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Vagifem Disease Interactions

There are 17 disease interactions with Vagifem (estradiol topical).

Major

Estrogens (applies to Vagifem) abnormal vaginal bleeding

Major Potential Hazard, High plausibility. Applicable conditions: Abnormal Uterine Bleeding

The use of estrogens is contraindicated in patients with undiagnosed, abnormal vaginal bleeding. Prolonged (> 1 year), unopposed estrogen use (i.e. estrogen without concomitant progestin therapy) has been associated with a significant, dose-related risk of endometrial carcinoma. The risk may be offset substantially by the addition of a progestin but may not be completely abolished. Prior to initiating estrogen therapy, appropriate diagnostic tests should be performed in patients with abnormal vaginal bleeding to rule out endometrial malignancy. The same applies if recurrent or persistent bleeding develops during estrogen therapy.

References

  1. Obrink A, Bunne G, Collen J, Tjernberg B (1979) "Endometrial cancer and exogenous estrogens." Acta Obstet Gynecol Scand, 58, p. 123
  2. Spengler RF, Clarke EA, Woolever CA, Newman AM, Osborn RW (1981) "Exogenous estrogens and endometrial cancer: a case-control study and assessment of potential biases." Am J Epidemiol, 114, p. 497-506
  3. Buring JE, Bain CJ, Ehrmann RL (1986) "Conjugated estrogen use and risk of endometrial cancer." Am J Epidemiol, 124, p. 434-41
  4. Persson I, Adami HO, Bergkvist L, Lindgren A, Pettersson B, Hoover R, Schairer C (1989) "Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study." BMJ, 298, p. 147-51
  5. Antunes CM, Strolley PD, Rosenshein NB, Davies JL, Tonascia JA, Brown C, Burnett L, Rutledge A, Pokempner M, Garcia R (1979) "Endometrial cancer and estrogen use. Report of a large case-control study." N Engl J Med, 300, p. 9-13
  6. Gordon J, Reagan JW, Finkle WD, Ziel HK (1977) "Estrogen and endometrial carcinoma. An independent pathology review supporting original risk estimate." N Engl J Med, 297, p. 570-1
  7. Shapiro S, Kelly JP, Rosenberg L, Kaufman DW, Helmrich SP, Rosenshein NB, Lewis JL Jr, Knapp RC, Stolley PD, Schottenfeld D (1985) "Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens." N Engl J Med, 313, p. 969-72
  8. Gray LA Sr, Christopherson WM, Hoover RN (1977) "Estrogens and endometrial carcinoma." Obstet Gynecol, 49, p. 385-9
  9. Woodruff JD, Pickar JH (1994) "Incidence of endometrial hyperplasia in postmenopausal women taking conjugated estrogens (Premarin) with medroxyprogesterone acetate or conjugated estrogens alone." Am J Obstet Gynecol, 170, p. 1213-23
  10. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  11. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  12. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  13. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  14. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  15. The Writing Group for the PEPI Trial (1996) "Effects of hormone replacement therapy on endometrial histology in postmenopausal women." JAMA, 275, p. 370-5
  16. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  17. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  18. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  19. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  20. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  21. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  22. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  23. (2001) "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn
  24. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  25. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  26. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  27. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  28. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  29. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
  30. (2023) "Product Information. Intrarosa (prasterone)." Theramex Australia Pty Ltd, 1
View all 30 references
Major

Estrogens (applies to Vagifem) carcinomas (estrogenic)

Major Potential Hazard, High plausibility. Applicable conditions: Neoplasia -- Estrogen Dependent

The use of estrogens is generally contraindicated in patients with known or suspected estrogen-dependent neoplasia such as breast and endometrial cancer, since it may stimulate tumor proliferation. High dosages of estrogens may be used for the palliative treatment of inoperable, metastatic breast cancer, but only in appropriately selected men and postmenopausal women.

