Premarin dosage, forms, and strengths

Medically reviewed by Anne Jacobson, MD, MPH
Board-Certified Family Physician
Written by Georgia C. Yalanis, MD
Medical Doctor
Updated Aug 28, 2025  •  Published May 27, 2022
Datos Verificados
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Premarin is a medication that consists of a mixture of conjugated estrogens. This prescription drug is available as a tablet, injection, and topical vaginal cream. Premarin has been approved by the Food and Drug Administration (FDA) for use in treating moderate to severe menopausal symptoms, low estrogen states, palliation for certain types of cancer, and prevention of postmenopausal osteoporosis. The standard dosages for this medication vary based on the condition it is being used to treat. Typical dosages range from 0.3-1.25 mg  per day. 

RELATED: 9 menopause questions and answers

Premarin forms and strengths

Premarin is available in several dosage forms and strengths.

Premarin dosage for adults

The risks and benefits of estrogen use were extensively studied during the Women’s Health Initiative (WHI). The results of these studies show that estrogen therapy is associated with some significant side effects or increased risk of adverse reactions in women with certain conditions. As such, Premarin has been issued a black box warning. There are some women who should not use Premarin or who should use Premarin with caution or in combination with progestins or other medications. 

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Premarin dosage chart
Indication Form Starting dosage Standard dosage Maximum dosage
Menopausal vasomotor symptoms (moderate to severe)* Oral tablet 0.3 mg once per day; OR 0.3 mg once per day for 25 days then off for five days. 0.3-1.25 mg once per day; OR 0.3-1.25 mg once per day for 25 days then off for five days 1.25 mg per day; OR 1.25 mg once per day for 25 days then off for five days
Vulvovaginal atrophy* Oral tablet 0.3 mg once per day; OR 0.3 mg once per day for 25 days then off for five days 0.3-1.25 mg once per day; OR 0.3-1.25 mg once per day for 25 days then off for five days 1.25 mg per day; OR 1.25 mg once per day for 25 days then off for five days
Vaginal cream 0.5-2 gm, applied daily for two weeks 0.5-2 gm, applied  one to three times a week OR applied daily for three weeks then off one week 2 gm, applied one to three times a week OR applied daily for three weeks, one week off 
Menopausal dypareunia  Vaginal cream 0.5 gm, applied two times per week; OR 0.5 gm applied daily for three weeks, one week off
Postmenopausal osteoporosis prevention* Oral tablet 0.3 mg once per day; OR 0.3 mg once per day for 25 days then off for five days 0.3-0.625 mg once per day; OR 0.3-0.625 mg once per day for 25 days then off for five days
Hypoestrogenism associated with hypogonadism*  Oral tablet 0.3-1.25 mg once per day day for 21 days then off for seven days
Hypoestrogenism associated with oophorectomy or primary ovarian failure*  Oral tablet 1.25 mg once per day for 21 days then off for seven days 
Metastatic breast cancer, palliative treatment  Oral tablet 10 mg three times per day for at least three months 
Advanced prostate cancer, palliative treatment  Oral tablet 1.25-2.5 mg three times per day 
Dysfunctional uterine bleeding  Injection 25 mg once, may be repeated
Uremic bleeding Injection 0.6 mg/kg per day for five days 

* Progestin should be added for 10 to 14 days if the uterus is intact.

Premarin dosage for conditions of menopause

Premarin is used in the management of moderate to severe symptoms of menopause. 

During menopause, the body makes less estrogen than it did before menopause. Lower estrogen can lead to thinning of the tissues around the vulva and vagina, which can make using the bathroom and sexual intercourse uncomfortable. Oral or topical estrogens, as are found in Premarin preparations, can help reduce these symptoms. 

Hormonal changes in menopause also have a direct effect on the temperature regulator in the body. Low estrogen tells the body that it is “too hot,” triggering a hot flash. Premarin can help reduce hot flashes by bringing estrogen levels closer to the levels they were before menopause. 

For symptoms of menopause: Premarin may be given as an oral tablet of 0.3-1.25 mg per day or a Premarin vaginal cream at 0.5-2 mg applied each day. 

RELATED: What is perimenopause?

Premarin dosage for postmenopausal osteoporosis prevention 

Osteoporosis is a condition where the bones become brittle as old bone is broken down faster than new bone is laid down. This may cause fractures, trouble walking, stooped posture, back pain, or bone pain. Estrogen preparations such as Premarin can slow down this process for those who are at high risk of osteoporosis. 

