Menopause Part 3 – Duavive

Brooke Thai, PharmD Candidate

The New Kid On the Block

Duavive^® is a new medication for menopause that’s been on the market since December of 2016.¹ It’s unlike the typical estrogen + progestin regimen used to treat menopausal symptoms, and we’d like to share a few interesting facts about Duavive^® today. So with that, let’s take a quick look as to what this medication is all about.

What is Duavive^®?

Duavive^® is an oral tablet that women can take once a day for two reasons:²

• To treat moderate-to-severe vasomotor symptoms (hot flashes)
• To prevent osteoporosis – a common complication of menopause

Postmenopausal Osteoporosis

In order to understand the benefits of Duavive^®, we need to briefly talk about osteoporosis. You may think that menopause and osteoporosis are two unrelated things. But in fact, the opposite is true. Osteoporosis, which refers to weaker bones that are more prone to fractures, occurs more commonly in postmenopausal women. This is because before menopause, estrogen produced in the body helps maintain bone strength, preventing bones from being broken down through a process called resorption. But after menopause, our body is no longer able to prevent resorption because it can’t make estrogen on its own. Therefore, bones continue to break down, causing them to become more frail, brittle, and easier to break.

How Does This Relate to Duavive^®?

To understand why this matters, let’s take a look at the components of Duavive^®, which is a combination tablet of conjugated estrogen and bazedoxifene:^2,3

• Conjugated estrogens: Just like Premarin^®, estrogen is typical of most menopausal treatments.
• Bazedoxifene: This medication belongs to a class of drugs called “Selective Estrogen Receptor Modulators,”  which work by traveling through the blood to different receptors in the body where they exert their effects. Sometimes, though, the receptors for these medications are found in places of the body we don’t want the medication to go to, which creates the potential for unwanted side effects. When it comes to treating menopause, we only want the medication to work in the uterus and bones, but not the breasts or brain. Why? If these medications are active in the breasts, for example, they can result in unwanted tissue growth. However, unlike most typical treatments,  Duavive^® is unique in that it only targets the estrogen receptors relevant to treating menopause and preventing postmenopausal osteoporosis while leaving other receptors perfectly alone – such as those in the breasts.

What Else?

Besides improving menopausal symptoms, preventing osteoporosis, and minimizing the side effects associated with most estrogen medications, Duavive^® is also free of progestin-related side effects:³

• Unscheduled bleeding
• Breast pain/tenderness
• Increase in breast density (this can interfere with mammogram results and is a risk factor for breast cancer)
• Negative effects on the mood

This is because Duavive^® doesn’t contain any progestins which are often used in combinations with estrogens to treat menopause, as discussed in our previous article. Additionally, Duavive^® is not meant to be taken with progestins, meaning anyone on Duavive^® should realistically be at zero risk of experiencing the side effects of progestins. One thing to note, however, is that women who’ve previously had a hysterectomy (removal of the uterus) should not take Duavive^® for various reasons.²

The Bottom Line

In a nutshell, Duavive^® appears to be an overall great medication for women who are experiencing menopausal symptoms and are at risk of developing osteoporosis. If you want to know more about your bone health and risk of osteoporosis, you should consult with your healthcare professional. But the bottom line is: women can take this medication knowing they’re deriving multiple benefits as well as avoiding some of the side effects seen with the typical estrogen + progestin regimens.

RESOURCES

1. Duavive Product Monograph: https://pdf.hres.ca/dpd_pm/00040239.PDF
2. Lexicomp
3. Current Perspectives on the use of Menopausal Hormonal Therapy (MHT) – A Guideline and Case-Based Approach to Management. (2018). Presentation by Dr. Nese Yuksel on May 10, 2018, Edmonton, AB
4. RxTx