References

  1. Ewertz M (1992) "Oral contraceptives and breast cancer risk in Denmark." Eur J Cancer, 28A, p. 1176-81
  2. Obrink A, Bunne G, Collen J, Tjernberg B (1979) "Endometrial cancer and exogenous estrogens." Acta Obstet Gynecol Scand, 58, p. 123
  3. Palmer JR, Rosenberg L, Clarke EA, Miller DR, Shapiro S (1991) "Breast cancer risk after estrogen replacement therapy: results from the Toronto Breast Cancer Study." Am J Epidemiol, 134, p. 1386-95
  4. Kaufman DW, Palmer JR, de Mouzon J, Rosenberg L, Stolley PD, Warshauer ME, Zauber AG, Shapiro S (1991) "Estrogen replacement therapy and the risk of breast cancer: results from the case-control surveillance study." Am J Epidemiol, 134, p. 1375-85
  5. Spengler RF, Clarke EA, Woolever CA, Newman AM, Osborn RW (1981) "Exogenous estrogens and endometrial cancer: a case-control study and assessment of potential biases." Am J Epidemiol, 114, p. 497-506
  6. Buring JE, Bain CJ, Ehrmann RL (1986) "Conjugated estrogen use and risk of endometrial cancer." Am J Epidemiol, 124, p. 434-41
  7. Persson I, Adami HO, Bergkvist L, Lindgren A, Pettersson B, Hoover R, Schairer C (1989) "Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study." BMJ, 298, p. 147-51
  8. Hoover R, Glass A, Finkle WD, Azevedo D, Milne K (1981) "Conjugated estrogens and breast cancer risk in women." J Natl Cancer Inst, 67, p. 815-20
  9. Thomas DB, Persing JP, Hutchinson WB (1982) "Exogenous estrogens and other risk factors for breast cancer in women with benign breast diseases." J Natl Cancer Inst, 69, p. 1017-25
  10. Antunes CM, Strolley PD, Rosenshein NB, Davies JL, Tonascia JA, Brown C, Burnett L, Rutledge A, Pokempner M, Garcia R (1979) "Endometrial cancer and estrogen use. Report of a large case-control study." N Engl J Med, 300, p. 9-13
  11. Gordon J, Reagan JW, Finkle WD, Ziel HK (1977) "Estrogen and endometrial carcinoma. An independent pathology review supporting original risk estimate." N Engl J Med, 297, p. 570-1
  12. Bergkvist L, Adami HO, Persson I, Hoover R, Schairer C (1989) "The risk of breast cancer after estrogen and estrogen-progestin replacement." N Engl J Med, 321, p. 293-7
  13. Shapiro S, Kelly JP, Rosenberg L, Kaufman DW, Helmrich SP, Rosenshein NB, Lewis JL Jr, Knapp RC, Stolley PD, Schottenfeld D (1985) "Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens." N Engl J Med, 313, p. 969-72
  14. Gray LA Sr, Christopherson WM, Hoover RN (1977) "Estrogens and endometrial carcinoma." Obstet Gynecol, 49, p. 385-9
  15. Delgado-Rodriguez M, Sillero-Arenas M, Martin-Moreno JM, Galvez-Vargas R (1992) "Oral contraceptives and cancer of the cervix uteri. A meta-analysis." Acta Obstet Gynecol Scand, 71, p. 368-76
  16. Sillero-Arenas M, Rodriguez-Contreras R, Delgado-Rodriguez M, Bueno-Cavanillas A, Galvez-Vargas R (1991) "Patterns of research. Oral contraceptives and cervical cancer." Acta Obstet Gynecol Scand, 70, p. 143-8
  17. Lund E (1992) "Oral contraceptives and breast cancer. A review with some comments on mathematical models." Acta Oncol, 31, p. 183-6
  18. Miller DR, Rosenberg L, Kaufman DW, Stolley P, Warshauer ME, Shapiro S (1989) "Breast cancer before age 45 and oral contraceptive use: new findings." Am J Epidemiol, 129, p. 269-80
  19. Rosenberg L, Palmer JR, Clarke EA, Shapiro S (1992) "A case-control study of the risk of breast cancer in relation to oral contraceptive use." Am J Epidemiol, 136, p. 1437-44
  20. Schlesselman JJ (1990) "Oral contraceptives and breast cancer." Am J Obstet Gynecol, 163, p. 1379-87
  21. Turnquest MA (1993) "Oral contraceptive use and incidence of cervical intraepithelial neoplasia." Am J Obstet Gynecol, 168, p. 1895-6
  22. Kaunitz AM (1992) "Oral contraceptives and gynecologic cancer: an update for the 1990s." Am J Obstet Gynecol, 167, p. 1171-6
  23. Romieu I, Willett WC, Colditz GA, Stampfer MJ, Rosner B, Hennekens CH, Speizer FE (1989) "Prospective study of oral contraceptive use and risk of breast cancer in women." J Natl Cancer Inst, 81, p. 1313-21
