Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
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Are There Alternatives to Premarin and Zoloft?

Tuesday, 08 Jun 2010 04:21 PM

Question: I take Premarin and Zoloft but would like to get off both of them. I still have 3 or 4 hot flashes a day as well as the stresses that lead to my taking the Zoloft, although they are less than they were. Can you suggest any alternatives to these drugs?
Dr. Hibberd's Answer:
Premarin therapy needs to be withdrawn very gradually to reduce nuisance flushing and other symptoms typical of estrogen deficiency. Avoid abrupt discontinuance unless you are on very low doses (i.e., 0.3 mg or less) The more gradual the withdrawal, the less you will notice the reduced dosage.
Hormone supplementation has been associated with an increased risk for breast, ovarian, and endometrial carcinomas. It is no longer used to prevent cardiovascular disease, and is no longer routinely recommended to prevent osteoporosis.
There are other medications that can be used to reduce flushing. However, you will need to have these prescribed by your doctor. Some women elect to increase their dietary estrogen by supplementing with soy products. Others prefer to use phytoestrogens (estrogen from vegetable products) to replace their prescription Premarin. Always inform your doctor when using these options for hormone replacement since they are still supplemental estrogen.
Zoloft is an antidepressant that should be withdrawn on professional counsel only. Some conditions need a minimum of 3-6 months treatment while others need indefinite treatment. This medication can be withdrawn abruptly without consequence to most patients, however, I do prefer to reduce dosage over at least 2 weeks or more depending on the amount used.

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