Progesterone: Nursing Drug Guide, Peanut Allergy & NCLEX Review
Micronized progesterone protects the endometrium when systemic estrogen is prescribed to a woman with a uterus—but Prometrium capsules contain peanut oil and are contraindicated in peanut allergy. Labeling also requires bedtime dosing because dizziness, drowsiness, and impaired driving can occur. Nurses confirm allergy status, verify progestin pairing on the MAR, and escalate thrombotic or anaphylaxis symptoms before the next capsule.
PROMETRIUM capsules contain peanut oil and must never be given to patients allergic to peanuts. Labeling also warns that progesterone may cause transient dizziness and drowsiness—capsules should be taken as a single daily dose at bedtime with caution when driving or operating machinery. When used with estrogen, discontinue progesterone immediately if DVT, pulmonary embolism, stroke, or myocardial infarction occurs or is suspected per cardiovascular warnings.
📋 Contents
⚡ Quick facts
💡 Key takeaway
Before every oral dose: confirm the patient has no peanut or peanut-oil allergy (Prometrium-specific), that progesterone is paired with estrogen when the uterus is intact, that the dose is scheduled at bedtime—not before driving—and that there are no new leg swelling, chest pain, undiagnosed bleeding, or severe CNS symptoms. Hold and clarify when peanut allergy is present, pregnancy is possible, thrombosis is suspected, or the patient took a daytime dose and feels impaired.
Most common brand names
Progesterone appears as micronized oral capsules, vaginal gel or inserts, and in compounded or fertility-clinic formulations—nurses must match the ordered product to route, strength, and excipient warnings on the label.
Prometrium (micronized progesterone capsules 100 and 200 mg; contains peanut oil) is the reference oral brand in U.S. labeling. Vaginal products such as Crinone (progesterone gel) and Endometrin (progesterone vaginal insert) use different routes and labels—do not substitute without prescriber and pharmacist approval. Generic micronized progesterone capsules may or may not contain peanut oil depending on manufacturer; verify the specific product insert.
Why we give it — Indications
Oral Prometrium is indicated for endometrial hyperplasia prevention during conjugated-estrogen therapy and for secondary amenorrhea. It may also support plans for conditions such as endometriosis per prescriber judgment outside Prometrium oral indications. Vaginal progesterone products carry separate fertility and luteal-support indications per their own labeling. Institutional protocols and product formulations may vary.
| Use | Detail |
|---|---|
| Endometrial hyperplasia prevention with estrogen | Prevention of endometrial hyperplasia in non-hysterectomized postmenopausal women receiving conjugated estrogens tablets; clinical studies with cyclic Prometrium 200 mg plus daily CE 0.625 mg showed lower hyperplasia rates than estrogen alone. |
| Secondary amenorrhea | Treatment of secondary amenorrhea; labeling gives 400 mg at bedtime for 10 days, with withdrawal bleeding reported in most women within 7 days after the course in clinical studies. |
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How it works
Micronized progesterone is chemically identical to ovarian progesterone and acts as a progestin on the endometrium, transforming proliferative endometrium to secretory endometrium when adequate estrogen is present. Oral micronization increases bioavailability. In menopause care, nurses link this to endometrial protection when systemic estrogen continues and the uterus is present, and to expected withdrawal bleeding after a short course for amenorrhea.
Onset, peak, duration, half-life
| Parameter | Value | Nursing relevance |
|---|---|---|
| Onset / peak | Maximum serum concentrations within ~3 hours after oral dose | Sedation may appear within hours—reinforce bedtime dosing and reassess if daytime doses occur |
| Peak (200 mg) | Mean Cmax ~38 ng/mL (labeling PK table; interpatient variability high) | Higher doses correlate with higher exposure; do not extrapolate beyond prescribed strength |
| Duration / half-life | Not specified in the reviewed prescribing information | Once-daily bedtime dosing per labeled regimens; do not assume next-day alertness without patient assessment |
| Food effect | Food increases bioavailability vs fasting at 200 mg | Counsel consistent timing; still take at bedtime |
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Dosing overview
Oral Prometrium dosing is indication-specific and must be taken at bedtime. Verify whether the order is cyclic with estrogen (12 days per 28-day cycle) or a 10-day amenorrhea course. Vaginal progesterone doses come from the specific product label. Dosing must be verified against current prescribing information, prescriber order, and local policy.
Missed dose: Not specified in the reviewed prescribing information. If a dose is missed, do not double without prescriber or pharmacist guidance; for cyclic estrogen–progesterone regimens, clarify whether to resume the cycle or restart sequencing.
