Evamist Spray: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Evamist is a prescription transdermal spray containing estradiol, a form of estrogen, from the estrogens drug class. It is used to reduce moderate to severe hot flashes (vasomotor symptoms) caused by menopause. The spray is applied daily to the inside of the forearm and delivers estradiol through the skin into the bloodstream. It carries important warnings regarding cancer risk, cardiovascular events, and accidental exposure in others.

What is Evamist Spray

Evamist is a prescription transdermal spray that delivers estradiol, a form of estrogen, through the skin into the bloodstream. Estrogen is a female sex hormone that regulates many processes in the body.

Evamist Spray uses

• Reduce moderate to severe hot flashes (vasomotor symptoms) due to menopause

Benefits of Evamist Spray

• Helps relieve moderate to severe hot flashes associated with menopause.
• Helps reduce night sweats and other vasomotor symptoms.
• Replaces some of the estrogen lost after menopause.
• Can help improve sleep and daily comfort when symptoms are related to low estrogen.
• Provides transdermal estradiol therapy through a convenient skin spray.

How Evamist Spray works

Estradiol works by attaching to estrogen receptors in tissues throughout the body, replacing some of the estrogen the ovaries stop making after menopause. This helps reduce hot flashes caused by the drop in the body's own estrogen levels.

Evamist Spray dosage

Apply Evamist at the same time each day. Apply only to clean, dry, unbroken skin on the inside of your forearm between the elbow and wrist. Do not apply to skin that is red, irritated, broken, or injured.

Never apply Evamist to the breasts or in or around the vagina, and do not apply to any other body area besides the forearm. You must prime a new applicator before its first use by pressing the pump fully 5 times with the cover on; do not prime it again before each daily dose.

Hold the applicator upright and press the pump firmly and fully one time for each spray. If more than one spray is prescribed, apply each spray to a different, non-overlapping area of skin on the same forearm, starting near the elbow.

Do not rub or massage the spray into the skin; let it dry undisturbed for at least 2 minutes before dressing. Do not wash the application site for at least 1 hour after applying.

Cover the treated skin with clothing once dry if another person might touch that area, to prevent them from being exposed to the medicine. Keep children and pets from touching the skin where you applied the spray; if contact happens, wash the area with soap and water right away.

If you use sunscreen, wait at least 1 hour after applying Evamist before applying sunscreen to the same area, since applying sunscreen too soon can reduce how much medicine your skin absorbs.

Avoid fire, flame, or smoking until the sprayed area has completely dried, because the product contains flammable alcohol.

Talk with your doctor regularly, generally every 3 to 6 months, about whether you still need this treatment. This medicine has not been studied enough in people over 65 to know if they respond differently than younger adults. This medicine is not intended for use in children.

Available forms and strengths

• Transdermal spray (1.53 mg estradiol per spray)

Side effects of Evamist Spray

Common

• Headache
• Breast pain or tenderness
• Nipple pain
• Nausea and vomiting
• Fluid retention/swelling
• Stomach or abdominal cramps, bloating
• Irregular vaginal bleeding or spotting, vaginal itching or discharge, changes in menstrual periods
• Thinning scalp hair (hair loss)
• Vaginal yeast infection
• Back pain
• Common cold-like symptoms (nasopharyngitis)

Serious

• Heart attack symptoms (chest pain or pressure, pain spreading to 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)
• Stroke (changes in vision or speech, sudden severe headache)
• Swelling or tenderness in the stomach, severe stomach pain spreading to the back, nausea and vomiting (signs of pancreatitis)
• Jaundice (yellowing of skin or eyes) or other liver problems
• Memory problems, confusion, unusual behavior, or dementia
• Unusual vaginal bleeding, pelvic pain
• A new lump in the breast
• High calcium levels (confusion, tiredness, nausea, vomiting, loss of appetite, constipation, increased thirst or urination, weight loss)
• Increased risk of uterine (endometrial) cancer, breast cancer, and ovarian cancer
• Gallbladder disease requiring surgery
• Vision changes, including retinal blood clots
• High blood pressure or high triglycerides
• Allergic reaction: hives, difficulty breathing, swelling of face, lips, tongue, or throat
• Unintentional exposure in children causing breast budding, breast masses, or enlarged breasts; in prepubertal boys, gynecomastia and breast masses

Warnings and precautions

• Do not use Evamist if you are pregnant or think you may be pregnant. This medicine is not meant for use during pregnancy.
• Estradiol can pass into breast milk and may harm a nursing baby. It may also reduce the amount of breast milk you make. Do not use Evamist while breastfeeding.
• Tell your doctor if you have kidney disease before using Evamist, so they can decide if it's safe for you.
• Do not use Evamist if you have liver disease, and use caution if you have ever had liver problems from past estrogen use or pregnancy, since estrogens may not be processed normally by a damaged liver.
• Evamist contains alcohol and is flammable until it dries on your skin, so avoid fire, flames, or smoking until the treated area has fully dried.
• Using estrogen alone can increase your risk of developing cancer of the uterus (womb). Report any unusual vaginal bleeding to your doctor right away, since this could be a warning sign of this cancer.
• Do not use estrogen therapy to try to prevent heart disease, stroke, or dementia — it may actually increase your risk of these conditions.
• Estrogen therapy, especially when combined with a progestin, can increase the risk of heart attack, stroke, blood clots, and breast cancer.
• Estrogen exposure may increase the chance of developing dementia in women 65 years and older.
• The estrogen in this spray can rub off onto other people's skin, especially children, and cause unexpected signs of puberty such as breast development. Keep the treated skin covered with clothing once dry and don't let others touch it.
• Do not use this medicine if you have a history of heart attack, stroke, or blood clots, liver disease, undiagnosed abnormal vaginal bleeding, an allergy to estradiol, or a hormone-related cancer such as breast or uterine cancer.

Storage

• Store at 20–25°C (68–77°F) at controlled room temperature.
• Keep the spray container properly closed and in its original packaging.
• Protect from excessive heat and direct sunlight; do not expose to high temperatures.
• Keep away from open flames, sparks, and smoking, as the spray is alcohol-based and flammable.
• Keep out of reach and sight of children and pets.

When to see a doctor

• Get emergency help right away if you have signs of an allergic reaction: hives, trouble breathing, or swelling of your face, lips, tongue, or throat.
• Call your doctor right away if you notice a new breast lump, unusual vaginal bleeding, changes in vision or speech, a sudden severe headache, or severe chest or leg pain with or without shortness of breath, weakness, or fatigue.
• Stop using Evamist and call your doctor immediately if you have symptoms of a heart attack (chest pain or pressure, pain spreading to jaw or shoulder, nausea, sweating) or a blood clot (sudden numbness or weakness, sudden vision loss, slurred speech, stabbing chest pain, coughing up blood, or leg pain/warmth).
• Call your doctor if a child who has been in close contact with you develops swollen nipples, breast lumps, or enlarged breasts, as this could be a sign of accidental exposure to this medicine.
• Seek emergency medical attention if you think you have used too much of this medicine, as overdose can cause nausea, vomiting, stomach pain, breast tenderness, drowsiness, and vaginal bleeding.

Alternatives

• Vivelle-Dot
• Climara
• Elestrin
• Divigel
• EstroGel