For osteoporosis prevention: Premarin is usually taken as a 0.3 mg tablet once per day. Note: Premarin is most effective in osteoporosis prevention when it is taken with calcium and vitamin D.

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Premarin dosage for conditions of low estrogen 

Hypoestrogenism (low estrogen) is not always due to menopause. Primary ovarian failure occurs when the ovaries lose function before the age of 40. Hypogonadism generally refers to a spectrum of conditions where the gonads (testes or ovaries) produce little, if any, sex hormones (testosterone and estrogen). This can occur before or after puberty. 

For conditions of low estrogen: Premarin is typically dosed at 0.3-1.25 mg tablets once per day. 

Premarin dosage for advanced androgen-dependant cancers

Some androgen-dependent cancers are very painful and may be so advanced that surgery, chemotherapy, or other therapies are not effective. When this happens in metastatic breast cancer and advanced prostate cancer, individuals may be prescribed Premarin to help with pain and other cancer symptoms. 

For advanced prostate cancer: Premarin is typically dosed at 1.25-2.25 mg tablets, three times per day. 

For metastatic breast cancer: Premarin is given at high doses, around 10 mg three times per day. 

Premarin dosage for dysfunctional uterine bleeding

Premarin has been used in the management of dysfunctional uterine bleeding (DUB) for decades. DUB is also called anovulatory bleeding.It is heavy or irregular bleeding from the vagina that occurs outside of the menstrual cycle. Estrogens and progestins are used to “reset” the ovulatory cycle and stop the bleeding. 

For dysfunctional uterine bleeding: Premarin is given as a 25 mg intravenous injection, which may be repeated after 12-24 hours. 

Premarin dosage for uremic bleeding 

Uremic bleeding occurs as a complication of renal failure. Bleeding can occur in different parts of the body. Conjugated estrogens such as Premarin are used with other medications to promote clotting and stop the bleeding. 

For uremic bleeding: Premarin is given as 0.6 mg/kg injection once per day for five days. 

Premarin dosage for children

Premarin is used in children and adolescents to treat delayed puberty, labial fusion, or abnormal uterine bleeding. It can be given as a tablet, with typical doses ranging from 0.3-1.25 mg per day, taken for several months. Premarin can also be applied as topical vaginal cream, where a 0.625 mg cream is applied twice per day for six weeks. The maximum dosage of this medication varies, depending on the indication and preparation. 

Pediatric Premarin dosages
Indication Weight/age Recommended dosage
Delayed puberty with hypogonadism  For all weights/ages 0.3-0.625 mg tablet every other day for six months, then once per day for three weeks then one week off. Treat for six months. 
Delayed puberty with constitutional causes  For all weights/ages 0.3-1.25 mg tablet once per day for three to six months 
Abnormal uterine bleeding  For all weights/ages 1.25 mg tablet twice per day for 21 days
Labial fusion  1 mo old and older 0.625 mg cream, applied twice per day for up to six weeks 

Premarin dosage restrictions 

Estrogens are associated with an increased risk of breast and endometrial cancer. Estrogens are also associated with elevated serum triglycerides and fatal blood clots. These medications should only be used under the care of a healthcare provider. 

The following are contraindications for estrogen use: 

  • Hypersensitivity to estrogen or other ingredients in the drugSevere liver disease or liver cancer

  • Undiagnosed vaginal bleeding 

  • History of breast cancer

  • History of ovarian, endometrial, or other estrogen-dependent cancers

  • History of blood clots 

  • History of stroke or heart attackConditions like Protein C or Protein S deficiency that increase the risk of blood clots

  • Pregnancy or suspected pregnancy 

Estrogen therapy should be used with caution in: 

  • Hypocalcemia 

  • Heart disease, high blood pressure, and other cardiovascular conditions

  • Obesity 

  • High triglycerides in the blood 

  • Smoking 

  • Surgery or long periods of not moving

  • Gallbladder disease

  • History of jaundice with pregnancy 

  • Porphyria 

  • Lupus 

  • Kidney disease

  • Seizures

  • Migraines

  • Movement disorders

  • Asthma

  • Liver hemangiomas

  • Hereditary angioedema

  • Use of condoms (vaginal cream form)

  • Diabetes mellitus

  • Thyroid disease 

  • Conditions with fluid retention

  • Endometriosis  

  • People age 65 and older 

  • Breastfeeding 

How to take Premarin

Premarin is a medication that is associated with serious side effects. It is important to take this medication exactly as prescribed. This medication should only be used by the individual it was prescribed for. Important information about this medication can be found by reading the labeling that is on the packaging as well as the prescribing inserts. 