Before you give it — Safety check
Pretreatment checks
- Confirm indication, route (oral vs vaginal), strength (100 vs 200 mg capsule), cycle day, and bedtime timing; complete medication reconciliation for all estrogen and progestin sources
- Screen for peanut or peanut-oil allergy before Prometrium—capsules contain peanut oil and are contraindicated in peanut allergy; verify generic manufacturer excipients if not Prometrium
- If patient takes systemic estradiol or other estrogen with an intact uterus, confirm progesterone is on the MAR and recently filled; check pregnancy status when relevant; review history of DVT, stroke, undiagnosed bleeding, or liver disease
Contraindications
- Hypersensitivity to ingredients—including peanut allergy (Prometrium contains peanut oil)
- Undiagnosed abnormal genital bleeding; known, suspected, or history of breast cancer or estrogen-dependent neoplasia
- Active or history of DVT, PE, arterial thromboembolic disease (stroke, MI), known liver dysfunction, or known or suspected pregnancy
Important interactions
| Drug / class | Effect | Nursing action |
|---|---|---|
| Ketoconazole and other strong CYP3A4 inhibitors | In vitro human liver microsome data suggest ketoconazole may increase progesterone bioavailability; clinical relevance unknown per labeling | Notify pharmacist when strong CYP3A4 inhibitors start or stop; monitor for increased sedation or progestin effects |
| Conjugated estrogens | Coadministration altered estrone/equilin and estradiol concentrations in a 12-day study; combined estrogen plus progestogen carries thrombotic and malignancy warnings in labeling | Never leave estrogen unopposed when uterus is intact; discontinue both if VTE occurs or is suspected |
| Food | Concomitant food increased Prometrium bioavailability relative to fasting state at 200 mg | Counsel consistent timing; bedtime dosing remains required regardless of food |
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Administration
Route: Oral micronized capsules (Prometrium 100 or 200 mg): single daily dose at bedtime with water; if swallowing is difficult, take with water while standing. Vaginal gel or inserts (e.g., Crinone, Endometrin) follow separate product labeling—do not interchange with oral capsules. Institutional protocols and product formulations may vary.
- Verify capsule strength (100 mg round peach vs 200 mg oval pale yellow) and imprint before administration—strengths are not interchangeable
- Confirm bedtime administration; do not give before shifts requiring driving if patient reports prior dizziness or sedation
- For cyclic regimens with estrogen, confirm prescribed cycle days (typically 12 sequential days per 28-day cycle with conjugated estrogens per labeling)
Prometrium may cause dizziness and drowsiness; labeling directs bedtime dosing and caution with driving or machinery. Capsules contain peanut oil—never administer to a patient with peanut allergy. A few women report blurred vision, slurred speech, or difficulty walking during initial therapy; escalate if symptoms occur.
Expected therapeutic response
- Reduced endometrial hyperplasia risk when cyclic Prometrium 200 mg is taken with daily conjugated estrogen in women with a uterus (6% vs 64% hyperplasia with estrogen alone in a 36-month study)
- Withdrawal bleeding typically within 7 days after completing a 10-day secondary-amenorrhea course when the endometrium was estrogen-primed
- Secretory endometrial transformation in estrogen-primed tissue at higher amenorrhea doses per clinical study endpoints
Red flags — Stop and act
Stop therapy and escalate per protocol when anaphylaxis, severe sedation, thrombotic, or undiagnosed bleeding red flags appear—especially on combined estrogen–progesterone therapy.
- Anaphylaxis, throat tightness, facial edema, or bronchospasm after a capsule—possible peanut or drug hypersensitivity; do not readminister Prometrium if peanut allergy
- Extreme dizziness, blurred vision, slurred speech, difficulty walking, or loss of consciousness after a dose—hold, monitor, notify prescriber per labeling CNS warnings
- Unilateral leg swelling with chest pain or shortness of breath—possible VTE; discontinue progesterone and estrogen if thrombosis occurs or is suspected
- Persistent or heavy abnormal vaginal bleeding—requires workup before continuing hormones
- Sudden partial vision loss, proptosis, diplopia, or severe headache—possible retinal vascular thrombosis or stroke; discontinue pending examination per labeling
Common and serious adverse effects
Prometrium trial data list frequent CNS, breast, and GI effects; postmarketing reports include anaphylaxis and severe sedation clusters. Nurses prioritize allergy, impairment, thrombotic, and bleeding signals.
