Estradiol-containing (0.01% w/w) medicinal products for topical use

  • Procedure started
  • Under evaluation
  • PRAC recommendation
  • CMDh final position
Current status:
CMDh final position

Overview

Four-week limit for use of high-strength estradiol creams confirmed

On 16 January 2020, EMA’s safety committee (PRAC) confirmed its recommendation to limit the use of high-strength creams containing 100 micrograms/gram (0.01%) of estradiol to a single treatment period of up to 4‑weeks. This followed a re-examination of its recommendation of October 2019 which was requested by one of the companies that market high-strength estradiol cream.

The PRAC reviewed available data on the safety and effectiveness of high-strength estradiol-containing creams used to treat symptoms of vaginal atrophy in women who have been through menopause. Data on these creams show that in postmenopausal women who use them, the levels of estradiol in the blood were higher than normal postmenopausal levels. The PRAC concluded that absorption of estradiol into the bloodstream is of concern and could result in similar side effects to those seen with hormone replacement therapy (HRT). The side effects of HRT taken orally or used transdermally (as patches) include venous thromboembolism (formation of blood clots in the veins), stroke, endometrial cancer (cancer of the lining of the womb) and breast cancer. In addition, there are limited safety data on long term use of high-strength estradiol creams. For these reasons, the PRAC recommended that these creams should only be used for a single treatment period of a maximum of 4 weeks.

The PRAC recommended that the prescribing information for these creams be updated with the new recommendations. A warning that the medicine is to be used for a single treatment period of up to 4 weeks only will be placed on the outer and inner packaging and the size of the tube will be limited to 25 grams to prevent use for longer than recommended.

The PRAC recommendations were adopted by the CMDh by consensus and will be implemented directly at national level.

Key facts

About this medicine
Approved name
Estradiol-containing (0.01% w/w) medicinal products for topical use
International non-proprietary name (INN) or common name

 estradiol

Associated names
  • Linoladiol
  • Linoladiol N
  • Linoladiol Estradiol
  • Estradiol Wolff
  • Montadiol
Class
Hormonal
About this procedure
Current status
CMDh final position
Reference number
EMEA/H/A-31/1482
Type
Article 31 referrals

This type of referral is triggered when the interest of the Union is involved, following concerns relating to the quality, safety or efficacy of a medicine or a class of medicines.

Decision making model
PRAC-CMDh
Authorisation model
Nationally authorised product(s)
Key dates and outcomes
Procedure start date
11/04/2019
PRAC recommendation date
16/01/2020
CHMP opinion/CMDh position date
30/01/2020
Outcome
Risk minimisation measures

All documents

Procedure started

  • List item

    Estradiol-containing (0.01% w/w) medicinal products for topical use Article 31 referral - Timetable (start of re-examination procedure) (PDF/139.88 KB)


    First published: 12/07/2019
    Last updated: 18/12/2019
    EMA/PRAC/214200/2019 Rev. 2

  • List item

    Estradiol-containing (0.01% w/w) medicinal products for topical use Article 31 referral - Notification (PDF/71.63 KB)


    First published: 12/04/2019

  • List item

    Estradiol-containing (0.01% w/w) medicinal products for topical use Article 31 referral - Annex I (PDF/127.58 KB)


    First published: 12/04/2019
    Last updated: 08/04/2020

  • List item

    Estradiol-containing (0.01% w/w) medicinal products for topical use Article 31 referral - PRAC list of questions (PDF/77 KB)


    First published: 12/04/2019
    EMA/PRAC/214199/2019

  • List item

    Estradiol-containing (0.01% w/w) medicinal products for topical use Article 31 referral - New review of risks with high-strength estradiol-containing creams (PDF/77.55 KB)


    First published: 12/04/2019
    EMA/215459/2019

  • Recommendation provided by Pharmacovigilance Risk Assessment Committee

    Position provided by CMDh

  • List item

    Estradiol-containing (0.01% w/w) medicinal products for topical use Article 31 referral - Four-week limit for use of high-strength estradiol creams confirmed (PDF/128.99 KB)


    First published: 31/01/2020
    Last updated: 08/04/2020
    EMA/48567/2020

  • List item

    Estradiol-containing (0.01% w/w) medicinal products for topical use Article 31 referral - Annex II (PDF/175 KB)


    First published: 08/04/2020

  • List item

    Estradiol-containing (0.01% w/w) medicinal products for topical use Article 31 referral - PRAC assessment report (PDF/554.03 KB)

    Adopted

    First published: 10/02/2020
    EMA/62697/2020

  • List item

    Estradiol-containing (0.01% w/w) medicinal products for topical use Article 31 referral - Timetable for the implementation of the CMDh position (PDF/48.5 KB)


    First published: 04/02/2020
    Last updated: 08/04/2020

  • List item

    Estradiol-containing (0.01% w/w) medicinal products for topical use Article 31 referral - Annex III (PDF/369.8 KB)


    First published: 31/01/2020
    Last updated: 08/04/2020

  • Document description

    • Annex I - List of the medicines affected by the referral
    • Annex II - Scientific conclusions of the CHMP or CMDh
    • Annex III - Changes to the summary of product characteristics, labelling or package leaflet - available when the CHMP or CMDh recommends changes to the product information. Also includes conditions for lifting of suspensions, if applicable
    • Annex IV - Conditions of the marketing authorisation - available when the CHMP or CMDh recommends other measures to be taken for the marketing authorisation such as safety measures or additional studies
    • Notification - A letter from a Member State, the European Commission or a marketing-authorisation holder requesting the initiation of a referral procedure
    • Rationale for triggering - Background provided by the party triggering the referral explaining the issues leading to the initiation of the procedure
    • PRAC list of questions - Questions agreed by the PRAC requesting further information to evaluate the issues identified
    • PRAC timetable - Timeframe agreed by the PRAC to receive information, assess the issues and adopt a recommendation
    • PRAC / CHMP or CMDh assessment report - The assessment and conclusions of the PRAC and CHMP or CMDh on the issues investigated

    News

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