had a heart attack or a stroke, and if you or anyone in your family has or has ever had blood clots or breast cancer.
Monitoring
You should examine your breasts every month and have a mammogram and a breast exam performed by a doctor every year to help detect breast cancer as early as possible. Your doctor will tell you how to properly examine your breasts and whether you should have these exams more often than once a year because of your personal or family medical history.
Lifestyle Factors
Talk to your doctor about eating grapefruit and drinking grapefruit juice while using this medication. Talk to your doctor about ways to increase the amount of calcium and vitamin D in your diet. Avoid smoking.
Surgery
Tell your doctor if you are having surgery or will be on bedrest.
Other Medications and Supplements
Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while using transdermal estradiol. The following herbal product may interact with transdermal estradiol: St. John's wort.
Interactions with Other Medications
The Dotti patch can interact with other medications, potentially affecting its efficacy or increasing the risk of side effects.
St. John's Wort
St. Johnâs wort, which is a supplement that may be used to treat depression, may interact with transdermal estradiol.
Seizure Medications
Phenobarbital or carbamazepine (Carbatrol, Tegretol, and others), which are medicines to control seizures, may interact with transdermal estradiol.
Antibiotics
Rifampin, which is a medicine used to treat an infection called tuberculosis, and erythromycin (Ery-Tab and others) or clarithromycin, which are medicines used for bacterial infections, may interact with transdermal estradiol.
Antifungals
Ketoconazole or itraconazole (Sporanox), which are medicines used for fungal infections, may interact with transdermal estradiol.
Lifestyle Considerations
Certain lifestyle factors can influence the effectiveness and safety of the Dotti patch.
Diet
Do not drink grapefruit juice while using transdermal estradiol. Grapefruit juice may increase the estradiol levels in your blood and cause serious side effects.
Alcohol
Limit the amount of alcohol you drink while using transdermal estradiol. There may be an increased risk for liver damage if you drink large amounts of alcohol.
Smoking
Avoid smoking, as it can increase the risk of blood clots and other cardiovascular issues.
Sun Exposure
Sunscreen may affect how transdermal estradiol your body absorbs. Read and follow any specific instructions about using sunscreen that come in the patient information with your transdermal estradiol.
Alternative Treatments
Women whose only bothersome symptoms are vaginal dryness, itching, or burning may benefit more from an estrogen product that is applied topically to the vagina. Women who only need a medication to prevent osteoporosis may benefit more from a different medication that does not contain estrogen.
Storage and Disposal
Store the patches at room temperature and away from excess heat and moisture (not in the bathroom). Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Always lock safety caps. Place the medication in a safe location â one that is up and away and out of their sight and reach. After removing a skin patch, fold it in half so it sticks together.
Dotti Patch and Weight Loss
It is important to note that the Dotti patch is not indicated for weight loss. Weight gain or loss can occur as a side effect of using transdermal estradiol, but it is not a primary effect of the medication.
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