Dotti dosage, forms, and strengths

Dotti is a brand-name transdermal system that delivers a steady dose of estradiol, a female estrogen hormone. It relieves menopausal symptoms and helps prevent loss of bone density after menopause. Healthcare professionals also use it as a hormone replacement treatment in women who don’t produce enough estrogen. Dotti patches are removed and replaced twice weekly. 

Dotti forms and strengths

• Biweekly patch: 0.025 mg/day, 0.0375 mg/day, 0.05 mg/day, 0.075 mg/day, 0.1 mg/day

Dotti dosage for adults

The FDA has approved Dotti as a treatment for vasomotor symptoms and genital and urinary complications of menopause. It’s also approved to prevent osteoporosis in postmenopausal women and as a hormone replacement therapy in women with low estrogen due to physical problems or ovary removal.

Most importantly, estrogen-only therapy is associated with an increased risk of uterine cancer, so women who have a uterus will also be prescribed a progestin to prevent this problem. Women without a uterus can use estrogen-alone products such as Dotti. 

The dose cycle will vary. For women with an intact uterus, Dotti is used cyclically: three weeks using the patches with one week off. Women without an intact uterus apply Dotti patches continuously until therapy ends.

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Dotti dosage for vasomotor symptoms due to menopause

The most common symptoms of menopause are “vasomotor” symptoms: night sweats, chills, and hot flashes. These are due to the sudden drop in estrogen, which disrupts the body’s ability to regulate its core body temperature cycles. Estrogen replacement therapy is the most effective treatment. 

• Standard Dotti dosage for menopausal vasomotor symptoms: dosing is typically started at 0.0375 mg twice weekly, but can be increased to 0.05 mg, 0.075 mg, or 0.1 mg/day patch applied to the skin twice weekly based on response. It is best to use the lowest dose possible that provides effective symptom relief. 

Dotti dosage for genitourinary symptoms of menopause

The sudden drop in estrogen during menopause also affects tissues in the vagina and vulva, causing vaginal dryness, vaginal atrophy, discomfort, and trouble urinating. For vulvovaginal symptoms alone, healthcare providers prefer to use topical dosage forms such as vaginal creams or gels to minimize side effects.

• Standard estradiol dosage for treatment of isolated menopausal vaginal symptoms: dosing is typically started at 0.0375 mg twice weekly, but can be increased to, 0.05 mg, 0.075 mg, or 0.1 mg/day patch applied to the skin twice weekly based on response. It is best to use the lowest dose possible that provides effective symptom relief. 

Dotti dosage for osteoporosis prevention in postmenopausal women

After menopause, the drop in estrogen gradually leads to loss of bone density (osteoporosis), increasing a woman’s vulnerability to fractures. The first-line treatment is oral estradiol in the form of tablets. Estradiol patches like Dotti are often used in severe cases when tablets don’t work.

• Standard estradiol dosage for osteoporosis prophylaxis in postmenopausal women: 0.025 mg/day patch applied to the skin twice weekly

Dotti dosage for estrogen deficiency in premenopausal women

Estrogen deficiency can occur long before menopause. Estradiol therapy is the treatment of choice when estrogen deficiency is due to underactive ovaries (hypogonadism), ovarian failure, or surgical removal of the ovaries. 

• Standard estradiol dosage for estrogen deficiency in premenopausal women: 0.025 mg, 0.0375 mg, 0.05 mg, 0.075 mg, or 0.1 mg/day patch applied to the skin twice weekly. It is best to use the lowest dose possible that provides effective symptom relief. 

Dotti dosage for children

Although healthcare professionals prescribe estradiol to adolescent girls 12 years of age or older with hypogonadism, Dotti is not FDA-approved for pediatric use. 

Dotti dosage restrictions

Dotti requires no dosage modifications.

How to take Dotti

Dotti is a patch that slowly delivers estradiol into the bloodstream through the skin. It only works for a few days, so the key to using the patch successfully is to consistently replace the patch twice a week. 

• Follow all the prescriber’s instructions.

• Please read and follow the Patient Information and Instructions for Use sheets that come with this medicine. 

• Follow the instructions on the back of the package to open the package.

• Patches should be replaced twice a week on the same days every week.

  • The inside flap of the package has a checklist of the days of the week. 

  • Check two days on that list. Those are the days you will replace the patch each week.

  • Follow this schedule.

• Always remove the old patch before applying a new patch.

  • Throw away the old patch by folding the sticky sides together.

  • Do not flush used patches down the toilet.

• Always apply patches to clean, dry skin on the lower abdomen or buttocks.

  • Do not apply patches to the waistline or they may get rubbed off.

  • Do not apply patches to the breasts.

  • Do not apply patches to skin that is irritated, injured, oily, or rash-covered.

  • Do not apply a new patch to the same site as the old patch. Wait at least one week before applying a patch to a site previously covered by a patch.

• Clean and dry the skin before applying a patch.

  • The skin should be clear of any powder, moisturizer, or lotion.

• Apply the patch immediately after removing it from the protective pouch.

  • First, wash and dry your hands.

  • Tear open the protective pouch at the tear notch.

  • Orient the patch so that the protective liner is facing the skin. The protective liner covers the sticky side of the patch.