  24. Olsson H, Moller TR, Ranstam J (1989) "Early oral contraceptive use and breast cancer among premenopausal women: final report from a study in southern Sweden." J Natl Cancer Inst, 81, p. 1000-4
  25. Jones MW, Silverberg SG (1989) "Cervical adenocarcinoma in young women: possible relationship to microglandular hyperplasia and use of oral contraceptives." Obstet Gynecol, 73, p. 984-9
  26. Murray PP, Stadel BV, Schlesselman JJ (1989) "Oral contraceptive use in women with a family history of breast cancer." Obstet Gynecol, 73, p. 977-83
  27. Thomas DB (1991) "Oral contraceptives and breast cancer: review of the epidemiologic literature." Contraception, 43, p. 597-642
  28. Brinton LA (1991) "Oral contraceptives and cervical neoplasia." Contraception, 43, p. 581-95
  29. (1992) "Oral contraceptives and neoplasia. WHO Scientific Group." World Health Organ Tech Rep Ser, 817, p. 1-46
  30. Woodruff JD, Pickar JH (1994) "Incidence of endometrial hyperplasia in postmenopausal women taking conjugated estrogens (Premarin) with medroxyprogesterone acetate or conjugated estrogens alone." Am J Obstet Gynecol, 170, p. 1213-23
  31. Mishell DR (1989) "Contraception." N Engl J Med, 320, p. 777-85
  32. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  33. Lavecchia C, Negri E, Franceschi S, Talamini R, Amadori D, Filiberti R, Conti E, Montella M, Veronesi A, Parazzini F, Ferraroni M (1995) "Oral contraceptives and breast cancer: a cooperative italian study." Int J Cancer, 60, p. 163-7
  34. Colditz GA, Hankinson SE, Hunter DJ, et al. (1995) "The use of estrogens and progestins and the risk of breast cancer in postmenopausal women." N Engl J Med, 332, p. 1589-93
  35. Stanford JL, Weiss NS, Voigt LF, Daling JR, Habel LA, Rossing MA (1995) "Combined estrogen and progestin hormone replacement therapy in relation to risk of breast cancer in middle-aged women." JAMA, 274, p. 137-42
  36. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  37. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  38. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  39. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  40. The Writing Group for the PEPI Trial (1996) "Effects of hormone replacement therapy on endometrial histology in postmenopausal women." JAMA, 275, p. 370-5
  41. Zondervan KT, Carpenter LM, Painter R, Vessey MP (1996) "Oral contraceptives and cervical cancer - further findings from the oxford family planning association contraceptive study." Br J Cancer, 73, p. 1291-7
  42. Calle EE, Heath CW, Miraclemcmahill HL, Coates RJ, Liff JM, Franceschi S, Talamini R, Chantarakul N, Koetsawang S, Rachawat D (1996) "Breast cancer and hormonal contraceptives: further results." Contraception, 54 (suppl, s1-106
  43. Rettig BA, Lemon HM (1996) "Cancers related to contraceptive use." Br J Cancer, 74, p. 1509-10
  44. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  45. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  46. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  47. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  48. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  49. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  50. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  51. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  52. Greendale GA, Reboussin BA, Sie A, et al. (1999) "Effects of estrogen and estrogen-progestin on mammographic parenchymal density." Ann Intern Med, 130, p. 262-9
  53. Gapstur SM, Morrow M, Sellers TA (1999) "Hormone replacement therapy and risk of breast cancer with a favorable histology: results of the Iowa women's health study." JAMA, 281, p. 2091-7
  54. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  55. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  56. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  57. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  58. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
  59. (2023) "Product Information. Intrarosa (prasterone)." Theramex Australia Pty Ltd, 1
View all 59 references
Major

