The US Food and Drug Administration is warning that inadvertent exposure to Evamist through skin contact with patients using this product has the potential for adverse effects in children and pets.

Evamist contains estradiol, an estrogen hormone, and is used in women to reduce hot flashes during menopause. The drug is sprayed on the skin between the elbow and wrist, on the inside of the forearm. The US FDA currently is reviewing reports of adverse events in children and pets who were inadvertently exposed to this topical estrogen product.

"Women using Evamist need to be aware of the potential risks to children who come in contact with the area of skin where this drug is applied," said Julie Beitz, director of the US FDA's Office of Drug Evaluation III. "It is important that people know to keep both children and pets away from the product to minimize exposure."

Evamist was US FDA approved in 2007. From July 2007 to June 2010, US FDA received eight post-marketing cases of unintended exposure to Evamist in children ages three years to five years. Adverse events reported in unintentionally exposed children include premature puberty, nipple swelling and breast development in females, and breast enlargement in males. Since 2007, two reports of secondary exposure to Evamist in dogs also have been received by US FDA's Center for Veterinary Medicine. Pets exposed to Evamist may exhibit signs such as mammary/nipple enlargement and vulvar swelling.

Patients using Evamist should not allow children to make contact with the area of the arm where Evamist is sprayed and should wash the child's skin with soap and water as soon as possible if contact does occur. Pets also should not be allowed to lick or touch the arm where Evamist is sprayed as small pets may be especially sensitive to the estrogen in this product. If direct contact with the arm where Evamist was sprayed cannot be avoided, it is recommended that women wear a garment that covers the area where the drug was applied.

At this time, it is unknown whether unintended exposure can occur with other topical estrogen products. The US FDA is continuing to review adverse event reports and evaluate ways to reduce unintended exposures to these products.