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Estramustine Disease Interactions

There are 9 disease interactions with estramustine:

Major

Estramustine (Includes Estramustine) ↔ Hypertension

Severe Potential Hazard, High plausibility

Applies to: Hypertension

The risk of myocardial infarction and strokes, including those associated with estrogen use, may be increased in patients with hypertension. Moreover, estramustine may elevate blood pressure and worsen the hypertension, thus compounding the risk. Therapy with estramustine should be administered cautiously in patients with preexisting hypertension. Patients should be monitored for changes in cardiovascular status, and their antihypertensive regimen adjusted as necessary.

References

  1. Crane MG, Harris JJ "Estrogens and hypertension: effect of discontinuing estrogens on blood pressure, exchangeable sodium, and the renin-aldosterone system." Am J Med Sci 276 (1978): 33-55
  2. Wren BG, Routledge DA "Blood pressure changes: oestrogens in climacteric women." Med J Aust 2 (1981): 528-31
  3. "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn, Kalamazoo, MI.
View all 6 references
Major

Estramustine (Includes Estramustine) ↔ Thromboembolism/Cardiovascular

Severe Potential Hazard, High plausibility

Applies to: Ischemic Heart Disease, Cerebral Vascular Disorder, Thrombotic/Thromboembolic Disorder, History - Thrombotic/Thromboembolic Disorder

The use of estramustine, a combination of estradiol and nornitrogen mustard, is contraindicated in patients with active thrombotic or thromboembolic disorders, unless the tumor mass is thought to be the source of these conditions. Estrogens, particularly in high dosages, can increase the risk of thrombotic events, myocardial infarction, and strokes. Therapy with estramustine should be administered cautiously and only after careful consideration of risks and benefits in patients with cerebrovascular disease, coronary artery disease, or a history of thrombotic or thromboembolic disorders.

References

  1. Rosenberg L, Slone D, Shapiro S, Kaufman D, Stolley PD, Miettinen OS "Noncontraceptive estrogens and myocardial infarction in young women." JAMA 244 (1980): 339-42
  2. Key JD, Hammill WW, Everett L "Pulmonary embolus in an adolescent on oral contraceptives." J Adolesc Health 13 (1992): 713-5
  3. Notelovitz M "Oral contraception and coagulation." Clin Obstet Gynecol 28 (1985): 73-83
View all 36 references
Major

Estrogens (Includes Estramustine) ↔ Abnormal Vaginal Bleeding

Severe Potential Hazard, High plausibility

Applies to: 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. Buring JE, Bain CJ, Ehrmann RL "Conjugated estrogen use and risk of endometrial cancer." Am J Epidemiol 124 (1986): 434-41
  2. Spengler RF, Clarke EA, Woolever CA, Newman AM, Osborn RW "Exogenous estrogens and endometrial cancer: a case-control study and assessment of potential biases." Am J Epidemiol 114 (1981): 497-506
  3. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho Pharmaceutical Corporation, Raritan, NJ.
View all 28 references
Major

Estrogens (Includes Estramustine) ↔ Hypercalcemia In Breast Cancer

Severe Potential Hazard, Moderate plausibility

Applies to: Breast Cancer

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. "Product Information. Climara (estradiol)." Berlex, Richmond, CA.
  2. "Product Information. Ogen (estropipate topical)" Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Estrace (estradiol)." Bristol-Myers Squibb, Princeton, NJ.
View all 11 references
Moderate

Estrogens (Includes Estramustine) ↔ Hypercalcemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction, Hyperparathyroidism, Hypercalcemia

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. "Product Information. Climara (estradiol)." Berlex, Richmond, CA.
  2. "Product Information. Estrace (estradiol)." Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Estraderm (estradiol)." Ciba Pharmaceuticals, Summit, NJ.
View all 6 references
Moderate

Estrogens (Includes Estramustine) ↔ Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease

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. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  2. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  3. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 22 references
Moderate

Estrogens/Progestogens (Includes Estramustine) ↔ Fluid Retention

Moderate Potential Hazard, High plausibility

Applies to: Fluid Retention, Asthma, Renal Dysfunction, Congestive Heart Failure, Migraine, Seizures

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. "Product Information. Estrace (estradiol)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Micronor (norethindrone)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  3. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho Pharmaceutical Corporation, Raritan, NJ.
View all 25 references
Moderate

Estrogens/Progestogens (Includes Estramustine) ↔ Glucose Intolerance

Moderate Potential Hazard, Moderate plausibility

Applies to: 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. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  2. Stubblefield PG "Choosing the best oral contraceptive." Clin Obstet Gynecol 32 (1989): 316-28
  3. Hannaford PC, Kay CR "Oral contraceptives and diabetes mellitus." BMJ 299 (1989): 1315-6
View all 23 references
Moderate

Estrogens/Progestogens (Includes Estramustine) ↔ Thyroid Function Tests

Moderate Potential Hazard, Moderate plausibility

Applies to: 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. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical, Raritan, NJ.
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Estratab (esterified estrogens)" Solvay Pharmaceuticals Inc, Marietta, GA.
View all 24 references

estramustine drug Interactions

There are 163 drug interactions with estramustine

estramustine alcohol/food Interactions

There are 2 alcohol/food interactions with estramustine

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

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.

Do not stop taking any medications without consulting your healthcare provider.

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