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Contact your eye doctor if these problems occur. Children may be more sensitive to the side effects of this drug. Discuss the possible effects of this medication with the doctor, and monitor your child's growth periodically. This medication must not be used during pregnancy.
If you become pregnant or think you may be pregnant, tell your doctor right away. This medication passes into breast milk. It may reduce the quality and amount of breast milk produced.
Consult your doctor before breast-feeding. What should I know regarding pregnancy, nursing and administering Estradiol to children or the elderly? Interactions Drug interactions may change how your medications work or increase your risk for serious side effects.
This document does not contain all possible drug interactions. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Some products that may interact with this drug include: This medication may interfere with certain laboratory tests including metyrapone test , possibly causing false test results.
Make sure laboratory personnel and all your doctors know you use this drug. Should I avoid certain foods while taking Estradiol? Overdose If someone has overdosed and has serious symptoms such as passing out or trouble breathing , call Otherwise, call a poison control center right away.
The excess risk becomes apparent within a few years of use but returns to baseline within a few at most 5 years after stopping treatment. HRT, especially oestrogen-progestagen combined treatment, increases the density of mammographic images which may adversely affect the radiological detection of breast cancer. Ovarian cancer Ovarian cancer is much rarer than breast cancer. Epidemiological evidence from a large meta-analysis suggests a slightly increased risk in women taking oestrogen-only or combined oestrogen-progestagen HRT, which becomes apparent within 5 years of use and diminishes over time after stopping.
Some other studies, including the WHI trial, suggest that use of combined HRTs may be associated with a similar or slightly smaller risk see Section 4. Venous thromboembolism HRT is associated with a 1. The occurrence of such an event is more likely in the first year of HRT than later see section 4. HRT is therefore contraindicated in these patients see section 4. There is no consensus about the possible role of varicose veins in VTE.
As in all postoperative patients, prophylactic measures need to be considered to prevent VTE following surgery. If prolonged immobilisation is to follow elective surgery, temporarily stopping HRT 4 to 6 weeks earlier is recommended. Minor As ketoconazole inhibits CYP3A4 activity, serum estrogen concentrations and estrogenic-related side effects e.
Moderate Concomitant use of lenalidomide with estrogens may increase the risk of thrombosis in patients with multiple myeloma patients who are also receiving dexamethasone. Use lenalidomide and estrogen-containing agents with caution in these patients. Monitor for signs of thromboembolism e. Moderate Lopinavir; ritonavir increases the metabolism of estrogens. Patients should be instructed to report any breakthrough bleeding or adverse events to their prescribers. Moderate Caution should be exercised when using melatonin in patients taking estrogens i.
Moderate Carefully consider the risks and benefits of coadministration before giving metreleptin and oral contraceptives concomitantly; the precise effect of metreleptin on hormone metabolism is not known. Leptin is a cytokine and may have the potential to alter the formation of cytochrome P CYP enzymes. The effect of metreleptin on CYP enzymes may be clinically relevant for CYP substrates with a narrow therapeutic index.
Severe A subtherapeutic response to metyrapone can be seen in patients on estrogen therapy. It is generally advisable to discontinue estrogens prior to and during metyrapone administration. Minor Oral contraceptives can increase the effects of midazolam because oral contraceptives inhibit oxidative metabolism, thereby increasing serum concentrations of concomitantly administered benzodiazepines that undergo oxidation.
Patients receiving oral contraceptive therapy should be observed for evidence of increased response to midazolam. Drugs that inhibit CYP3A4 such as mifepristone may increase plasma concentrations of estrogens and cause estrogen-related side effects such as nausea and breast tenderness.
Minor While information regarding this interaction is limited, it appears that the simultaneous oral administration of estrogens and mineral oil may decrease the oral absorption of the estrogens, resulting in lower estrogen plasma concentrations. This interaction may be more likely with the chronic administration of mineral oil, as opposed to a single dose of mineral oil used for occasional constipation.
In order to avoid an interaction, it would be prudent to separate administration times, giving estrogens 1 hour before or 2 hours after the oral administration of mineral oil. Minor Estrogens can cause fluid retention, increasing blood pressure and thereby antagonizing the antihypertensive effects of minoxidil. Estrogens are metabolized by CYP3A4. A decrease in estrogen concentrations, and thus efficacy, may occur in patients taking estrogens for hormone replacement therapy. If these drugs are used together, monitor patients for a decrease in clinical effects.
Dosage adjustments may be necessary. Estrogenic-related side effects, such as nausea and breast tenderness, may potentially increase when nefazodone is co-administered with either estrogens or combined hormonal contraceptives, including oral contraceptives.
An interaction has been reported clinically, but more study is needed to determine the clinical significance of this interaction in the general population. Moderate Nelfinavir has been shown to increase the metabolism of ethinyl estradiol; a similar interaction may occur with other estrogens used for hormone replacement therapy.
Patients should report any breakthrough bleeding or adverse events to their prescribers. Moderate Anti-infectives that disrupt the normal GI flora, including neomycin, may potentially decrease the effectiveness of estrogen-containing oral contraceptives. Moderate Anti-infectives which disrupt the normal GI flora, including neomycin, may potentially decrease the effectiveness of estrogen containing oral contraceptives.
Moderate Nevirapine may decrease plasma concentrations of oral contraceptives and non-oral combination contraceptives i. However despite lower exposures, literature suggests that use of nevirapine has no effect on pregnancy rates among HIV-infected women on combined oral contraceptives.
