CombiPatch (Estradiol/Norethindrone)

Name: CombiPatch
Brand: Sandoz
SKU: 0257
Availability: InStock

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Product

Manufacturer

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Qty-Price (USD)

Type:

Product: CombiPatch (ON BACKORDER)

Manufacturer: Sandoz

Country: Canada

Dosage: 0.05 mg/0.14 mg

Qty-Price (USD):

Type:

Product: CombiPatch (ON BACKORDER)

Manufacturer: Sandoz

Country: Canada

Dosage: 0.05 mg/0.25 mg

Qty-Price (USD):

Generic Equivalent of CombiPatch

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There is no generic product of CombiPatch.

CombiPatch Information

medically reviewed by Dr. HaVy Ngo, Pharmacist on June 27, 2025.

CombiPatch and Estradiol/Norethindrone at CanadaPharmacyOnline.com

Estalis is the estradiol/norethindrone combination patch available from Sandoz in Canada, while the brand name CombiPatch is more commonly associated with the United States market.

The generic version is currently unavailable (at this pharmacy).

Dosage:

CombiPatch is a transdermal patch that combines estradiol and norethindrone acetate. It is available in two strengths: 0.05 mg estradiol with either 0.14 mg or 0.25 mg of norethindrone acetate.

Your doctor will determine the appropriate dose based on your individual needs and medical conditions.

Usage:

CombiPatch (estradiol/norethindrone) is a prescription transdermal patch containing estradiol and norethindrone acetate, primarily used to treat moderate to severe menopausal symptoms such as hot flashes and vaginal dryness in women with an intact uterus. The estradiol replaces declining estrogen, alleviating symptoms, while the norethindrone acetate protects the uterus lining in women with a uterus. As a form of hormone replacement therapy (HRT), it should be used at the lowest effective dose for the shortest duration due to potential risks like blood clots and cancer; women with a hysterectomy may not need the progestin. Discuss risks and benefits with your doctor, who may suggest topical options for vaginal symptoms alone.

Mechanism of Action:
CombiPatch delivers estradiol and norethindrone acetate transdermally, bypassing first-pass liver metabolism for consistent hormone levels. Estradiol, an estrogen, replenishes declining levels, alleviating menopausal symptoms like hot flashes and vaginal dryness, and helping to maintain bone density and prevent osteoporosis. Norethindrone acetate, a progestin, is co-administered to protect the uterus's lining from estrogen-induced overgrowth, thus reducing the risk of endometrial hyperplasia and cancer. This dual-hormone action in a patch offers convenient relief of menopausal symptoms while mitigating uterine risks in women with a uterus.

Use CombiPatch exactly as your doctor prescribes, following the instructions on the Consumer Information | Novartis Canada: https://www.novartis.com/ca-en/sites/novartis_ca/files/estalis_patient_e.pdf. Consult your doctor for personalized guidance and safe use.

The information below summarizes some, but not all, potential side effects, risks, and interactions. Before taking CombiPatch, it is essential to discuss all possible side effects, risks, and interactions with your doctor or pharmacist.

Side Effects:

The information below outlines potential side effects of CombiPatch (estradiol/norethindrone). It is not an exhaustive list, and individual reactions can vary.

Common side effects - These are some common side effects of CombiPatch, but others are possible. Contact your doctor promptly if any side effects are persistent, worsening, or concerning, or if you experience any other concerning symptoms.
• Back pain
• Breast tenderness or pain
• Diarrhea
• Fluid retention (swelling of hands, ankles, feet)
• Hair loss
• Headache
• Mood changes
• Pelvic pain or cramps
• Nausea
• Skin reactions at the application site: redness, irritation, itching, rash
• Stomach pain or bloating
• Trouble sleeping (insomnia)
• Vaginitis: vaginal pain, itching, burning, or discharge
• Weakness
• Weight gain

