Short answer: Both are estradiol patches changed twice a week, in strengths from 0.025 to 0.1 mg a day.12 Minivelle is approved for menopausal hot flashes and preventing postmenopausal osteoporosis. Vivelle-Dot adds vaginal atrophy and low estrogen from hypogonadism, castration or primary ovarian failure. Neither had its own trials; both labels use Vivelle data. Both carry the estrogen boxed warning.
| Minivelle | Vivelle-Dot | |
|---|---|---|
| Approved for | Moderate to severe hot flashes from menopause; preventing postmenopausal osteoporosis1 | Moderate to severe hot flashes and vulvar and vaginal atrophy from menopause; low estrogen from hypogonadism, castration or primary ovarian failure; preventing postmenopausal osteoporosis2 |
| Strengths | 0.025, 0.0375, 0.05, 0.075 and 0.1 mg a day1 | 0.025, 0.0375, 0.05, 0.075 and 0.1 mg a day2 |
| Starting dose | Hot flashes: 0.0375 mg a day. Bone: 0.025 mg a day1 | Hot flashes or vaginal atrophy: 0.0375 mg a day. Bone: 0.025 mg a day2 |
| How often | Twice weekly, every 3 to 4 days1 | Twice weekly2 |
| Where it goes | Lower abdomen below the navel, or buttocks; not the breasts1 | Trunk, including the abdomen or buttocks; not the breasts2 |
| Side effects (Vivelle data) | Headache 31.1% on 0.05 mg vs 23.6% on placebo; breast tenderness 12.9% on 0.1 mg vs 01 | Same Vivelle table: headache 31.1% on 0.05 mg vs 23.6% on placebo; breast tenderness 12.9% on 0.1 mg vs 02 |
| If a patch falls off | Reapply it or put a new one on another spot, and keep the original schedule1 | Reapply it or put a new one on another spot, and keep the original schedule2 |
| Boxed warning | Endometrial cancer, cardiovascular disorders, probable dementia and breast cancer1 | Endometrial cancer, cardiovascular disorders, probable dementia and breast cancer2 |
Mostly the approved uses and the wording on placement. Vivelle-Dot is also approved for vaginal atrophy and for low estrogen from hypogonadism, castration or primary ovarian failure; Minivelle is not.21 The Vivelle-Dot label describes giving the patch continuously to a woman without a uterus and on a cycle, such as 3 weeks on and 1 week off, to a woman with one.2 The Minivelle label reports that in about 98% of 208 observations the patch stayed at least 90% stuck over its 84-hour wear period.1 Both labels say the side-effect numbers come from Vivelle, to which each is bioequivalent.12
Yes. Both carry the full estrogen boxed warning, based on the Women's Health Initiative studies of oral conjugated estrogens with or without medroxyprogesterone acetate. Both say a woman with a uterus generally adds a progestogen to lower endometrial cancer risk, and both list the same reasons not to use estrogen, such as past breast cancer, blood clots, stroke or heart attack, or liver disease.12 Both say to use the lowest effective dose for the shortest time that fits treatment goals.
Which, if either, fits is for your prescriber. More detail: Minivelle side effects, Vivelle-Dot side effects, the Minivelle and Vivelle-Dot dosing schedules, the Minivelle and estradiol patch missed-dose pages, and Climara vs Vivelle-Dot: how do the two estradiol patches differ?.