Evorel patches have been subject to shortages since 2019. Today the stock of Evorel patches, including Evorel Conti and Evorel Sequi is being replenished with improved availability in many pharmacies due to imposed supply restrictions by the wholesaler which redistributes Evorel products. Use it with private prescriptions. Today I am looking at different options for treatment of Hormone Replacement Therapy (HRT), focusing on Evorel, Evorel Conti and Evorel Sequi alternative drugs. Additionally, stock availability in the UK for Evorel, Evorel range will be discussed.
Hormone replacement therapy (HRT) explained (video)
Evorel patches: out of stock update
No specific information exists to why Evorel range went out of stock; however, last year there was a change of the ownership of Evorel range, which most likely contributed to delay in the manufacturing process. Theramex bought Evorel range of products from Janssen Pharmaceutical Companies (Johnson & Johnson) in October 2019. By that time, most of the Evorel products were out of stock.
Theramex committed to increase manufacturing of Evorel products by investing in an additional manufacturer and additional packaging equipment. They have also been working with UK Health Authorities to bring the range faster to the market.
In the latest update on product availability (July 2020), Theramex provided the following information:
- Evorel 25 and 100 patches are available
- Evorel Conti and Sequi are available
- Evorel 50: intermittent supply during the first half of July
- Evorel 75: unavailable until August
In the UK, Alliance Healthcare, one of the leading wholesalers, redistributes Evorel product to pharmacies. Alliance applied monthly quotas to limit the number of Evorel products pharmacies can order to improve availability across the country.
Evorel alternative drugs
Patients who cannot obtain Evorel products should in the first instance try alternative pharmacy to see if the product is available or if a pharmacy can order the stock to fulfil the prescription. A phone call to the pharmacy would be sufficient to get the information.
Patients can transfer their prescription between pharmacies. Patients who were issued an electronic prescription need to ask the pharmacy at which the prescription is located to ‘return to the spine’ (this can be done over the phone). Once returned, the prescription is available for any pharmacy to dispense.
When a paper prescription is produced, the patient needs to take a prescription from one pharmacy to a new pharmacy to process the prescription.
Patients who fail to find the sock of required Evorel products need to contact their GP to talk about suitable alternatives.
The next two paragraphs briefly explain active ingredients and the indicated use of Evorel range to give an understanding of the alternative treatment for Evorel, Evorel Conti and Evorel Sequi parches.
Evorel patches: active ingredients
Evorel patches (25, 50, 75 and 100) are oestrogen-only HRT patch containing estradiol.
Evorel Conti and Evorel Sequi patches contain the same active ingredients:
- norethisterone acetate
Each Evorel Conti contains both active ingredients in one parch, which provides continuous HRT therapy. Evorel Conti patches are worn continuously. Patches are applied twice weekly. Follow the directions of the prescriber and read product information leaflet for more details.
Evorel Sequi therapy pack compromises of 4 Evorel 50 patches containing norethisterone acetate and 4 Evorel Conti patches containing both estradiol and norethisterone. Evorel Sequi provides continuous sequential HRT therapy. During first 14 days one Evorel 50 patch (providing for estradiol) is worn, and during days 15-28 one Evorel Conti patch is worn providing for estradiol + norethisterone. Patches are changed twice weekly. Follow the directions of the prescriber and read product information leaflet for more details.
Evorel alternative patches (estradiol only patches)
As we learnt, Evorel patches are estradiol only. Alternative drugs to Evorel patches include other HRT patches, tablets and gels.
Elleste Solo MX range including:
- Elleste Solo MX40, which delivers approximately 40 micrograms of estradiol/24 hrs
- Elleste Solo MX80, which provides around 80 micrograms of estradiol/24 hrs
Estradem MX range including:
- Estraderm MX25 (delivers 25 micrograms of estradiol /day)
- Estraderm MX50 (delivers 50 micrograms of estradiol /day)
- Estraderm MX75 (delivers 75 micrograms of estradiol /day)
- Estraderm MX100 (delivers 100 micrograms of estradiol /day)
Estradot range including
- Estradot 25 (delivers 25 micrograms of estradiol /day)
- Estradot 37.5 (delivers 37.5 micrograms of estradiol /day)
- Estradot 50 (delivers 50 micrograms of estradiol /day)
- Estradot 75 (delivers 75 micrograms of estradiol /day)
- Estradot 100 (delivers 100 micrograms of estradiol /day)
- Progynova TS 50 micrograms/24 hours
- Progynova TS 100 micrograms/24 hours
- FemSeven 50, 75 & 100: out of stock till mid-2020.
