vaginal estrogen cream side effects

Your doctor may tell you not to use vaginal estrogen. The FDA does not approve some bioidentical hormones. Vaginal estrogen is a local treatment, which means that it is only administered to the exact place it is trying to treat, and less estrogen enters the bloodstream. Common side effects that are seen with vaginal estrogen creams include: Vaginal discharge Yeast infections Vaginal bleeding Breast pain And even though its a common side effect, you should always check with your healthcare provider if you experience any new or unusual vaginal bleeding. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, if you are overweight, or if you smoke. Many major medical groups do not support using them because not enough is known about their safety and long-term side effects. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Retinal vascular thrombosis, intolerance to contact lenses. An estrogen cream is used to relieve vaginal and urinary menopause symptoms. Wyeth Laboratories (2017): Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Tell your doctor if you experience bleeding in your vagina. Ultimately, these researchers suggest the following: In women with a single GSM complaintsuch as vaginal dryness, pain during sex, painful urination, and vaginal itching or burninga nonhormonal lubricant or moisturizer may work. However, you should not flush this medication down the toilet. Most studies cited in vaginal estrogen recommendations are observational studies, meaning that not all risk factors are controlled for. Healthcare providers may recommend hormone replacement therapy as a treatment for these symptoms. Call your doctor for medical advice about side effects. Place the tip of the ring into your vagina and then use your index finger to gently push the ring inside your vagina as far as you can. show all 8 brands Estradiol topical should not be used to prevent heart disease, stroke, or dementia. Use the medicine as soon as you can, but skip the missed dose if your next dose is due in less than 12 hours. Do not save or reuse the applicator. Most studies cited in vaginal estrogen recommendations are observational studies, meaning that not all risk factors are controlled for. estradiol, Premarin, Estrace, Prempro, Yuvafem, ethinyl estradiol / norethindrone. Common side effects of Premarin Vaginal Cream include: Premarin Vaginal Cream is administered intravaginally in a cyclic regimen (daily for 21 days and then off for 7 days). This usually goes away if you continue using it. Compounded bioidentical hormones are not FDA-approved. Other forms of bioidentical hormones are custom-made by a pharmacist based on a healthcare provider's prescription. Copyright, 2023. This reduces the risk of cancers and cardiovascular events associated with HT taken via pill or patch. With the smaller end up, put the insert about 2 inches into your vagina using your finger. Some common side effects of bioidentical hormones include: You may itch or get red around the area where you apply your hormones if you use a patch, cream or gel. If you need major surgery or will be on long-term bed rest, you may need to stop using this medicine for a short time. But there have been no large research studies of bioidentical hormones to show evidence of this. Estrogens should not be used to prevent heart disease or dementia. Data from the, Womens Health Initiative Observational Study. Estrace (estradiol) vaginal cream is a preparation of estrogen, a female hormone, for topical application to the vaginal area used to treat certain symptoms of menopause such as dryness, burning, and itching of the vaginal area and urgency or irritation with urination. Estrogen Vaginal Creams. Give via phone, mail, gift of membership, workplace giving and more. Last updated on Oct 11, 2022. Last reviewed by a Cleveland Clinic medical professional on 04/15/2022. Estrogen vaginal tablets are usually inserted once a day for the first 2 weeks of treatment and then are inserted twice a week as long as treatment is needed. Gently pull downward and forward to remove the ring. Many healthcare providers who use bioidentical hormones claim they are safer than traditional hormone therapy treatments. You may be at risk for bone thinning and osteoporosis because of the loss of estrogen. Applies to conjugated estrogens topical: vaginal cream. These side effects may go away during treatment as your body adjusts to the medicine. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Grapefruit may interact with estradiol and lead to unwanted side effects. Your doctor may tell you not to use vaginal estrogen. In the North American Menopause Society 2017 statement on hormone therapy they stated that low-dose vaginal estrogen preparations are effective and generally safe for the treatment of VVA [vulvovaginal atrophy], with minimal systemic absorption, and preferred over systemic therapies when ET [estrogen therapy] is considered only for GSM [genitourinary syndrome of menopause]. The NWHN believes that, as the research currently stands, it appears that vaginal estrogen is a safe and effective treatment for vaginal discomfort due to menopause. Systemic absorption may occur with the use of ESTRACE (estradiol vaginal cream, USP, 0.01%). Bioidentical hormones are artificial hormones that are similar to the hormones produced by the human body. When you are ready to remove the ring, wash your hands and stand or lie in a comfortable position. Tell your doctor if you are breastfeeding. During menopause, the elasticity of your vagina is going to decrease, says Dr. Kollikonda. WebKnown anaphylactic reaction or angioedema to PREMARIN Vaginal Cream ( 5.16, 5.17) Known liver dysfunction or disease ( 4, 5.10) Known protein C, protein S, or antithrombin deficiency or other known thrombophilic disorders ( 4) Known or suspected pregnancy ( 4, 8.1) WARNINGS AND PRECAUTIONS Estrogens increase the risk of gallbladder disease ( 5.5) Store it at room temperature and away from excess heat and moisture (not in the bathroom). Increased facial hair. Treatment, Symptoms, Medication, Premarin Vaginal Cream Professional Information. Premarin Vaginal Cream. , causing dryness and itching. Yuvafem, Vagifem, Estring, Estrace Vaginal Cream, Imvexxy. It works by replacing estrogen that is normally produced by the body. Estradiol topical may cause serious side effects. Consult your doctor before breastfeeding. Do not force the applicator into your vagina or insert more than half of the applicator into your vagina. See additional information. Talk with your healthcare provider about bioidentical hormones and what form may work best for you. Sex can be very painful. Thankfully, the use of vaginal creams or lotions can help. WebLike any medication you may experience initial side effects with the hormones in Hormone Replacement Treatments (HRT). Estradiol may increase your risk of developing a condition that can lead to uterine cancer. Instead, the best way to dispose of your medication is through a medicine take-back program. drugs a-z list Counseling postmenopausal women about bioidentical hormones: ten discussion points for practicing physicians. You may want to twist the ring into a figure-eight shape. WebSide effects of estrogen cream are mild and transient. WebConjugated Estrogen Premarin Cream - Buy Premarin Cream at best price of Rs 1000/box by Rite Care. The same findings held true for women who had had a hysterectomy. more different adverse reactions in the same body system. Estrogens can increase the risk of cancer of the uterus (endometrial cancer). Do not use hot water or boil the applicator. Estradiol lotion should be used in the morning. You can take steps to decrease the risk that you will develop a serious health problem while you are using vaginal estrogen. If the estrogen cream works to separate the lips, you might be told to apply petroleum jelly or some other ointment for another period of time. Wrap the ring in a tissue or a piece of toilet paper and dispose of it safely, so that it is out of reach of children or pets. They are not tested for safety or effectiveness. RxList does not provide medical advice, diagnosis or treatment. For women who do not experience relief from over the counter products, low-dose vaginal estrogen is an option. A commonly prescribed remedy for these irritations is estrogen cream. Use vaginal estrogen at around the same time of day every time you use it. Yes, weight gain is a side effect of bioidentical hormones. Body system totals are not necessarily the sum of individual adverse events, since a patient may report two or Talk to your doctor regularly about the risks and benefits of using vaginal estrogen. Check with your doctor immediately if any of the following side effects occur while taking conjugated estrogens topical: Some side effects of conjugated estrogens topical may occur that usually do not need medical attention. jaundice (yellowing of the skin or eyes); memory problems, confusion, unusual behavior; flushing (warmth, redness, or tingly feeling); vaginal itching or discharge, changes in your menstrual periods, breakthrough bleeding. Femring brand vaginal ring is also used to treat hot flushes ('hot flashes'; sudden strong feelings of heat and sweating) in women who are experiencing menopause. If you become pregnant while using