Short answer: CombiPatch is one patch on the lower abdomen, replaced every 3 to 4 days (twice weekly). The continuous combined regimen uses CombiPatch through the whole 28-day cycle. The continuous sequential regimen uses a 0.05 mg estradiol-only patch for days 1 to 14, then CombiPatch for days 15 to 28. The 0.05/0.14 mg patch is the starting choice; 0.05/0.25 mg gives more progestin.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What CombiPatch is approved for: CombiPatch is a patch that releases both estradiol, an estrogen, and norethindrone acetate (NETA), a progestin. It is approved for a woman with a uterus to treat moderate to severe hot flashes due to menopause, moderate to severe symptoms of vulvar and vaginal atrophy due to menopause, and low estrogen due to hypogonadism, castration or primary ovarian failure (Indications and Usage). For vaginal symptoms alone, the label says topical vaginal products should be considered.
Source
COMBIPATCH (estradiol/norethindrone acetate transdermal system), prescribing information, Patient Information and Instructions for Use. Noven Pharmaceuticals. DailyMed, version published February 27, 2024. DailyMed setid 83198ef1-11c4-11e4-9191-0800200c9a66
CombiPatch is placed on a smooth, clean, dry area of the lower abdomen, not on or near the breasts, and not on the waistline. Sites are rotated, with at least one week before the same site is used again (Dosage and Administration).
The liner is peeled off, the patch pressed on firmly for at least 10 seconds, and only one patch is worn at a time. Long sun exposure on the patch is avoided (Dosage and Administration).
Patches are kept in the refrigerator at 36°F to 46°F (2°C to 8°C) in the sealed pouch, and allowed to reach room temperature before use (How Supplied, Patient Information). Each carton has 8 systems.
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Regimen | Days 1 to 14 of the 28-day cycle | Days 15 to 28 | Change |
|---|---|---|---|
| Continuous combined | CombiPatch 0.05 mg estradiol/0.14 mg NETA per day (9 cm2) | CombiPatch 0.05/0.14 mg per day | New patch every 3 to 4 days (twice weekly) |
| Continuous sequential | Estradiol-only patch 0.05 mg per day (Vivelle-Dot) | CombiPatch 0.05/0.14 mg per day | New patch every 3 to 4 days (twice weekly) |
| Either regimen, more progestin | As above | CombiPatch 0.05 mg estradiol/0.25 mg NETA per day (16 cm2) | New patch every 3 to 4 days (twice weekly) |
Patients start at the lowest dose; the lowest effective dose of CombiPatch has not been determined in clinical trials. Women are re-evaluated at 3- to 6-month intervals to see whether therapy is still appropriate.
A woman not on continuous estrogen or estrogen plus progestin may start at any time. A woman already on such therapy finishes the current cycle first; the first day of withdrawal bleeding is a suitable start day.
On the continuous combined regimen, irregular bleeding may occur, mainly in the first six months, and generally decreases, often to no bleeding. On the sequential regimen, monthly withdrawal bleeding often occurs.
If a patch falls off, the same patch may be put back on another area of the lower abdomen, or a new one applied, and the original schedule is continued.
If feasible, estrogens are stopped at least 4 to 6 weeks before surgery linked to a higher risk of blood clots, or during long immobilization.
The Patient Information says: "If you forget to apply a new CombiPatch, you should apply a new CombiPatch as soon as possible." The Instructions for Use add that a forgotten or stopped patch may bring spotting or bleeding, and symptoms may come back.
More on this: missed a dose of CombiPatch.
Women currently using continuous estrogen or estrogen plus progestin therapy complete the current cycle before starting CombiPatch.
In Dose Track you set up CombiPatch as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.