- FemSeven range also acquired by Theramex, a company which produces Evorel range of patches.
HRT tablets alternative to Evorel patches
Elleste range of HRT products is subject to shortages since December 2019. Stocks should come back in the second half of 2020.
Elleste Solo range including:
- Elleste Solo 1 mg tablets (1mg of estradiol)
- Elleste Solo 2 mg tablets (2mg of estradiol)
Progynova range including:
- Progynova 1 mg tablets (1mg of estradiol)
- Progynova 2 mg tablets (2mg of estradiol)
- Zumenon 1 mg tablets (1mg of estradiol)
- Zumenon 2 mg tablets (2mg of estradiol)
Evorel alternative drugs: HRT spray
- Lenzetto 1.53 mg/spray (contains 1.58 of estradiol hemihydrate)
Lenzetto spray delivers estradiol with the application of the spray to the skin of the forearm.
Evorel alternative products: gels
- Sandrena 0.5 mg gel
- Sandrena 1 mg gel
- Oestrogel Pump-Pack 750 micrograms
Sandrea gel comes in the form of estradiol containing sachets. The gel is applied to lower trunk of the left or right thigh (alternatively).
Oestrogel Pump-Pack is applied to the skin of on the arms, shoulders or inner thighs.
Evorel Conti Alternative drugs
Evorel Conti alternative patches
The only alternative patches to Evorel Conti patches are FemSeven Conti patches. FemSeven Conti has been out of stock throughout 2020 with stock expected in second-quarter 4 of 2020. FemSeven Conti patches contain a combination of estradiol and levonorgestrel (a different progestogen component).
Evorel Conti alternative HRT tablets
- Femoston Conti 0.5mg/2.5mg and 1mg/5mg (combination of estradiol and dydrogesterone)
- Elleste Duet Conti (2mg oestradiol + 1mg norethisterone)
- Kliofem (estradiol 2mg, norethisterone 1mg)
- Kliovance (estradiol 1mg, norethisterone 500mcg)
- Indivina 1mg/2.5mg, 1mg/5mg and 2mg/5mg (combination of estradiol/ medroxyprogesterone)
Oestrogen patch + oral progestogen as an alternative to Evorel Conti
Women who struggle to obtain Evorel Conti patches may be considered for treatment with oestrogen patches (for example Estradot, Estraderm, FemSeven Mono, Progynova, Elleste MX) or gel preparations (Oestrogel, Sandrea) plus progestogen preparation such as Utrogestan 100mg capsules (micronised progesterone 100mg) or Provera tablets.
Progestogen is not available in form of patches only as oral preparations. Additional progestogen can be used as part of combined sequential or continuous treatment.
Evorel Sequi Alternatives
Evorel Sequi alternative patches
The only alternative patches to Evorel Sequi patches are FemSeven Sequi patches. FemSeven Sequi patches are currently out of stock with expected availability in quarter 1 of 2021.
Evorel Sequi alternative tablets
- Elleste Duet 1mg and 2mg (combination of estradiol 1mg and norethisterone 1mg or estradiol 2mg and norethisterone 2mg)
- Femoston 1mg/10mg and 2mg/20mg (estradiol 1mg and dydrogesterone 10mg or estradiol 2mg and dydrogesterone 10mg)
- Tridestra (estradiol 2mg, medroxyprogesterone 20mg)
Has Evorel Conti been discontinued?
Evorel Conti has not been discontinued. Evorel Conti has been subject to shortages, however, stock of Evorel Conti patches is being replenished.
Is Estradot the same as Evorel?
Estradot and Evorel contain the same active ingredient – estradiol. Estradot release 25, 37.5, 50, 75 and 100mcg of estradiol/24hrs whereas Evorel as 25, 50, 75 and 100mcg of estradiol/24hrs.
Do Evorel Conti patches come in different strengths?
Evorel Conti patches come only in one form. Each Evorel Conti therapy compromises of 4 Evorel 50 patches and 4 Evorel Conti patches.
Who makes Evorel Conti?
Theramex HQ UK Limited makes Evorel Conti patches.
Is Evorel Sequi available?
Evorel Sequi was subject to drug shortages at the and of 2019 and beginning of 2020, however, the stock is being replenished with better availability in quarter 2 of 2020.
Newton, Katherine M., et al. “Use of alternative therapies for menopause symptoms: results of a population-based survey.” Obstetrics & Gynecology 100.1 (2002): 18-25. Available at https://www.sciencedirect.com/science/article/abs/pii/S0029784402020057