| Category | Examples | Nursing focus |
|---|---|---|
| CNS / sedation | Dizziness (15–24% in trials), drowsiness; postmarketing blurred vision, slurred speech, vertigo, feeling drunk | Enforce bedtime dosing; hold and escalate severe impairment; fall and driving precautions |
| Hypersensitivity | Anaphylactic reaction, throat tightness, face edema, asthma; peanut oil excipient in Prometrium | Screen peanut allergy before first dose; never administer contraindicated capsules |
| Bleeding / GU | Breakthrough bleeding, spotting, abdominal cramping; abnormal uterine bleeding warnings | Distinguish expected withdrawal bleed from persistent bleeding needing workup |
| Thrombotic | DVT, PE, stroke, MI warnings with estrogen plus progestogen class data (WHI CE/MPA cited in labeling) | Discontinue if VTE occurs or is suspected; teach leg and chest red flags |
| Breast / GU other | Breast tenderness, vaginal discharge, yeast infection; breast carcinoma reported ≥2% in one trial arm | Ensure screening mammography; report new masses or nipple changes |
| Hepatic / metabolic | Cholestatic jaundice, hepatic failure (postmarketing); fluid retention, weight change | Monitor in cardiac or renal dysfunction; stop if jaundice develops |
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Overdose and antidote
No studies on overdosage have been conducted in humans per Prometrium labeling. In the case of overdosage, progesterone capsules should be discontinued and the patient treated symptomatically.
Management
- No specific antidote listed in the reviewed prescribing information—supportive care only
- Monitor for worsening dizziness, somnolence, GI symptoms, and bleeding pattern
- Contact local poison control or medical toxicology services per facility protocol when ingestion is significant or symptoms are severe
- Document product strength and all estrogen/progestin sources, including vaginal or compounded formulations
Hold further doses until prescriber and poison control advise; reassess for intentional overdose, duplicate capsules, or daytime impairment requiring observation.
Look-alike / sound-alike and error prevention
- Progesterone vs medroxyprogesterone vs prednisone—read full generic name; progestin vs corticosteroid errors are high risk
- Prometrium vs Premarin—progestin vs estrogen; verify both orders when uterus is present
- Oral Prometrium vs vaginal Crinone/Endometrin—confirm route; never administer vaginal product orally or vice versa
- 100 mg vs 200 mg capsules—peach round vs pale yellow oval; independent double-check
- Peanut-oil Prometrium vs peanut-free progestin—critical allergy verification before first dose
- Progestin omitted on MAR—critical error when estrogen continues and uterus is intact
Practical bedside notes
| Topic | Bedside guidance |
|---|---|
| Bedtime dosing | Labeling requires HS administration because of sedation; document actual time given |
| Peanut oil | Prometrium contains peanut oil—hold for peanut allergy; read generic label excipients |
| With food | Food increases oral bioavailability; still take at bedtime per labeling |
| Swallowing | If difficulty swallowing, take with water while standing per administration section |
| Withdrawal bleed | After a 10-day amenorrhea course, bleeding may occur within 7 days—document if stable |
| Commonly missed | Allergy to peanuts not linked to Prometrium order; daytime dosing before driving |
| Ask pharmacy when | Peanut-free alternative needed, unfilled progestin alerts, or vaginal vs oral product confusion |
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High-risk populations
| Population | Considerations |
|---|---|
| Peanut or tree-nut allergy history | Prometrium is contraindicated in peanut allergy because of peanut oil; clarify all nut allergies and product excipients before first dose |
| Women with uterus on systemic estrogen | Missing progesterone while estrogen continues increases unopposed estrogen exposure and endometrial hyperplasia risk; confirm pharmacy fills and cycle adherence |
| Prior VTE, obesity, smoking, cardiac or renal dysfunction | Labeling cites WHI CE/MPA thrombotic data as context for estrogen plus progestogen class risks; progesterone may cause fluid retention—observe cardiac and renal patients carefully |
| Pregnancy | Prometrium capsules should not be used during pregnancy and are contraindicated in known or suspected pregnancy. Reproductive animal studies showed little fetal harm, but there is no pregnancy indication on the reviewed label. Discontinue if pregnancy is confirmed. |
| Lactation | Detectable progestin has been identified in breast milk; use caution when administering to nursing women per labeling. Discuss alternatives with prescriber. |
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Monitoring and documentation
Monitor
- Bleeding pattern—expected withdrawal bleed vs persistent abnormal bleeding; evaluate uterine fibroids or other structural causes when bleeding is unexplained