Serious Side Effects: These are rare but potentially severe side effects. Seek immediate medical attention or call emergency services if you experience any of the following:
• Breast changes: new lumps, pain, nipple discharge.
• High blood pressure: severe headache, dizziness, vision changes.
• Memory problems, confusion, or other mental/mood changes.
• Severe allergic reaction: rash, hives, itching, swelling (especially of the face, lips, tongue, or throat), trouble breathing, severe dizziness.
• Signs of a blood clot:
o Confusion
o Coughing up blood
o Pain, swelling, warmth, or tenderness in one leg
o Slurred speech
o Sudden chest pain
o Sudden severe headache
o Trouble breathing or shortness of breath
o Vision changes or loss
o Weakness or numbness on one side of the body
• Signs of a stroke: sudden numbness or weakness (especially on one side of the body), sudden severe headache, confusion, trouble speaking or understanding, sudden vision changes, difficulty walking, dizziness, loss of balance or coordination.
• Signs of a heart attack: chest pain or pressure, pain spreading to the arm or shoulder, nausea, sweating, shortness of breath.
• Signs of liver problems: yellowing of the skin or eyes (jaundice), dark urine, pale stools, severe abdominal pain, nausea, vomiting, unusual fatigue. • Signs of gallbladder problems: severe pain in the upper right abdomen, nausea, vomiting, fever.
• Unusual vaginal bleeding: spotting, breakthrough bleeding, prolonged or heavy bleeding.

Other Potential Side Effects:
• Brown spots on the face (melasma)
• Changes in appetite
• Changes in sexual desire
• Difficulty wearing contact lenses
• Increased thirst or urination

Contraindications:

The following is not an exhaustive list of contraindications. Before starting CombiPatch, it is crucial to discuss all your medical conditions, past and present, and all medications you are taking with your doctor or pharmacist.

CombiPatch should not be used if you:
• Are allergic to estrogen, progestin, or any ingredients in CombiPatch.
• Are pregnant or think you might be pregnant.
• Have unusual vaginal bleeding that a doctor has not evaluated.
• Have or have had certain types of cancer, such as breast cancer, uterine cancer, or any other hormone-sensitive cancer. • Have or have had blood clots, such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Have had a stroke or heart attack.
• Have liver disease.
• Have a known blood clotting disorder.
• Have had a hysterectomy (removal of the uterus), as the progestin component is not needed and adds unnecessary risks.

Tell your doctor about all of your medical conditions, past and present, before starting CombiPatch. This is crucial because certain conditions affect whether CombiPatch is right for you. These conditions may include, but are not limited to:
• Cardiovascular Disorders: History of heart disease, stroke, high blood pressure, high cholesterol, or smoking.
• Dementia: Increased risk of probable dementia has been reported in women 65 years of age or older using estrogen plus progestin therapy.
• Gallbladder Disease: Increased risk of gallbladder disease requiring surgery.
• Hypercalcemia: High levels of calcium in the blood, especially in patients with breast cancer and bone metastases.
• Malignant Neoplasms: Personal or family history of breast cancer, ovarian cancer, or endometrial cancer.
• Other Conditions: Endometriosis, asthma, seizures, diabetes, migraine headaches, thyroid problems, lupus, fluid retention.
• Visual Abnormalities: Sudden partial or complete vision loss, bulging eyes, double vision, or migraine headache.

Drug Interactions:

Before taking CombiPatch, it is essential to discuss all potential risks and interactions with your doctor or pharmacist. For complete and up-to-date information, refer to Details for: Estalis - Drug and Health Product Register: https://hpr-rps.hres.ca/details.php?drugproductid=3237.

Provide your doctor with a complete list of all your medications, including prescriptions, over-the-counter (OTC) drugs, vitamins, and herbal supplements. CombiPatch may interact with other medicines, but is not limited to:

Drugs that may decrease the effectiveness of CombiPatch:
• Anticonvulsants: Certain medications used to treat seizures, including carbamazepine, phenobarbital, and phenytoin, can increase the metabolism of estrogen and progestin, potentially reducing their effectiveness.
• Antifungal medications: Oral azole antifungals like ketoconazole and itraconazole can increase the levels of estradiol and norethindrone, potentially leading to increased side effects.
• Antiviral drugs: Protease inhibitors, such as ritonavir and nelfinavir, used to treat HIV, can also increase CombiPatch levels.
• Certain antibiotics: Macrolide antibiotics like clarithromycin and erythromycin may interact with CombiPatch. However, broad-spectrum antibiotics, such as amoxicillin and azithromycin, are unlikely to significantly reduce the effectiveness of transdermal patches like CombiPatch, as transdermal delivery bypasses the gut flora interactions seen with oral estrogens.

