Divigel Dosage/Direction for Use

Divigel can be used for continuous, cyclical or sequential treatment.
The usual starting dose is estradiol 1 mg (1 g gel) daily but the selection of the initial dose can be based on the severity of the patients' symptoms. Depending on the clinical response, the dosage can be re-adjusted after 2-3 cycles individually from 0.5-1.5 g/day, corresponding to estradiol 0.5-1.5 mg/day.
In patients with an intact uterus, it is recommended to combine Divigel, with an adequate dose of progestin for adequate duration eg, 12-14 consecutive days per month/28 day cycle or to oppose estrogen-stimulated hyperplasia of the endometrium.
Unless there is a previous diagnosis of endometriosis, it is not recommended to add a progestagen in hysterectomised women.
Administration: Divigel is a gel for transdermal use.
Apply on dry and clean skin.
The Divigel dose is applied once daily, on the skin of the lower trunk or the right or left thigh, on alternate days. The application surface should be 1-2 times the size of a hand. Divigel should not be applied on the breasts, on the face or irritated skin. After application, the gel should be allowed to dry for a few minutes and the application site should not be washed within 1 hr. Contact of the gel with the eyes should be avoided. Hands should be washed after application.
In women who are not using HRT, or women transferring from continuous combined HRT-product, treatment with Divigel may be started on any convenient day. In women transferring from a sequential or cyclic HRT regimen, treatment should begin the day following completion of the prior 28 days regimen.
For initiation and continuation of treatment of postmenopausal symptoms, the lowest effective dose for the shortest duration (see Precautions) should be used.
If the patient has forgotten to apply a dose, the forgotten dose is to be applied as soon as possible if the dose is not >12 hrs late. If the dose is >12 hrs late, the dose should be forgotten and continue as normal. Forgetting a dose may increase the likelihood of breakthrough bleeding and spotting.