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Premarin: the intriguing history of a controverisal drug

The history of Premarin is entangled in a fascinating story of human intrigue involving ingenuity, influence, controversy, animal rights, competition, money, protection of stockholders, government regulatory power, patient rights, emotions, greed, power, personal and professional freedom, state rights, and perhaps even, ultimately, constitutional issues. As the saga of Premarin evolves, it no doubt will continue to be one of the more interesting and compelling stories of the practice of pharmacy.

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 Hoof Beats: Premarin has been around since the 1940s. It's still controversial

Premarin is still dependent on the urine of pregnant mares, surprising given how cautious Pfizer has been since the 1970s. According to another pubmed abstract, the company wants to be known for its development of the first COVID-19 vaccine, not a company that tortures animals. Good luck with that, Pfizer.

 Premarin Controversy Continues

There are few drugs in modern history that have stimulated greater controversy than Premarin. Since its FDA approval in the early 1940s more than 30 billion doses have been dispensed. The estrogens in this hormone replacement therapy (HRT) are made from purified pregnant mare’s urine.

Articles of Interest

Estradiol, but not Premarin, preserves key brain regions in postmenopausal women at risk for dementia, study shows

When initiated soon after menopause, hormone therapy with estradiol prevented degeneration in key brain regions of women who were at heightened risk for dementia.

Hormone Replacement Therapy: The Tragedy of Premarin

Each year, thousands of horses are impregnated and then confined to cramped stalls so that their estrogen-rich urine can be collected and used by pharmaceutical companies to make the drug Premarin for hormone replacement therapy (HRT).

Menopause, as Brought to You by Big Pharma

MILLIONS of American women in the 1990s were told they could help their bodies ward off major illness by taking menopausal hormone drugs. Some medical associations said so. Many gynecologists and physicians said so. Respected medical journals said so, too. Part of the Premarin saga shows how a drug maker successfully and cannily expanded a franchise whose central ingredient is horse estrogens into a billion-dollar panacea for aging women. Yet several hundred pages of court documents also raise questions about another aspect of Premarin’s trajectory: how Wyeth worked over decades to maintain the image and credibility of its hormone drugs even as the products were repeatedly under siege.

Premarin is Extracted from Horse Urine, and that's Okay

Premarin is an important drug for many people. It’s also not the right medication, medically speaking, for many people. But claims about how the horses are mistreated seem to be just that–claims, not facts. It is ranching, and it’s well-regulated.

The checkered history of Pfizer’s Premarin family of drugs

The name Premarin® spells out in its name what it is made from — PREgant MAres uRINe. Pfizer’s Premarin® family of hormone replacement therapy drugs of today includes not only Premarin®, but also similarly manufactured pharmaceuticals — marketed at various times — under the names Prempro®, Premphase®, Provera® and later Aprela® (originally called Duavee or Duavive before its release). Add to the list Premplus which was developed by Wyeth until Pfizer came along and made them part of its empire. Premarin®, Prempro® and Premphase® are typically prescribed to women to help reduce symptoms of menopause such as hot flashes and vaginal dryness.

The Strange Case of Premarin

Until 1986, Premarin wasn’t such a big deal. Isolated from pregnant mares, the complex mixture now known to contain more than 50 estrogens was introduced in 1942 by Wyeth Ayerst (now a division of American Home Products, based in Philadelphia) as a treatment for hot flashes and other symptoms of menopause. It was a successful product for the manufacturer, but its best days were yet to come.

‘She will not become dull and unattractive’: The charming history of menopause and HRT

Premarin was marketed as not only a “cure” for menopause (which had by this time started to be framed as a disease to be treated) but as a fountain of youth. And it was promoted in ways that to our modern eyes are pretty sexist. Advertising of the era speaks of women’s misery and fear. One ad I found spells it out: “[A woman] is likely to feel that her charm is gone, and the golden days of her womanhood are irrevocably past”.