Estrogens (applies to Vagifem) hypercalcemia in breast cancer

Major Potential Hazard, Moderate plausibility.

When treated with an estrogen, patients with breast cancer and bone metastases may develop severe hypercalcemia, in which case the drug should be stopped and measures be taken to reduce serum calcium levels.

References

  1. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  2. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  3. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  4. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  5. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  6. (2001) "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn
  7. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  8. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  9. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  10. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  11. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
View all 11 references
Major

Estrogens (applies to Vagifem) hypertension

Major Potential Hazard, High plausibility.

The risk of myocardial infarction and strokes, including those associated with oral contraceptive use and some estrogen use, is increased in patients with hypertension. Moreover, estrogens (and progestogens) may elevate blood pressure and worsen the hypertension, thus compounding the risk. Clinically significant blood pressure increases have been reported during estrogen therapy, particularly in patients receiving high dosages or treated with oral contraceptive combinations having high progestational activity. These effects also increase with duration of therapy and patient age. Therapy with estrogens should be administered cautiously in patients with preexisting hypertension. Patients should be monitored for changes in cardiovascular status, and their antihypertensive regimen adjusted or estrogen therapy withdrawn as necessary. In patients requiring contraception, alternative methods should be considered for those who are hypertensive, over age 35, and smoke.

References

  1. Leiman G (1972) "Depo-medroxyprogesterone acetate as a contraceptive agent: its effect on weight and blood pressure." Am J Obstet Gynecol, 114, p. 97-102
  2. Williams RS (1992) "Benefits and risks of oral contraceptive use." Postgrad Med, 92, p. 155-7
  3. Crane MG, Harris JJ (1978) "Estrogens and hypertension: effect of discontinuing estrogens on blood pressure, exchangeable sodium, and the renin-aldosterone system." Am J Med Sci, 276, p. 33-55
  4. Crane MG, Harris JJ, Winsor W 3d (1971) "Hypertension, oral contraceptive agents, and conjugated estrogens." Ann Intern Med, 74, p. 13-21
  5. Rosenberg L, Slone D, Shapiro S, Kaufman D, Stolley PD, Miettinen OS (1980) "Noncontraceptive estrogens and myocardial infarction in young women." JAMA, 244, p. 339-42
  6. Jick H, Dinan B, Rothman KJ (1978) "Noncontraceptive estrogens and nonfatal myocardial infarction." JAMA, 239, p. 1407-8
  7. Wren BG, Routledge DA (1981) "Blood pressure changes: oestrogens in climacteric women." Med J Aust, 2, p. 528-31
  8. Rosenberg L, Palmer JR, Lesko SM, Shapiro S (1990) "Oral contraceptive use and the risk of myocardial infarction." Am J Epidemiol, 131, p. 1009-16
  9. Thorogood M, Mann J, Murphy M, Vessey M (1992) "Fatal stroke and use of oral contraceptives: findings from a case- control study." Am J Epidemiol, 136, p. 35-45
  10. Leaf DA, Bland D, Schaad D, Neighbor WE, Scott CS (1991) "Oral contraceptive use and coronary risk factors in women." Am J Med Sci, 301, p. 365-8
  11. Thorneycroft IH (1990) "Oral contraceptives and myocardial infarction." Am J Obstet Gynecol, 163, p. 1393-7
  12. Lidegaard O (1993) "Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study." BMJ, 306, p. 956-63
  13. Derman RJ (1990) "Oral contraceptives and cardiovascular risk. Taking a safe course of action." Postgrad Med, 88, p. 119-22
  14. Hannaford PC, Croft PR, Kay CR (1994) "Oral contraception and stroke. Evidence from the Royal College of General Practitioners' Oral Contraception Study." Stroke, 25, p. 935-42
  15. Steinberg WM (1989) "Oral contraception: risks and benefits." Adv Contracept, 5, p. 219-28
  16. Peterson HB, Lee NC (1990) "Long-term health risks and benefits of oral contraceptive use." Obstet Gynecol Clin North Am, 17, p. 775-88
  17. Derman R (1989) "Oral contraceptives: a reassessment." Obstet Gynecol Surv, 44, p. 662-8
  18. Belchetz PE (1994) "Hormonal treatment of postmenopausal women." N Engl J Med, 330, p. 1062-71
  19. Stampfer MJ, Colditz GA, Willett WC, et al. (1991) "Postmenopausal estrogen and cardiovascular disease. Ten-year follow-up from the Nurses' Health Study." N Engl J Med, 325, p. 756-62
  20. Barrett-Connor E, Bush TL (1991) "Estrogen and coronary heart disease in women." JAMA, 265, p. 1861-7
  21. Barrett-Connor E, Wingard DL, Criqui MH (1989) "Postmenopausal estrogen use and heart disease risk factors in the 1980s. Rancho Bernardo, Calif, revisited." JAMA, 261, p. 1095-2100
  22. Mishell DR (1989) "Contraception." N Engl J Med, 320, p. 777-85
  23. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  24. Schwartz J, Freeman R, Frishman W (1995) "Clinical pharmacology of estrogens: cardiovascular actions and cardioprotective benefits of replacement therapy in postmenopausal women." J Clin Pharmacol, 35, p. 1-16
  25. The Writing Group for the PEPI Trial (1995) "Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial." JAMA, 273, p. 199-208
  26. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  27. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  28. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  29. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  30. Norris LA, Bonnar J (1996) "The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives." Br J Obstet Gynaecol, 103, p. 261-7
  31. Levine AB, Teppa J, Mcgough B, Cowchock FS (1996) "Evaluation of the prethrombotic state in pregnancy and in women using oral contraceptives." Contraception, 53, p. 255-7
  32. Petitti DB, Sidney S, Bernstein A, Wolf S, Quesenberry C, Ziel HK (1996) "Stroke in users of low-dose oral contraceptives." N Engl J Med, 335, p. 8-15
  33. Speroff L (1996) "Oral contraceptives and venous thromboembolism." Int J Gynaecol Obstet, 54, p. 45-50
  34. Poulter NR, Chang CL, Farley TMM, Meirik O, Marmot MG, Debertribeiro M, Medina E, Artigas J, Shen H, Zhong YH, Zhang DW, (1996) "Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case-control study." Lancet, 348, p. 498-505
  35. Poulter NR, Chang CL, Farley TMM, Meirik O, Marmot MG (1996) "Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study." Lancet, 348, p. 505-10
  36. Piegsa K, Guillebaud J (1996) "Oral contraceptives and the risk of DVT." Practitioner, 240, p. 544
  37. Martinelli I, Rosendaal FR, Vandenbroucke JP, Mannucci PM (1996) "Oral contraceptives are a risk factor for cerebral vein thrombosis." Thromb Haemost, 76, p. 477-8
  38. Farley TMM, Meirik O, Poulter NR, Chang CL, Marmot MG (1996) "Oral contraceptives and thrombotic diseases: impact of new epidemiological studies." Contraception, 54, p. 193-5
  39. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  40. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  41. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  42. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  43. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  44. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  45. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  46. Sidney S, Petitti DB, Quesenberry CP (1997) "Myocardial infarction and the use of estrogen and estrogen-progestogen in postmenopausal women." Ann Intern Med, 127, p. 501-8
  47. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  48. Thorogood M (1999) "Risk of stroke in users of oral contraceptives." JAMA, 281, p. 1255-6
  49. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  50. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  51. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  52. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  53. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 53 references
Major