  1. Follow medical advice while taking this medication. Inform your healthcare provider about any history of cancer, all medical conditions you have, any medications or supplements you are taking or have taken in the past, and any allergic reactions you have had to medications.

  2. Store and dispose of this medication correctly and out of the reach of children. Premarin should be stored at room temperature (68 to 77 degrees Fahrenheit). This medication should be stored away from other medications as overdose could be life threatening. 

  3. If you are prescribed this medication, complete all doses even if you feel well after taking the first few. The dose may need to be adjusted several times to find what is most effective.

  4. Swallow Premarin tablets whole. Do not cut, crush, or chew the tablet. You may take this medication with or without food. 

  5. Apply the vaginal cream to the vaginal tissues only. This medication should not be applied to other parts of the body. 

  6. Notify your healthcare provider if you are pregnant or are planning to become pregnant. Use of this medication in pregnancy can result in harm to the developing fetus. 

  7. Nursing mothers should consider supplemental forms of infant nutrition. Premarin is passed in human breast milk. Estrogens are known to decrease the quantity and quality of breastmilk. 

  8. Immediately seek medical care if any evidence of heart attack, stroke, deep vein thrombosis, or blood clot occurs. Blood clots could be debilitating or fatal.

  9. Immediately seek medical care if any type of allergic reaction to this medication occurs. Allergies to this and any medication could be severe or life threatening. 

RELATED: Estrace vs Premarin: Differences, similarities, and which is better for you

Premarin dosage FAQs

How long can you take Premarin?

Premarin is typically given for three to six months at time, according to the prescribing information. After a short break, another cycle may be administered if needed. 

How do I stop taking Premarin?

Individuals on a low-dose of Premarin or who have only been taking Premarin for a short period of time may be able to stop the medication without withdrawal symptoms. While stopping Premarin is not associated with typical withdrawal symptoms, there is an association with migraine headaches and rebound menopausal symptoms, especially hot flashes. Thus it is typically recommended that this medication be tapered once treatments are no longer needed. 

Can you overdose on Premarin?

Premarin should only be taken in the dosages that were prescribed by a healthcare professional. While taking too much medication may not result in imminent death, synthetic estrogens like Premarin are associated with an increased risk of certain types of cancers and life-threatening clotting events. Taking more medication than prescribed or taking this medication longer than prescribed increases these risks. 

What interacts with Premarin?

It is possible for drug interactions to occur between Premarin and other medications. Some of these medications include: 

  • Aromatase inhibitors: Aromatase inhibitors and estrogens have opposing pharmacologic actions.

  • CYP3A4 inhibitors: Estrogens are metabolized by CYP3A4. Medications that inhibit this enzyme may produce concentrations of estrogens that are too high, increasing the risk of side effects.

  • Hepatic enzyme-inducing medications: May reduce the concentration of estrogens to lower than effective states.

  • Selective estrogen receptor modulators (SERMs): SERMs block the effects of estrogens on target tissues and should not be used with estrogens.

  • Tranexamic acid: Increased risk of clots

  • Warfarin: May increase the risk of bleeding 

Talk to your healthcare provider about all medications you are taking to check for possible interactions.

Is it safe to take Premarin during pregnancy?

Premarin is contraindicated for use during pregnancy as it may harm the developing fetus. 

Medically reviewed by Anne Jacobson, MD, MPH
Board-Certified Family Physician

Anne Jacobson, MD, MPH, is a board-certified family physician, writer, editor, teacher, and consultant. She is a graduate of University of Wisconsin School of Medicine and Public Health, and trained at West Suburban Family Medicine in Oak Park, Illinois. She later completed a fellowship in community medicine at PCC Community Wellness and a master's in Public Health at the University of Illinois-Chicago. She lives with her family near Chicago.

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Written by Georgia C. Yalanis, MD
Medical Doctor

Georgia C. Yalanis, MD, MSc, is a physician-scientist with expertise in “bench-to-bedside” medicine. She uses translational medicine applications to help clients and companies create products that are scientifically and technologically advanced while still being clinically useful. She has worked in the regulatory and biotech space and has a passion for individuals being empowered to make informed decisions about their medical and health care.

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