  • Never touch the sticky side of the patch.

  • Remove half the protective liner from the patch. 

  • Hold the half of the patch that still has a protective liner on the sticky side and fold the patch in half. 

  • Attach the uncovered sticky half of the patch to your skin.

  • Firmly press the patch on the skin.

  • Remove the rest of the liner while pressing the other half of the patch onto the skin.

  • Press down on the entire patch for 10 seconds.

  • Rub a finger around the edge to make sure the edges are sealed.

• If a patch falls off, reapply it.

  • If that doesn’t work, apply a new patch as soon as possible.

  • Replace the patch on the day the replacement is scheduled.

• Store Dotti patches in their protective pouches at room temperature.

Dotti dosage FAQs

How long does it take Dotti to work?

In clinical studies, Dotti significantly reduced vasomotor symptoms within the first four weeks of use. 

How long does Dotti stay in your system?

In clinical studies, estrogen levels in the body returned to their original values 24 hours after a patch was removed.

What happens if I miss a dose of Dotti?

If a patch is not replaced on its scheduled day, replace the patch as soon as possible. When applying the next patch, keep to the patch replacement schedule no matter when you apply a missed patch. Do not use two patches to make up for a missed dose.

How long can you take Dotti?

The FDA advises doctors to prescribe Dotti at the lowest possible dose for the shortest time possible. Doctors will re-evaluate treatment every three or six months to decide if Dotti patches are still needed.

How do I stop taking Dotti?

Dotti can be stopped at any time without causing withdrawal, but get medical advice first. 

If the patch is a problem, the doctor can prescribe other estradiol transdermal patches such as Minivelle, Vivelle-Dot, Menostar, Climara, and Climara Pro, which also contains a progestin. The prescriber can also use other estradiol dosage forms such as tablets, injections, or topical estradiol.

Hormone therapy is the standard and most effective treatment for menopausal symptoms but is not the only treatment. If hormone replacement isn’t possible, doctors can prescribe other effective prescription drugs, such as SSRIs or SNRIs.

Because of side effects, hormone replacement is not the ideal treatment for osteoporosis prevention in postmenopausal women. Other treatments include bisphosphonates, vitamin D supplements, calcium supplements, and weight-bearing exercise. Severe osteoporosis is treated by stronger drugs such as estradiol receptor modulators, parathyroid hormone peptides, or Xgeva (denosumab), a monoclonal antibody.

What interacts with Dotti?

Drugs, supplements, or foods that can cause problems with estradiol include but are not limited to:

• Macrolide antibiotics 

• Oral azole antifungals 

• Antiviral drugs called protease inhibitors

• The COVID-19 treatment Paxlovid 

• The antiseizure drugs phenobarbital or carbamazepine

• St. John’s wort

• Grapefruit juice

• Make sure you check with your healthcare provider about your specific medications and how they may interact with Dotti. 

What happens when you mix Dotti and alcohol?

Women should be cautious about drinking alcohol when wearing a Dotti patch because of the increased risk of side effects.

Is it safe to take Dotti during pregnancy?

No. Pregnant women should never use Dotti patches for any reason. 

Is it safe to take Dotti while breastfeeding?

Women nursing an infant should avoid Dotti patches. The estradiol in the patch decreases lactation and reduces the quality of breast milk. 

Who should not use Dotti?

Dotti should never be used by women who are pregnant or have:

• Undiagnosed vaginal bleeding 

• Breast cancer or a history of breast cancer

• Other estrogen-dependent cancers, such as ovarian cancer

• Blood clot problems such as deep vein thrombosis (DVT) or pulmonary embolism (PE)

• A history of stroke or heart attack

• Liver disease

• Certain types of bleeding problem,s such as protein C, protein S, or antithrombin deficiency

• Known allergies to Dotti

What should I tell the doctor before using Dotti?

To avoid possible complications or side effects, tell the prescriber about all medical conditions, particularly:

• Unusual vaginal bleeding

• Endometriosis

• Heart disease

• Kidney disease

• Thyroid disease

• Parathyroid disease

• High blood pressure

• High cholesterol or a family history of high cholesterol

• A seizure disorder

• Diabetes

• Asthma

• Migraine

• High calcium

• Lupus 

• Porphyria

What are the usual side effects of Dotti?

People using Dotti most commonly experience side effects such as headache, breast tenderness, upper respiratory tract infections, back pain, bloating, fluid retention, and occasional vaginal spotting or irregular bleeding. 

What are the serious side effects of Dotti?

Estradiol therapy poses risks that have to be balanced with the benefits of treatment.. Possible serious side effects of estradiol treatment include blood clots, cardiovascular problems, stroke, vision loss, breast cancer, endometrial cancer, gallbladder disease, liver problems, elevated blood pressure, high cholesterol, calcium imbalances, underactive thyroid, and serious allergic reactions such as angioedema or anaphylaxis.

Sources

• Alcohol, hormones, and postmenopausal women, Alcohol Health and Research World

• Dotti extended-release estradiol patch prescribing information, DailyMed (NIH National Library of Medicine)

• Elestrin drug summary, Prescriber’s Digital Reference (PDR)

• Estrace drug summary, Prescriber’s Digital Reference (PDR)

• Hormone replacement therapy, StatPearls