Estrogens (applies to Vagifem) thromboembolism/cardiovascular

Major Potential Hazard, High plausibility. Applicable conditions: History - Thrombotic/Thromboembolic Disorder, Ischemic Heart Disease, Thrombotic/Thromboembolic Disorder, Migraine, Cerebral Vascular Disorder

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic or thromboembolic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Although the clinical significance of these effects is unknown, epidemiological data suggest it may be dose-dependent. The risk is probably slight with the use of newer, low-dose oral contraceptives in the absence of known risk factors (e.g., smoker, particularly over the age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40). However, a much more significant risk has been reported with higher dosages, such as those used to treat prostate or metastatic breast cancer or those used in older formulations of birth control pills. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of breast or prostatic malignancy.

References

  1. Notelovitz M (1985) "Oral contraception and coagulation." Clin Obstet Gynecol, 28, p. 73-83
  2. Meade TW (1982) "Oral contraceptives, clotting factors, and thrombosis." Am J Obstet Gynecol, 142, p. 758-61
  3. Williams RS (1992) "Benefits and risks of oral contraceptive use." Postgrad Med, 92, p. 155-7
  4. Rosenberg L, Slone D, Shapiro S, Kaufman D, Stolley PD, Miettinen OS (1980) "Noncontraceptive estrogens and myocardial infarction in young women." JAMA, 244, p. 339-42
  5. Jick H, Dinan B, Rothman KJ (1978) "Noncontraceptive estrogens and nonfatal myocardial infarction." JAMA, 239, p. 1407-8
  6. Boschetti C, Cortellaro M, Nencioni T, Bertolli V, Della Volpe A, Zanussi C (1991) "Short- and long-term effects of hormone replacement therapy (transdermal estradiol vs oral conjugated equine estrogens, combined with medroxyprogesterone acetate) on blood coagulation factors in postmenopausal women." Thromb Res, 62, p. 1-8
  7. Rosenberg L, Palmer JR, Lesko SM, Shapiro S (1990) "Oral contraceptive use and the risk of myocardial infarction." Am J Epidemiol, 131, p. 1009-16
  8. Thorogood M, Mann J, Murphy M, Vessey M (1992) "Fatal stroke and use of oral contraceptives: findings from a case- control study." Am J Epidemiol, 136, p. 35-45
  9. Leaf DA, Bland D, Schaad D, Neighbor WE, Scott CS (1991) "Oral contraceptive use and coronary risk factors in women." Am J Med Sci, 301, p. 365-8
  10. Thorneycroft IH (1990) "Oral contraceptives and myocardial infarction." Am J Obstet Gynecol, 163, p. 1393-7
  11. Lidegaard O (1993) "Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study." BMJ, 306, p. 956-63
  12. Derman RJ (1990) "Oral contraceptives and cardiovascular risk. Taking a safe course of action." Postgrad Med, 88, p. 119-22
  13. Hannaford PC, Croft PR, Kay CR (1994) "Oral contraception and stroke. Evidence from the Royal College of General Practitioners' Oral Contraception Study." Stroke, 25, p. 935-42
  14. Steinberg WM (1989) "Oral contraception: risks and benefits." Adv Contracept, 5, p. 219-28
  15. Miwa LJ, Edmunds AL, Shaefer MS, Raynor SC (1989) "Idiopathic thromboembolism associated with triphasic oral contraceptives." DICP, 23, p. 773-5
  16. Beaumont V, Lemort N, Beaumont JL (1991) "Oral contraceptives, sex steroid-induced antibodies and vascular thrombosis: results from 1318 cases." Eur Heart J, 12, p. 1219-24
  17. Key JD, Hammill WW, Everett L (1992) "Pulmonary embolus in an adolescent on oral contraceptives." J Adolesc Health, 13, p. 713-5
  18. Burkman RT Jr (1991) "Benefits and risk of oral contraceptives. A reassessment." J Reprod Med, 36, p. 217-8
  19. Peterson HB, Lee NC (1990) "Long-term health risks and benefits of oral contraceptive use." Obstet Gynecol Clin North Am, 17, p. 775-88
  20. Boston Collaborative Drug Surveilance Program (1974) "Surgically confirmed gallbladder disease, venous thromboembolism, and breast tumors in relation to postmenopausal estrogen therapy." N Engl J Med, 290, p. 15-9
  21. Belchetz PE (1994) "Hormonal treatment of postmenopausal women." N Engl J Med, 330, p. 1062-71
  22. Devor M, Barrett-Connor E, Renvall M, Feigal D, Ramsdell J (1992) "Estrogen replacement therapy and the risk of venous thrombosis." Am J Med, 92, p. 275-81
  23. Barrett-Connor E, Bush TL (1991) "Estrogen and coronary heart disease in women." JAMA, 265, p. 1861-7
  24. Grady D, Rubin SM, Petiti DB, et al. (1992) "Hormone therapy to prevent disease and prolong life in postmenopausal women." Ann Intern Med, 117, p. 1016-36
  25. Barrett-Connor E, Wingard DL, Criqui MH (1989) "Postmenopausal estrogen use and heart disease risk factors in the 1980s. Rancho Bernardo, Calif, revisited." JAMA, 261, p. 1095-2100
  26. Mishell DR (1989) "Contraception." N Engl J Med, 320, p. 777-85
  27. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  28. Schwartz J, Freeman R, Frishman W (1995) "Clinical pharmacology of estrogens: cardiovascular actions and cardioprotective benefits of replacement therapy in postmenopausal women." J Clin Pharmacol, 35, p. 1-16
  29. Lidegaard O (1995) "Oral contraceptives, pregnancy and the risk of cerebral thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease." Br J Obstet Gynaecol, 102, p. 153-9
  30. The Writing Group for the PEPI Trial (1995) "Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial." JAMA, 273, p. 199-208
  31. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  32. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  33. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  34. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  35. Norris LA, Bonnar J (1996) "The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives." Br J Obstet Gynaecol, 103, p. 261-7
  36. Levine AB, Teppa J, Mcgough B, Cowchock FS (1996) "Evaluation of the prethrombotic state in pregnancy and in women using oral contraceptives." Contraception, 53, p. 255-7
  37. Petitti DB, Sidney S, Bernstein A, Wolf S, Quesenberry C, Ziel HK (1996) "Stroke in users of low-dose oral contraceptives." N Engl J Med, 335, p. 8-15
  38. Speroff L (1996) "Oral contraceptives and venous thromboembolism." Int J Gynaecol Obstet, 54, p. 45-50
  39. Poulter NR, Chang CL, Farley TMM, Meirik O, Marmot MG, Debertribeiro M, Medina E, Artigas J, Shen H, Zhong YH, Zhang DW, (1996) "Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case-control study." Lancet, 348, p. 498-505
  40. Poulter NR, Chang CL, Farley TMM, Meirik O, Marmot MG (1996) "Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study." Lancet, 348, p. 505-10
  41. Piegsa K, Guillebaud J (1996) "Oral contraceptives and the risk of DVT." Practitioner, 240, p. 544
  42. Martinelli I, Rosendaal FR, Vandenbroucke JP, Mannucci PM (1996) "Oral contraceptives are a risk factor for cerebral vein thrombosis." Thromb Haemost, 76, p. 477-8
  43. Farley TMM, Meirik O, Poulter NR, Chang CL, Marmot MG (1996) "Oral contraceptives and thrombotic diseases: impact of new epidemiological studies." Contraception, 54, p. 193-5
  44. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  45. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  46. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  47. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  48. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  49. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  50. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  51. Sidney S, Petitti DB, Quesenberry CP (1997) "Myocardial infarction and the use of estrogen and estrogen-progestogen in postmenopausal women." Ann Intern Med, 127, p. 501-8
  52. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E (1998) "Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women." JAMA, 280, p. 605-13
  53. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  54. Petitti DB (1998) "Hormone replacement therapy and heart disease prevention: experimentation trumps observation." JAMA, 280, p. 650-2
  55. Thorogood M (1999) "Risk of stroke in users of oral contraceptives." JAMA, 281, p. 1255-6
  56. Mendelsohn ME, Karas RH (1999) "The protective effects of estrogen on the cardiovascular system." N Engl J Med, 340, p. 1801-11
  57. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  58. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  59. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  60. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  61. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
  62. (2023) "Product Information. Intrarosa (prasterone)." Theramex Australia Pty Ltd, 1
View all 62 references
Major