- Sedation, dizziness, and CNS symptoms after dosing; VTE symptoms, blood pressure, weight, and edema on combined therapy
- Annual breast exam and mammography; Pap smear per screening plan; endometrial evaluation when bleeding persists
Document
- Product name (Prometrium vs generic), dose, bedtime time given, cycle days, and estrogen pairing on MAR
- Peanut allergy screen, patient teaching on bedtime dosing and thrombotic symptoms, and any sedation or driving restrictions
- Hold events, pharmacy non-fill alerts, alternative progestin orders, and prescriber reevaluation notes
Patient teaching
- Take progesterone at bedtime exactly as prescribed—daytime doses can cause dizziness or drowsiness that impairs driving
- Tell your care team about any peanut allergy before taking Prometrium; the capsule contains peanut oil
- Report leg swelling, chest pain, sudden shortness of breath, severe headache, vision changes, or heavy bleeding immediately
- If you still have a uterus and take estrogen, do not skip progesterone even when hot flashes improve on estrogen alone
- Swallow capsules with water while standing if you have trouble swallowing; contact prescriber if nausea or bloating is severe
The Hold Rule
Do not give and contact the prescriber/pharmacist when:
- Documented peanut or peanut-oil allergy when Prometrium (or peanut-oil-containing generic) is ordered—contact prescriber/pharmacist for an alternative progestin
- Known or suspected pregnancy, undiagnosed abnormal genital bleeding, active or recent DVT/PE/stroke/MI, or liver dysfunction
- Severe dizziness, blurred vision, slurred speech, or difficulty walking after a dose—especially if taken outside bedtime
- New unilateral leg swelling, acute chest pain, or sudden neurologic deficit on combined estrogen–progesterone therapy
- Estrogen on MAR without progestin when uterus is present—clarify endometrial protection plan before giving either hormone
Hold parameters may vary by institutional protocol. Follow prescriber orders, pharmacy guidance, and facility policy.
Clinical practice integration and workflow
Progesterone appears in menopause clinics, gynecology units, and fertility pathways—but every oral dose requires allergy verification, bedtime scheduling, and estrogen pairing checks that busy shifts can miss.
1. Check-before-you-give protocol
- Peanut allergy status and specific capsule manufacturer excipients
- Bedtime timing on MAR and patient alertness if dose was recently taken
- Uterus status, estrogen co-order, bleeding pattern, and thrombotic symptom screen
- Correct strength (100 vs 200 mg) and cycle day for cyclic regimens
2. High-alert and safety badge
Not a universal high-alert medicationTreat as high-stakes hormone therapy—peanut-oil contraindication, bedtime sedation risk, and progestin pairing with estrogen are core nursing responsibilities per Prometrium and estrogen-plus-progestogen labeling.
3. Clinical workflow: hold and question rules
- Admission reconciliation: verify progesterone product and peanut allergy status; substitute non–peanut-oil formulation when needed
- Pharmacy alerts for unfilled progestin while estrogen continues—contact prescriber before discharge
- If feasible, discontinue progesterone 4–6 weeks before major surgery associated with thromboembolism risk per labeling
4. Critical teach-back questions
- “Why must you take progesterone at bedtime instead of in the morning?” Because it can cause dizziness and drowsiness that make driving or working unsafe.
- “What should you report before taking Prometrium if you have a peanut allergy?” Do not take it—Prometrium contains peanut oil; the prescriber must choose a different progestin.
5. Care coordination
Prescriber / gynecology: Alternative progestin selection when peanut allergy exists, bleeding workup, cycle planning, and duration of therapy.
Pharmacist: Excipient review (peanut oil), estrogen–progesterone pairing, interaction screening, and LASA checks between progesterone and medroxyprogesterone.
🧠 Quick mental checklist
- Does this capsule contain peanut oil, and is the patient allergic to peanuts?
- Is the dose scheduled at bedtime, and is the patient safe to drive or work after prior doses?
- Is estrogen running without progesterone while the uterus is still present?
- Any new leg swelling, chest pain, neuro symptoms, or undiagnosed bleeding?
- Correct strength and cycle day—and is this oral capsule, not a vaginal product?
Progesterone NCLEX practice questions
Rehearse NCLEX-style clinical judgment practice for progesterone using a tabbed women’s-health case (MAR · Labs · History · Nursing notes) focused on peanut-oil allergy, bedtime sedation, and estrogen pairing, then work through priority action, SATA cue recognition, trend SATA, matrix urgency sorting, clinical judgment MCQ, and a documentation cloze—recognise cues → analyse → prioritise → act → evaluate outcomes.
