Short answer: The Evamist label starts with one spray (1.53 mg estradiol) once daily each morning on the inner forearm, near the elbow. Dose changes to two or three sprays are guided by clinical response, each on a next-to but non-overlapping area. The spray dries for about 2 minutes before clothing covers it, and the site is not washed for at least one hour.
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 Evamist is approved for: Evamist is an estradiol spray applied to the inner forearm. It is approved to treat moderate to severe hot flashes (vasomotor symptoms) due to menopause (section 1.1). The label says a woman with a uterus generally also needs a progestogen to reduce the risk of endometrial cancer (section 2).
Source
EVAMIST (estradiol transdermal spray), prescribing information, Patient Information and Instructions for Use. Padagis. DailyMed, version published November 1, 2024. DailyMed setid 9a0aa631-133d-406b-9d32-8a1a99af4e50
A new applicator is primed once with 5 sprays, cover on, held upright. It is not primed again before daily doses (section 2.1, Instructions for Use).
Sprays go on the inner surface of the forearm, starting near the elbow; other skin areas have not been adequately studied and are not used. The site dries for about 2 minutes before it is covered, and is not washed for at least one hour (section 2.1).
Each applicator gives 56 sprays of 90 mcL after priming and is not used past 56 sprays, even if not empty. It is stored at 20°C to 25°C and not frozen (section 16, Instructions for Use).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Item | Label value |
|---|---|
| Starting dose | One spray once daily each morning |
| Dose adjustment | Two or three sprays, guided by clinical response |
| Each spray | 90 mcL containing 1.53 mg estradiol |
| Where | Inner surface of the forearm, starting near the elbow; extra sprays on adjacent, non-overlapping areas |
| Priming | 5 sprays before the first dose from a new applicator |
| Sprays per applicator | 56 after priming (8.1 mL) |
When estrogen is prescribed for a woman with a uterus, adding a progestogen is generally considered to reduce the risk of endometrial cancer. A woman without a uterus generally does not need one, though some with past endometriosis may.
Estrogen is used at the lowest effective dose for the shortest duration consistent with treatment goals and risks, with periodic re-evaluation of whether treatment is still needed.
The application site is covered with clothing if another person may come into contact with it after the spray dries.
If someone touches the application site, that skin is washed thoroughly with soap and water. Pets may also be exposed if these steps are not followed.
Dose and the need for treatment are talked over regularly, for example every 3 to 6 months.
The Evamist label gives no missed-dose instruction. The Patient Information says to apply Evamist at the same time each day, but neither it nor the prescribing information says what to do if a dose is missed. Ask your prescriber what to do.
In Dose Track you set up Evamist 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.