Estrogens/progestogens (applies to Vagifem) hepatic neoplasms

Major Potential Hazard, High plausibility. Applicable conditions: Hepatic Tumor

The use of oral contraceptives is contraindicated in patients with liver tumors. An increased risk of benign hepatic adenomas and hepatocellular carcinomas has been associated with long-term, oral estrogen- progestin contraceptive use of at least 4 years and 8 years, respectively. Although these tumors are rare and have not been reported with other types of estrogen or progestogen therapies, any preparation containing estrogens and/or progestogens should probably be avoided in patients with existing tumors of the liver. Hepatic hemangiomas and nodular hyperplasia of the liver have been reported with isolated estrogen therapy.

References

  1. Tao LC (1991) "Oral contraceptive-associated liver cell adenoma and hepatocellular carcinoma." Cancer, 68, p. 341-7
  2. (1991) "Depot-medroxyprogesterone acetate (DMPA) and risk of liver cancer. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives." Int J Cancer, 49, p. 182-5
  3. Conter RL, Longmire WP Jr (1988) "Recurrent hepatic hemangiomas. Possible association with estrogen therapy." Ann Surg, 207, p. 115-9
  4. Aldinger K, Ben-Menachem Y, Whalen G (1977) "Focal nodular hyperplasia of the liver associated with high-dosage estrogens." Arch Intern Med, 137, p. 357-9
  5. Palmer JR, Rosenberg L, Kaufman DW, Warshauer ME, Stolley P, Shapiro S (1989) "Oral contraceptive use and liver cancer." Am J Epidemiol, 130, p. 878-82
  6. Mooney MJ, Nyreen MR, Hall RA, Carter PL (1993) "Hepatic adenoma presenting as a right lower quadrant mass." Am Surg, 59, p. 229-31
  7. Gyorffy EJ, Bredfeldt JE, Black WC (1989) "Transformation of hepatic cell adenoma to hepatocellular carcinoma due to oral contraceptive use." Ann Intern Med, 110, p. 489-90
  8. Tavani A, Negri E, Parazzini F, Franceschi S, La Vecchia C (1993) "Female hormone utilisation and risk of hepatocellular carcinoma." Br J Cancer, 67, p. 635-7
  9. Mathieu D, Zafrani ES, Anglade MC, Dhumeaux D (1989) "Association of focal nodular hyperplasia and hepatic hemangioma." Gastroenterology, 97, p. 154-7
  10. Le Bail B, Jouhanole H, Deugnier Y, Salame G, Pellegrin JL, Saric J, Balabaud C, Bioulac-Sage P (1992) "Liver adenomatosis with granulomas in two patients on long-term oral contraceptives." Am J Surg Pathol, 16, p. 982-7
  11. (1992) "Oral contraceptives and neoplasia. WHO Scientific Group." World Health Organ Tech Rep Ser, 817, p. 1-46
  12. Mishell DR (1989) "Contraception." N Engl J Med, 320, p. 777-85
  13. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  14. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  15. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  16. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  17. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  18. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  19. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  20. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  21. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  22. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  23. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  24. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  25. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  26. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  27. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  28. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  29. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  30. (2001) "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories
  31. (2001) "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical
  32. (2001) "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories
  33. (2006) "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals
  34. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 34 references
Moderate

Estrogens (applies to Vagifem) angioedema

Moderate Potential Hazard, Moderate plausibility.

The use of exogenous estrogens may induce or exacerbate symptoms of angioedema, particularly in women with hereditary angioedema. Close monitoring is recommended when prescribing these agents to patients predisposed to angioedema.

References

  1. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  2. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  3. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  4. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  5. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  6. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  7. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 7 references
Moderate

Estrogens (applies to Vagifem) gallbladder disease

Moderate Potential Hazard, Moderate plausibility.

A two- to four-fold increase in risk of gallbladder disease has been noted in women receiving postmenopausal estrogen therapy. The risk for gallbladder disease may be less for premenopausal women using oral contraceptives containing low-dose estrogens and/or progestins. Therapy with estrogens should be administered cautiously in patients with preexisting gallbladder disease.

References

  1. Boston Collaborative Drug Surveilance Program (1974) "Surgically confirmed gallbladder disease, venous thromboembolism, and breast tumors in relation to postmenopausal estrogen therapy." N Engl J Med, 290, p. 15-9
  2. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  3. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  4. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  5. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  6. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  7. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  8. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  9. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  10. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  11. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  12. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  13. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  14. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  15. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  16. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  17. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  18. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  19. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 19 references
Moderate

Estrogens (applies to Vagifem) hypercalcemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Hyperparathyroidism, Renal Dysfunction

Estrogens influence the metabolism of calcium and phosphorus. Intestinal absorption and retention of calcium are increased, which may occasionally result in hypercalcemia. Therapy with estrogens should be administered cautiously in patients with preexisting hypercalcemia, renal dysfunction, or metabolic bone diseases that are associated with hypercalcemia.

References

  1. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  2. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  3. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  4. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  5. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  6. (2001) "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn
  7. (2013) "Product Information. Duavee (bazedoxifene-conjugated estrogens)." Pfizer U.S. Pharmaceuticals Group
View all 7 references
Moderate

Estrogens (applies to Vagifem) hyperlipidemia

Moderate Potential Hazard, Moderate plausibility.