Unfolding case. Elena is a 56-year-old postmenopausal woman with an intact uterus on conjugated estrogens 0.625 mg PO daily plus progesterone (Prometrium) 200 mg at bedtime. Yesterday her allergy list was updated to peanuts — anaphylaxis. Pharmacy reports she has not filled progesterone for 5 weeks. She reports daily spotting, left calf heaviness for 3 days, and dizziness after taking a sample capsule at breakfast. Review the case tabs before tonight's dose.
Select a tab to view MAR, labs, History, and nursing note details for this case.
- Conjugated estrogens 0.625 mg PO daily — active
- Progesterone (Prometrium) 200 mg PO at bedtime — ordered; not filled for 5 weeks per pharmacy
- Allergy list updated yesterday: Peanuts — anaphylaxis
- D-dimer today: 0.92 µg/mL FEU (elevated vs reference <0.50)
- CMP: AST 20 U/L, ALT 18 U/L; bilirubin WNL
- Last mammogram 10 months ago: BI-RADS 2 benign
- Lower-extremity venous duplex ordered; pending
- Postmenopausal; uterus intact; BMI 31
- Former smoker; sister had PE after hip surgery
- On conjugated estrogen 6 weeks; reports 2 weeks of daily spotting
- Left calf heaviness 3 days; took yesterday's progesterone sample at breakfast and felt dizzy driving
- 0910: Left calf 1 cm larger than right; mild tenderness
- 0915: Brief pleuritic chest pain overnight; currently denies pain; SpO₂ 98%
- 0920: Patient asks why pharmacy sent "peanut oil capsules" when she is allergic to peanuts
Answer key & rationale
Frequently asked questions
Why must nurses ask about peanut allergy before giving Prometrium?
Prometrium capsules contain peanut oil and are contraindicated in patients allergic to peanuts. Giving the capsule to a peanut-allergic patient can cause serious hypersensitivity, including anaphylaxis. Verify allergy history and excipients on the specific product label; choose an alternative progestin with prescriber and pharmacist when needed.
When should a nurse hold progesterone and contact the prescriber or pharmacist?
Hold for peanut allergy with peanut-oil capsules, known or suspected pregnancy, undiagnosed abnormal bleeding, active or recent DVT/PE/stroke/MI, liver disease, severe post-dose CNS impairment, or new thrombotic symptoms. Also hold and clarify when estrogen continues without progestin despite an intact uterus.
Why is progesterone taken at bedtime?
Prometrium labeling states capsules may cause transient dizziness and drowsiness and should be taken as a single daily dose at bedtime with caution when driving or operating machinery. Some women report blurred vision, slurred speech, or difficulty walking during initial therapy.
What adverse effects matter most when monitoring progesterone?
Prioritize anaphylaxis or hypersensitivity (especially with peanut oil capsules), severe dizziness or neurologic-like symptoms after dosing, thrombotic events on combined estrogen therapy, and abnormal bleeding requiring malignancy workup. Common labeled effects include headache, breast tenderness, bloating, nausea, and mood changes.
Is there an antidote for progesterone overdose?
No human overdosage studies and no specific antidote are listed in the reviewed Prometrium prescribing information. Management is discontinuation of the drug and symptomatic supportive care. Contact poison control or medical toxicology services per facility protocol when ingestion is significant or symptoms are severe.
References
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DailyMed — PROMETRIUM (progesterone, USP) capsules prescribing informationhttps://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1cf237ff-c4f8-4faa-a7aa-77599c856889
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DailyMed — PROGESTERONE capsule (generic micronized progesterone prescribing information)https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cf73c385-5173-4b54-af23-069581c5d560
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NIH NHLBI — Women’s Health Initiative (estrogen plus progestin substudy context cited in labeling)https://www.nhlbi.nih.gov/research/womens-health/womens-health-initiative
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NIH Bookshelf — LactMed: Progesterone (breastfeeding reference)https://www.ncbi.nlm.nih.gov/books/NBK546657/
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FDA — Prometrium (progesterone capsules) prescribing information update (February 2026 label revision context)https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/019781s026lbl.pdf
Review and transparency
This medication guide is written and reviewed using NurseOnShift editorial and clinical review standards.
Educational use only. This content does not replace clinical judgment, prescriber orders, pharmacist guidance, product labeling, or institutional protocols.