Thus, the manufacturer states that no dose adjustments are needed when these drugs are used for contraception in combination with nevirapine. When these oral contraceptives are used for hormone replacement and given with nevirapine, the therapeutic effect of the hormonal therapy should be monitored. Minor Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormonal therapy should be monitored for antihypertensive effectiveness.
Estradiol is a substrate of UGT1A1. Increased concentrations of estradiol may occur following coadministration with nilotinib. Moderate Anti-infectives that disrupt the normal GI flora may potentially decrease the effectiveness of estrogen-containing oral contraceptives. Minor The administration of estrogens may increase blood pressure, and thereby antagonizing the antihypertensive effects of nitroprusside. Major Ospemifene should not be used concomitantly with estrogens.
Moderate Estrogens are susceptible to drug interactions with hepatic enzyme inducing drugs such as oxcarbazepine. Concurrent administration of oxcarbazepine with estrogens, oral contraceptives, or non-oral combination contraceptives, progestins may increase the hormone's elimination. If used for contraception, an alternate or additional form of contraception should be considered.
Patients taking these hormones for other indications may need to be monitored for reduced clinical effect while on oxcarbazepine, with dose adjustments made based on clinical efficacy. Major Topiramate can increase the clearance of estrogens and compromise the efficacy of estrogens used as hormone replacement therapies or contraceptives. Patients taking oral contraceptives, non-oral combination contraceptives, or progestions for contraception or patients taking estrogens or progestins for hormone replacement therapy should report changes in their bleeding patterns to their prescribers.
Reduced contraceptive efficacy can occur even in the absence of breakthrough bleeding. Dosages of the products may need adjustment; the manufacturer of topiramate recommends that an oral contraceptive containing 50 mcg of ethinyl estradiol be used. Different or additional forms of contraception may also be needed.
Drugs that inhibit CYP3A4 such as systemic azole antifungals fluconazole, itraconazole, ketoconazole, miconazole, posaconazole, and voriconazole may increase plasma concentrations of estrogens and cause estrogen-related side effects such as nausea and breast tenderness. Moderate Either additive or antagonistic effects could potentially occur if prasterone is combined with estrogen therapy. Major The concurrent use of raloxifene and systemic estrogens or other hormone replacement therapy has not been studied in prospective clinical trials.
Thus, concomitant use of raloxifene with systemic estrogens is not recommended. Major Estrogens are susceptible to drug interactions with hepatic enzyme inducing drugs such as rifampin, rifabutin, or rifapentine. Concurrent administration of these drugs with estrogens, oral contraceptives, non-oral combination contraceptives, or progestins may increase the hormone's elimination.
In addition, free estrogen-hormone concentrations are decreased because rifampin increases estrogenic protein binding ability. Additionally, like other anti-infectives, rifampin indirectly inhibits the enterohepatic recirculation of estrogen through disruption of GI flora growth. If used for contraception, an alternate or additional form of contraception should be considered in patients prescribed rifampin, rifabutin, or rifapentine.
Higher-dose hormonal regimens may be indicated where acceptable or applicable. The alternative or additional contraceptive agent may need to be continued for 1 month after discontinuation of the interacting medication. Patients taking these hormones for other indications may need to be monitored for reduced clinical effect while on rifampin, rifabutin, or rifapentine, with dose adjustments made based on clinical efficacy.
Minor Estrogens reduce the oral clearance of ropinirole by 36 percent. Dosage adjustment may not be needed for ropinirole in patients on estrogen therapy because patients must be carefully titrated with ropinirole to tolerance or adequate effect. However, if estrogen therapy is stopped or started during treatment with ropinirole, then adjustment of the ropinirole dose may be required.
Moderate Saquinavir has been shown to increase the metabolism of ethinyl estradiol; a similar interaction may occur with other estrogens used for hormone replacement therapy. Moderate Selegiline concentrations may be increased by the co-administration of oral contraceptives containing estrogens and progestins. The metabolism of selegiline appears to be decreased by the presence of oral contraceptives.
Dose reductions in selegiline may be necessary in patients on combined contraceptive agents in order to limit the risk of increased MAO type B inhibition. Moderate Selegiline concentrations may be increased by the coadministration of oral contraceptives containing estrogens and progestins. In one pharmacokinetic study, it was reported that both peak and total selegiline concentrations were increased and fold, respectively, in users of oral contraceptives versus non-users.
Dose reductions in selegiline may be necessary in patients on ethinyl estradiol or hormonal combined contraceptive agents in order to limit the risk of increased MAO type B inhibition. Moderate Somatropin can induce the activity of cytochrome-mediated metabolism of antipyrine clearance. Because estrogens are also metabolized in this way, somatropin may alter the metabolism of estrogens. In addition, growth-hormone deficient women also treated with estrogen replacement therapy require substantially more somatropin therapy to obtain comparable effects when compared to women not taking estrogen.
Patients should be monitored for changes in efficacy of either drug when somatropin and estrogens are coadministered. Although specific drug interaction studies have not been completed, systemic exposure to substrates of UGT1A1, like estradiol, and UGT1A9 may increase when coadministered with sorafenib.
Moderate Theoretically, the soy isoflavones may compete with or have additive effects with, drugs that have estrogenic activity or which selectively modulate estrogen receptors. The soy isoflavones have a diphenolic structure similar to that of the potent synthetic and natural estrogens. All isoflavones are competitive ligands of in vitro estrogen receptor assays and appear to function as selective estrogen receptor modifiers SERMs.
However, the estrogenic potencies of the soy isoflavones genistein and daidzein are much weaker than that of native estradiol.
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