Drugs that may increase the risk of side effects when used with CombiPatch:
Certain medications can affect estrogen levels, such as strong CYP3A4 inhibitors (e.g., some antifungals, certain HIV medications), which can increase estradiol levels.

Other medications:
These medications are generally enzyme inducers and may decrease the effectiveness of CombiPatch by increasing the metabolism of its components:
• Apalutamide (used to treat prostate cancer)
• Armodafinil and modafinil (used to treat sleep disorders)
• Bosentan (used to treat pulmonary hypertension)
• Belzutifan (used to treat kidney cancer and other tumors)
• Rifampin and rifabutin (antibiotics used to treat tuberculosis)
• St. John's Wort (a herbal supplement used for depression)

Other potential interactions:
• Certain antidepressants (tricyclic antidepressants)
• Corticosteroids (such as hydrocortisone, cortisone, prednisolone)
• Medications for diabetes: Estrogen may affect blood sugar control.
• Thyroid hormones: CombiPatch may affect thyroid hormone levels
• Warfarin (a blood thinner): CombiPatch may affect how warfarin works.

Contact Lens Use:
If you wear contact lenses, inform your doctor, as hormone therapy can sometimes cause changes in vision or make contact lenses uncomfortable.

MRI Scans:
If you are scheduled for an MRI, let your doctor know you are using a patch, as some patches contain metallic backing that could interfere with the scan or cause burns.

Smoking:
Smoking increases the risk of serious cardiovascular side effects, such as blood clots, stroke, and heart attack, especially in women over 35 years old who are using hormone therapy.

Upcoming Surgery or Medical Procedures:
If you are scheduled for any surgery or medical procedures, inform your doctor that you are using CombiPatch. You may need to stop using it temporarily.

Frequently Asked Questions about CombiPatch at Canada Pharmacy Online:

Why is CombiPatch more affordable in Canada than in the United States?

Prescription drug prices, including CombiPatch, are generally lower in Canada than in the US due to a combination of factors, primarily government price regulations, differing market dynamics, and other economic considerations. In Canada, provincial and federal governments negotiate drug prices with pharmaceutical companies, which often results in lower costs compared to the U.S., where market forces play a more significant role. For more information, see the FAQs on Prescription Drug Importation from the Kaiser Family Foundation (KFF): https://www.kff.org/health-costs/issue-brief/faqs-on-prescription-drug-importation/

What is the difference between CombiPatch 0.05 mg/0.14 mg and 0.05 mg/0.25 mg?

The difference in dosage represents the different amount of the same active ingredient (estradiol/norethindrone) present in each patch.

How much is the shipping?

Our shipping fee is a flat rate of $10.00 per order. Our pharmacy focuses on offering you the lowest prices on high-quality products.

How do I order from your pharmacy?

Ordering from us is very simple. You can purchase online or call Customer Service at 1866.920.3784; for more information or to learn about the ordering process, visit our How to Order page.

Is there a limit on how many patches I am allowed to order at one time?

CanadaPharmacyOnline.com can only dispense a maximum of a three-month supply of CombiPatch at once, per your doctor's prescription.

Can I buy over the counter from you?

No, CombiPatch requires a valid prescription from your doctor. We do not sell this product without a valid prescription.

Do you ship to the United States?

Yes, we do. It usually takes 7 to 18 business days to receive your order from our pharmacy.

Can I shower, bathe, or swim while wearing CombiPatch?

You can bathe, shower, or swim while wearing CombiPatch, as these activities should not affect the patch. However, avoid prolonged sun exposure to the patch.

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The information on this page is sourced from independent third parties contracted by CanadaPharmacyOnline. While we cannot guarantee its medical accuracy, we strongly recommend consulting a healthcare professional for personalized advice regarding medications or medical conditions.

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