Although estrogens have generally favorable effects on plasma lipids, including increases in HDL and decreases in total cholesterol and LDL, they have also been associated with significant elevations in triglyceride levels, particularly when high dosages are used. Severe hyperlipidemia is known to sometimes cause pancreatitis. Patients with preexisting hyperlipidemia may require closer monitoring during estrogen therapy, and adjustments made accordingly in their lipid-lowering regimen.

References

  1. Molitch ME, Oill P, Odell WD (1974) "Massive hyperlipemia during estrogen therapy." JAMA, 227, p. 522-5
  2. Janaud A, Rouffy J, Upmalis D, Dain MP (1992) "A comparison study of lipid and androgen metabolism with triphasic oral contraceptive formulations containing norgestimate or levonorgestrel." Acta Obstet Gynecol Scand Suppl, 156, p. 33-8
  3. Steinberg WM (1989) "Oral contraception: risks and benefits." Adv Contracept, 5, p. 219-28
  4. Burkman RT, Zacur HA, Kimball AW, Kwiterovich P, Bell WR (1989) "Oral contraceptives and lipids and lipoproteins: Part I--Variations in mean levels by oral contraceptive type." Contraception, 40, p. 553-61
  5. Derman R (1989) "Oral contraceptives: a reassessment." Obstet Gynecol Surv, 44, p. 662-8
  6. Godsland IF, Crook D (1994) "Update on the metabolic effects of steroidal contraceptives and their relationship to cardiovascular disease risk." Am J Obstet Gynecol, 170, p. 1528-36
  7. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  9. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  10. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  11. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  12. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  13. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  14. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  15. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  16. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  17. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  18. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  19. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E (1998) "Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women." JAMA, 280, p. 605-13
  20. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  21. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  22. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  23. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  24. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  25. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 25 references
Moderate

Estrogens (applies to Vagifem) liver disease

Moderate Potential Hazard, High plausibility.

Estrogens are primarily metabolized by the liver. Patients with impaired hepatic function may be at increased risk for adverse effects associated with estrogen administration due to decreased drug clearance. Therapy with estrogens should be administered cautiously in patients with liver disease. In addition, clinicians should be aware that estrogen therapy may affect liver function tests. Increased sulfobromophthalein retention has been reported with the use of estrogen-containing oral contraceptives and may be expected with larger doses of estrogens.

References

  1. Bhavnani BR, Cecutti A (1994) "Pharmacokinetics of 17 beta-dihydroequilin sulfate and 17 beta- dihydroequilin in normal postmenopausal women." J Clin Endocrinol Metab, 78, p. 197-204
  2. Adlercrueuta H (1974) "Hepatic metabolism of estrogens in health and disease." N Engl J Med, 290, p. 1081-3
  3. Goldzieher JW (1989) "Pharmacology of contraceptive steroids: a brief review." Am J Obstet Gynecol, 160, p. 1260-4
  4. Kuhnz W, al-Yacoub G, Fuhrmeister A (1992) "Pharmacokinetics of levonorgestrel and ethinylestradiol in 9 women who received a low-dose oral contraceptive over a treatment period of 3 months and the same contraceptive formulation." Contraception, 46, p. 455-69
  5. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  6. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  7. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  8. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  9. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  10. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  11. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  12. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  13. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  14. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  15. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  16. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  17. (2001) "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn
  18. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  19. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  20. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  21. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  22. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  23. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 23 references
Moderate

Estrogens (applies to Vagifem) melasma

Moderate Potential Hazard, Moderate plausibility.

The use of exogenous estrogens may occasionally cause chloasma, especially in women with a history of chloasma gravidarum. Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet radiation while taking combination oral contraceptives.

References

  1. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  2. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  3. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  4. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  5. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  6. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  7. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 7 references
Moderate

Estrogens/progestogens (applies to Vagifem) depression

Moderate Potential Hazard, Moderate plausibility.

The use of oral contraceptives has been associated with an increased incidence of depression. It is uncertain whether this effect is related to the estrogenic or the progestogenic component of the contraceptive, although excess progesterone activity is associated with depression. Patients with a history of depression receiving estrogen and/or progestogen therapy should be followed closely. The manufacturer of medroxyprogesterone recommends monitoring patients who have a history of depression and to not re- administer medroxyprogesterone if depression recurs.

References

  1. (2001) "Product Information. Depo-Provera (medroxyprogesterone)." Pharmacia and Upjohn
  2. (2001) "Product Information. Provera (medroxyprogesterone)." Pharmacia and Upjohn
  3. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  4. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  5. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  6. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  7. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  8. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  9. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  10. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  11. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  12. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  13. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  14. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  15. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  16. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  17. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  18. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  19. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  20. (2001) "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories
  21. (2001) "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical
  22. (2001) "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories
  23. (2006) "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals
  24. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 24 references
Moderate

Estrogens/progestogens (applies to Vagifem) fluid retention

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Seizures, Congestive Heart Failure, Renal Dysfunction, Migraine, Asthma

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

References

  1. Leiman G (1972) "Depo-medroxyprogesterone acetate as a contraceptive agent: its effect on weight and blood pressure." Am J Obstet Gynecol, 114, p. 97-102
  2. (2001) "Product Information. Depo-Provera (medroxyprogesterone)." Pharmacia and Upjohn
  3. (2001) "Product Information. Provera (medroxyprogesterone)." Pharmacia and Upjohn
  4. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  5. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  6. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  7. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  8. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  9. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  10. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  11. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  12. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  13. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  14. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  15. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  16. (2001) "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn
  17. (2001) "Product Information. Megace (megestrol)." Bristol-Myers Squibb
  18. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  19. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  20. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  21. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  22. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  23. (2001) "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories
  24. (2001) "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical
  25. (2001) "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories
  26. (2001) "Product Information. Prometrium (progesterone)." Virtus Pharmaceuticals LLC
  27. (2006) "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals
View all 27 references
Moderate

Estrogens/progestogens (applies to Vagifem) glucose intolerance

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

Impaired glucose tolerance has been observed in some patients administered oral contraceptives and appears to be related primarily to the estrogen dose. However, progestogens can increase insulin secretion and produce insulin resistance to varying degrees, depending on the agent. Patients with diabetes mellitus should be monitored more closely during therapy with estrogens and/or progestogens, and adjustments made accordingly in their antidiabetic regimen.