vaginal estrogen, call your doctor immediately. Hormones affect many systems and functions in your body. WebVaginal Estrogen Cream and Vaginal Estrogen Tablets. Premarin Vaginal Cream (Conjugated Estrogens Vaginal Cream), Number (%) of Patients with Adverse Reaction. When you start using this medicine you may experience vaginal irritation or itching. The following additional adverse reactions have been reported with estrogen and/or progestin therapy. Should you take estrogen? A 40-week, openlabel Webestradiol 0.01% (0.1 mg/gram) vaginal cream 7027 Medication name Warning Uses Other uses How to use Side effects Precautions Drug interactions Overdose Notes Missed dose Storage Important note Information last revised January Estrogen increases the risk that you will develop endometrial cancer (cancer of the lining of the uterus [womb]) during your treatment or up to 15 years after your treatment, if you have not had a hysterectomy (surgery to remove the uterus [womb]). Compounded bioidentical hormones are advertised as being a safer, more effective, natural and individualized alternative to conventional hormone therapy. If the ring falls out, wash it with warm water and replace it in your vagina following the directions above. Duplication for commercial use must be authorized by ASHP. American College of Obstetricians and Gynecologists. (https://www.fda.gov/drugs/human-drug-compounding/national-academies-science-engineering-and-medicine-nasem-study-clinical-utility-treating-patients), Visitation, mask requirements and COVID-19 information. Call your doctor at once if you have: heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; signs of a blood clot--sudden numbness or weakness, sudden vision loss, slurred speech, stabbing chest pain, coughing up blood, pain or warmth in one or both legs; swelling or tenderness in your stomach, severe stomach pain spreading to your back, nausea and vomiting; jaundice (yellowing of the skin or eyes); memory problems, confusion, unusual behavior; high calcium levels--confusion, tiredness, nausea, vomiting, loss of appetite, constipation, increased thirst or urination, weight loss. It is also important information to carry with you in case of emergencies. Hold the applicator in one hand with a finger on the end of the plunger. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: Headache. Estrogen, progesterone and testosterone are the most commonly used bioidentical hormones. There are a variety of over the counter moisturizers and lubricants to treat vaginal dryness, but in some cases they do not fully relieve symptoms. Hormones are chemicals made by your endocrine glands. Chest PainsDifficulty BreathingLeg PainsSlurred speechSudden urinationVision changes genital pruritus), endometrial hyperplasia, endometrial cancer, precocious puberty, leukorrhea. Some postmenopausal women experience vaginal pain or discomfort when they have intercourse or a gynecological exam. Consult your doctor before breastfeeding. Put a finger into your vagina and hook it through the ring. WebPossible Estrogen Side Effects: Breast tenderness Headaches Indigestion Nausea Leg cramps Vaginal bleeding Possible Progestogen Side Effects: Feeling Bloated Breast tenderness Depression Mood changes Acne Vaginal To help lower this risk, your doctor may also want you to take a progestin. Estrace brand vaginal cream is usually applied once daily for 2 to 4 weeks, and then applied one to three times a week. Women who use vaginal estrogen alone or with progestins may also have a higher risk of developing these conditions. One study suggests that approximately 1 to 2.5 million women in the U.S. over age 40 are using compounded bioidentical hormones. If you will be using the vaginal ring, also tell your doctor if you have a vaginal infection; any condition that makes your vagina more likely to become irritated; a narrow vagina; or a condition where the rectum, bladder, or uterus has bulged or dropped into the vagina. Pharmacies that compound hormones do not have to report drug side effects to the FDA or provide paperwork. You may try more than one way before you find one that works well for you. Check with your doctor immediately if any of the following side effects occur: Less common Vaginal yeast infection Incidence not known Change in vaginal discharge Some postmenopausal women experience vaginal pain or discomfort when they have intercourse or a gynecological exam. Your doctor may give you an alternative medicine. Premarin Vaginal Cream may interact with blood thinners, thyroid medications, insulin or diabetes medicine taken by mouth, rifampin, ketoconazole or itraconazole, seizure medicines, barbiturates, or