References

  1. Haiba NA, el-Habashy MA, Said SA, Darwish EA, Abdel-Sayed WS, Nayel SE (1989) "Clinical evaluation of two monthly injectable contraceptives and their effects on some metabolic parameters." Contraception, 39, p. 619-32
  2. Virutamasen P, Wongsrichanalai C, Tangkeo P, Nitichai Y, Rienprayoon D (1986) "Metabolic effects of depot-medroxyprogesterone acetate in long-term users: a cross-sectional study." Int J Gynaecol Obstet, 24, p. 291-6
  3. Who Task Force on Long-acting Agents for Fertility Regulation (1986) "Metabolic side-effects of injectable depot-medroxyprogesterone acetate, 150 mg three-monthly, in undernourished lactating women." Bull World Health Organ, 64, p. 587-94
  4. Garg SK, Chase HP, Marshall G, Hoops SL, Holmes DL, Jackson WE (1994) "Oral contraceptives and renal and retinal complications in young women with insulin-dependent diabetes mellitus." JAMA, 271, p. 1099-102
  5. Hannaford PC, Kay CR (1989) "Oral contraceptives and diabetes mellitus." BMJ, 299, p. 1315-6
  6. Stubblefield PG (1989) "Choosing the best oral contraceptive." Clin Obstet Gynecol, 32, p. 316-28
  7. Spellacy WN, Ellingson AB, Tsibris JC (1989) "The effects of two triphasic oral contraceptives on carbohydrate metabolism in women during 1 year of use." Fertil Steril, 51, p. 71-4
  8. Steinberg WM (1989) "Oral contraception: risks and benefits." Adv Contracept, 5, p. 219-28
  9. Derman R (1989) "Oral contraceptives: a reassessment." Obstet Gynecol Surv, 44, p. 662-8
  10. Belchetz PE (1994) "Hormonal treatment of postmenopausal women." N Engl J Med, 330, p. 1062-71
  11. Luciano AA, De Souza MJ, Roy MP, Schoenfeld MJ, Nulsen JC, Halvorson CV (1993) "Evaluation of low-dose estrogen and progestin therapy in postmenopausal women." J Reprod Med, 38, p. 207-14
  12. Kaunitz AM (1994) "Long-acting injectable contraception with depot medroxyprogesterone acetate." Am J Obstet Gynecol, 170, p. 1543-9
  13. "Product Information. Ortho-Novum 1/35 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  14. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  15. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  16. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  17. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  18. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  19. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  20. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  21. (2001) "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories
  22. (2001) "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical
  23. (2001) "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories
  24. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 24 references
Moderate

Estrogens/progestogens (applies to Vagifem) retinal thrombosis

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Visual Defect/Disturbance

Estrogens and progestogens may cause retinal thrombosis. Oral contraceptives should be discontinued if there is unexplained partial or complete loss of vision; onset of proptosis or diplopia; papilledema; or retinal vascular lesions. Therapy with these agents should be administered cautiously in patients who have preexisting ocular problems and appropriate diagnostic and therapeutic measures should be instituted. Contact lens wearers who develop visual changes or changes in lens tolerance should be assessed by an ophthalmologist.

References

  1. "Product Information. Ortho-Novum 1/35 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  2. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  3. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  4. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  5. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  6. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  7. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  8. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  9. (2001) "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories
  10. (2001) "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical
  11. (2001) "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories
  12. (2001) "Product Information. Prometrium (progesterone)." Virtus Pharmaceuticals LLC
  13. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 13 references
Moderate

Estrogens/progestogens (applies to Vagifem) thyroid function tests

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Thyroid Disease

When administering estrogen and/or progestogen therapy in patients with thyroid disorders, clinicians should be aware that these hormones may affect thyroid function tests. Changes have mostly been reported with the use of combination oral contraceptives. Specifically, thyroid-binding globulin (TBG) may be increased, resulting in elevated circulating total thyroid hormone, as measured by PBI (protein-bound iodine), T4 by column or radioimmunoassay, or T3 by radioimmunoassay. Free T3 resin uptake may be decreased. On the contrary, a decrease in TBG and, consequently, thyroxine concentration, has been reported by the manufacturers of the progestin-only (norethindrone) oral contraceptives.

References

  1. (2001) "Product Information. Depo-Provera (medroxyprogesterone)." Pharmacia and Upjohn
  2. (2001) "Product Information. Provera (medroxyprogesterone)." Pharmacia and Upjohn
  3. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  4. (2001) "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn
  5. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  6. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  7. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  8. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  9. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  10. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  11. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  12. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  13. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  14. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  15. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  16. (2001) "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn
  17. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  18. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  19. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  20. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  21. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  22. (2001) "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories
  23. (2001) "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical
  24. (2001) "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories
  25. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 25 references

Vagifem drug interactions

There are 222 drug interactions with Vagifem (estradiol topical).

Vagifem alcohol/food interactions

There are 2 alcohol/food interactions with Vagifem (estradiol topical).


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.