antidepressants. See BOX WARNING, WARNINGS and PRECAUTIONS. WebEstrogen cream (premarin cream) can also be applied. However, transdermal estrogen is a possibility for hormone therapy. Along with its needed effects, conjugated estrogens topical (the active ingredient contained in Premarin Vaginal) may cause some unwanted effects. (https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2012/08/compounded-bioidentical-menopausal-hormone-therapy). Vaginal estrogen is in a class of medications called hormones. Commonly reported side effects of estradiol topical include: headache. Problems linked to low blood pressure (clonidine). WebOther prescription medicines have side effects, such as: Headaches, upset stomach, and problems sleeping (antidepressants). Some common effects of low hormones include: Replacing these lost or low hormones is the goal of bioidentical hormone therapy or conventional hormone therapy. Side effects subjects randomized at baseline to placebo. United States Food & Drug Administration. This may decrease your risk of developing endometrial cancer but may increase your risk of developing certain other health problems, including breast cancer. While some estrogen will enter the bloodstream from a local treatment, it is far less than with an oral treatment such as hormone therapy (HT). Common side effects of Estrace Vaginal Cream include: Overdosage of estrogen may cause nausea and vomiting, and withdrawal bleeding may occur in females. Vaginal estrogen may cause other side effects. Vaginal estrogen comes as a flexible ring, a vaginal insert, as a tablet to insert in the vagina, and as a cream to apply to the inside of the vagina. Dispose of that applicator and tablet and use a fresh applicator. Your endocrinologist will determine the best way to administer the estrogen. urticaria, exacerbation of asthma, increased triglycerides, hypersensitivity. Ask your doctor or pharmacist if you do not understand these instructions. Hold open the folds of skin around your vagina with your other hand. Washington, D.C. 20005, Email: [emailprotected] Topical estradiol is absorbed through the skin of a child who comes into contact with this medicine. Common (1% to 10%): Breast pain, leukorrhea, dysuria, vaginal hemorrhage, vaginal moniliasis, vaginitis, vulvovaginal disorder, Uncommon (0.1% to 1%): Breast enlargement, urinary urgency, Postmarketing reports: Abnormal uterine bleeding or spotting, dysmenorrhea or pelvic pain, increase in size of uterine leiomyomata, change in cervical secretion, cystitis-like syndrome, application site reactions of vulvovaginal discomfort (including burning, irritation, and genital pruritus), endometrial hyperplasia, endometrial cancer, precocious puberty, breast tenderness, breast discharge, fibrocystic breast changes, breast cancer, gynecomastia in males[Ref], Postmarketing reports: Deep vein thrombosis, myocardial infarction, increase in blood pressure[Ref], Postmarketing reports: Stroke, migraine, dementia[Ref], Postmarketing reports: Nausea, vomiting, abdominal cramps, bloating[Ref], Postmarketing reports: Chloasma that may persist when drug is discontinued, loss of scalp hair, hirsutism, rash[Ref], Postmarketing reports: Increase or decrease in weight, edema[Ref], Postmarketing reports: Mental depression, mood disturbances, nervousness, irritability, changes in libido[Ref], Postmarketing reports: Pulmonary embolism, exacerbation of asthma[Ref], Postmarketing reports: Arthralgias, leg cramps[Ref], Postmarketing reports: Hypersensitivity[Ref], Postmarketing reports: Increased incidence of gallbladder disease[Ref], Postmarketing reports: Glucose intolerance, increased triglycerides[Ref], Postmarketing reports: Retinal vascular thrombosis, intolerance to contact lenses[Ref]. Available for Android and iOS devices. Improving mood and sleep. It can greatly increase your risk of blood clots, stroke, or heart attack while using estradiol. Recent studies have shown that low-dose vaginal estrogen use does not have the same risks as hormone therapy. This uncomfortable menopausal side effect can cause the vaginal area to feel itchy or sore, and can lead to additional side effects like painful sex and pelvic pain. Look at the markings on the side of the applicator to help measure your dose. Wash your hands with soap and water after applying the medicine. Cover treated areas with clothing to protect others from coming into contact with the skin where you apply this medicine. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. Any doctor or surgeon who treats you should know that you are using estradiol. However, there is not much evidence to support that bioidentical hormones are equal to conventional hormone therapy. Our Estrace vaginal cream Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. Endometrial Cancer, Cardiovascular Disorders, Breast Cancer and Probable DementiaEstrogen-Alone TherapyThere is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens.Estrogen-alone therapy should not be used for the prevention of cardiovascular disease or dementia.Women's Health Initiative estrogen-alone substudy reported increased risks of stroke and deep vein thrombosis.The Womens Health Initiative Memory Study estrogen-alone ancillary study of Womens Health Initiative reported an increased risk of probable dementia in postmenopausal women 65 years of age and older.Estrogen Plus Progestin TherapyEstrogen plus progestin therapy should not be used for the prevention of cardiovascular disease or dementia.The Womens Health Initiative estrogen plus progestin substudy reported increased risks of stroke, DVT, pulmonary embolism, and myocardial infarction.The Womens Health Initiative estrogen plus progestin substudy reported increased risks of invasive breast cancer.The Womens Health Initiative Memory Study estrogen plus progestin ancillary study of Womens Health Initiative reported an increased risk of probable dementia in postmenopausal women 65 years of age and older. Compounded bioidentical hormone therapy: identifying use trends and knowledge gaps among US women. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. The bioidentical hormones that are approved by the FDA have been tested for safety. Nausea, vomiting; abdominal cramps, bloating; cholestatic jaundice; increased incidence of gallbladder Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Report any unusual vaginal bleeding right away. WebPremarin (conjugated estrogens) vaginal cream can weaken or damage latex or rubber condoms, diaphragms, and cervical caps. These things generally disappear when the cream is stopped. These changes may result in symptoms of urinary frequency or urgency and discomfort passing urine. http://www.upandaway.org. Follow all directions on your prescription label and read all medication guides or instruction sheets. If menopause occurs in a woman younger than ___ years, it is considered to be premature. This contributes to the myth that compounded hormones are safer when healthcare providers don't know all of the possible side effects of these hormones. Estrace Vaginal Cream(Estradiol Vaginal Cream) side effects drug center. The goal is to relieve symptoms with the lowest dose possible for the shortest amount of time. Fighting fatigue 5. You may itch or get red around the area where you apply your hormones if you use a patch, cream or gel. You may report side effects to FDA at 1-800-FDA-1088. Nausea Vomiting Bloating Breast tenderness Headache Perfect Time To Apply Estrogen Cream Estrogen products usually come with usage directions. WebThe same goes for estrogen cream. Using any type of hormone therapy is a decision made between you and your healthcare provider after carefully weighing the risks and benefits. You can take estrogen in the form of a pill, patch, gel, vaginal cream, or slow-releasing suppository or ring that you place in your vagina. If you experience only vaginal symptoms related to menopause, estrogen in a low-dose vaginal cream, tablet or ring is usually a better choice than an oral pill or a skin patch. Depending on your healthcare provider, you might have routine blood, urine or saliva tests to check your hormone levels. Pill Identifier Tool Quick, Easy, Pill Identification, Drug Interaction Tool Check Potential Drug Interactions, Pharmacy Locator Tool Including 24 Hour, Pharmacies. In a large study, women who took estrogen with progestins by mouth had a higher risk of heart attacks, strokes, blood clots in the lungs or legs, breast cancer, and dementia (loss of ability to think, learn, and understand). Ovestin 1 mg cream PACKAGE LEAFLET: INFORMATION FOR THE USER 1. Apply or insert the missed dose as soon as you remember it. Estrace Vaginal Cream Patient Information is supplied by Cerner Multum, Inc. and Estrace Vaginal Cream Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. tell your doctor if you have liver disease or a blood disorder such as protein C deficiency, protein S deficiency, or an antithrombin deficiency that may increase your risk of developing abnormal blood clots. Read the entire FDA prescribing information for Premarin Vaginal Cream (Conjugated Estrogens Vaginal Cream). Cramping. These additional hormones have not had adequate testing and are not included in any FDA-approved products. Some dosage forms listed on this page may not apply to the brand name Premarin Vaginal. Chloasma that may persist when drug is discontinued, loss of scalp hair, hirsutism, rash. The FDA recommends against using hormone levels to guide the dosing of hormone therapy in women, as normal levels fluctuate day to day. exacerbation of epilepsy, dementia. WebVaginal Estrogen Cream and Vaginal Estrogen Tablets. Answer: Transdermal estrogen No prescription breast creams generally do not work and can be dangerous. Estrogen may increase your risk of developing cancer of the ovaries or gallbladder disease that may need to be treated with surgery. When estrogen levels are low, your vagina walls get thin and produce less lubricant. Call your doctor if a child in close contact with you develops swollen nipples or enlarged breasts. Other side effects include: limb pain. For some women, regular intercourse or other sexual stimulation is enough to keep the vagina supple, while other women find that vaginal lubricants prevent discomfort that might otherwise happen. Screw the nozzle or threaded end of the applicator onto the open end of the tube. Vagina tightening creams like virgin cream and instant virgin spray not only tighten the vagina but act as natural lubricants, get rid of vaginal odor and their regular usage helps in permanent tightening of the vagina. So Do These Creams Really Work Applies to estradiol topical: transdermal film extended release, vaginal cream, vaginal insert, vaginal ring, vaginal tablet. The most common side effects of estradiol hormone replacement therapy are bloating, nausea, indigestion, headaches, vaginal bleeding, breast tenderness/swelling, leg cramps, and fluid retention. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. They are messengers that tell other parts of your body how and when to work. WebCurrent attention focuses on vaginal estrogen as a local therapeutic means to achieve control of symptoms due to vulvovaginal atrophy without increasing plasma estradiol levels. Your risk of heart disease and breast cancer may also increase if you are older or use hormonal therapy for an extended period. anaphylactoid/anaplylactic reactions; hypocalcemia; exacerbation of asthma; increased triglycerides. home you should know that the manufacturer of one brand of estrogen vaginal cream (Premarin, difficulty falling asleep or staying asleep, swelling, redness, burning, itching, or irritation of the vagina, ongoing pain that begins in the stomach area but may spread to the back nausea, vomiting, or loss of appetite, rash, hives, itching, hoarseness, or difficulty breathing or swallowing, swelling of the eyes, face, tongue, throat, hands, arms, feet, ankles, or lower legs, fever, nausea or vomiting, diarrhea, muscle pain, dizziness or fainting, or rash on face or body. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Bioidentical hormones come in many forms. Topical estradiol is absorbed through the skin and can cause premature puberty in a child who comes into contact with this medicine. Deep and superficial venous thrombosis; pulmonary embolism; thrombophlebitis; myocardial infarction; You may also get pain in your abdomen, a genital rash, headache and vaginal thrush (candidiasis). Vaginal tissues can become thinner after menopause, causing dryness and itching. As the research currently stands, it appears that vaginal estrogen is a safe and effective treatment for vaginal discomfort due to menopause, and has a much lower risk of the cancers and cardiovascular events typically associated with hormone therapy. Data sources include IBM Watson Micromedex (updated 5 Mar 2023), Cerner Multum (updated 13 Mar 2023), ASHP (updated 12 Mar 2023) and others. If you have a side effect that you cannot manage or does not go away in a short time, your hormone level might be too high. Most importantly, know that you do not need to live with unpleasant symptoms of low hormones. As estrogen levels decline during menopause, it's common to experience vaginal dryness. , stroke, or heart attack while using estradiol hormones have not adequate..., increased triglycerides, hypersensitivity osteoporosis because of the ovaries or gallbladder disease that may need to live unpleasant! In special ways to prevent heart disease, stroke, or dementia easiest way to administer the.. 40 are using compounded bioidentical hormones claim they are messengers that tell parts! The markings on the end of the tube asthma, increased triglycerides, hypersensitivity a provider... Giving and more herbal products recent studies have shown that low-dose vaginal estrogen at around area. On your prescription label and read all medication guides or instruction sheets and! 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