Interactions between Cholestyramine and Estrofem

The estradiol in Estrofem has a major potential interaction with Abnormal Uterine Bleeding.

The use of estrogens is contraindicated in patients with undiagnosed, abnormal vaginal bleeding. Prolonged (greater than 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.

Cholestyramine has a moderate potential interaction with Anemia.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

The estradiol in Estrofem has a moderate potential interaction with Angioedema.

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

The estradiol in Estrofem has a moderate potential interaction with 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.

Cholestyramine has a major potential interaction with Biliary Obstruction.

The use of bile acid sequestrants is contraindicated in patients with complete biliary obstruction where bile is not secreted into the intestine. These agents adsorb and combine with bile acids in the intestine to form an insoluble complex that is excreted in the feces, resulting in partial removal of bile acids from the enterohepatic circulation. Bile acid sequestrants are ineffective if bile does not reach the intestine.

The estradiol in Estrofem has a major potential interaction with 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.

The estradiol in Estrofem has a major potential interaction with Cerebral Vascular Disorder.

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic 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. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. 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 metastatic breast or prostatic malignancy.

Cholestyramine has a moderate potential interaction with Coagulation Defects and Disorders.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Cholestyramine has a moderate potential interaction with Constipation.

The use of bile acid sequestrants may produce or worsen preexisting constipation. Constipation associated with these agents may aggravate hemorrhoids. Therapy with bile acid sequestrants should be administered cautiously in patients with preexisting constipation, hemorrhoids, or symptomatic coronary artery disease. The dosage should be increased very gradually according to manufacturer guidelines to minimize the risk of fecal impaction, and patients should be encouraged to increase fluid and fiber intake. Occasional use of a stool softener may also be indicated. If constipation worsens or develops during therapy, or the desired therapeutic response is not achieved at the maximum recommended daily dosage, combination therapy or an alternative agent should be considered.

Cholestyramine has a moderate potential interaction with Dehydration.

Bile acid sequestrants are chloride forms of anion exchange resins and may produce hyperchloremic acidosis with chronic use. Therapy with bile acid sequestrants should be administered cautiously in patients who may be particularly susceptible, including children or smaller patients and patients with renal impairment or volume depletion.

The estradiol in Estrofem has a moderate potential interaction with 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. Caution and close monitoring are recommended in patients with diabetes mellitus during therapy with estrogens and/or progestogens, and adjustments made accordingly in their antidiabetic regimen.

The estradiol in Estrofem has a moderate potential interaction with Fluid Retention.

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.

Cholestyramine has a moderate potential interaction with Folic Acid/Cyanocobalamin Deficiency.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

The estradiol in Estrofem has a moderate potential interaction with Gallbladder Disease.

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 or a history of pregnancy-related cholestasis.

The estradiol in Estrofem has a moderate potential interaction with Heart Failure.

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.

Cholestyramine has a moderate potential interaction with Hemorrhoids.

The use of bile acid sequestrants may produce or worsen preexisting constipation. Constipation associated with these agents may aggravate hemorrhoids. Therapy with bile acid sequestrants should be administered cautiously in patients with preexisting constipation, hemorrhoids, or symptomatic coronary artery disease. The dosage should be increased very gradually according to manufacturer guidelines to minimize the risk of fecal impaction, and patients should be encouraged to increase fluid and fiber intake. Occasional use of a stool softener may also be indicated. If constipation worsens or develops during therapy, or the desired therapeutic response is not achieved at the maximum recommended daily dosage, combination therapy or an alternative agent should be considered.

The estradiol in Estrofem has a major potential interaction with High Blood Pressure.

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. Some estrogen-based therapies, such as combined hormonal contraceptives, may be contraindicated in patients with uncontrolled hypertension or hypertension with vascular disease. 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.

The estradiol in Estrofem has a moderate potential interaction with High Cholesterol.

Estrogens may cause adverse lipid changes. Use of estrogens has been associated with elevations in triglyceride levels, particularly in women with pre-existing hypertriglyceridemia. Discontinue therapy if elevated triglycerides lead to pancreatitis. Manage hypercholesterolemia appropriately as indicated.

The estradiol in Estrofem has a major potential interaction with History, Thrombotic/Thromboembolic Disorder.

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic 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. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. 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 metastatic breast or prostatic malignancy.

The estradiol in Estrofem has a moderate potential interaction with Hypoparathyroidism.

Estrogens should be used with caution in individuals with severe hypocalcemia or hypoparathyroidism. Estrogen-induced hypocalcemia may occur in patients with hypoparathyroidism; consider whether the benefits of estrogen therapy outweigh the risks.

The estradiol in Estrofem has a major potential interaction with Ischemic Heart Disease.

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic 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. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. 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 metastatic breast or prostatic malignancy.

Cholestyramine has a moderate potential interaction with Ischemic Heart Disease.

The use of bile acid sequestrants may produce or worsen preexisting constipation. Constipation associated with these agents may aggravate hemorrhoids. Therapy with bile acid sequestrants should be administered cautiously in patients with preexisting constipation, hemorrhoids, or symptomatic coronary artery disease. The dosage should be increased very gradually according to manufacturer guidelines to minimize the risk of fecal impaction, and patients should be encouraged to increase fluid and fiber intake. Occasional use of a stool softener may also be indicated. If constipation worsens or develops during therapy, or the desired therapeutic response is not achieved at the maximum recommended daily dosage, combination therapy or an alternative agent should be considered.

The estradiol in Estrofem has a moderate potential interaction with Liver Disease.

Estrogens are primarily metabolized by the liver. Use of estrogen therapy is contraindicated in patients with liver dysfunction or disease. Patients with impaired hepatic function may be at increased risk for adverse effects associated with estrogen administration due to decreased drug clearance. Patients with hepatic hemangiomas are at increased risk of exacerbation with use of estrogens. Therapy with estrogens should be administered cautiously in patients with cholestatic jaundice associated with past estrogen use or with pregnancy. In addition, clinicians should be aware that estrogen therapy may affect liver function tests.

The estradiol in Estrofem has a major potential interaction with Migraine.

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic 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. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. 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 metastatic breast or prostatic malignancy.

The estradiol in Estrofem has a moderate potential interaction with Migraine.

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.

The estradiol in Estrofem has a major potential interaction with 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.

The estradiol in Estrofem has a moderate potential interaction with Pancreatitis.

Estrogens may cause adverse lipid changes. Use of estrogens has been associated with elevations in triglyceride levels, particularly in women with pre-existing hypertriglyceridemia. Discontinue therapy if elevated triglycerides lead to pancreatitis. Manage hypercholesterolemia appropriately as indicated.

Cholestyramine has a moderate potential interaction with Phenylketonuria.

Questran Light and LoCholest Light (brands of cholestyramine) contain 16.8 mg and 22.4 mg of phenylalanine, respectively, per each dose. Flavored Colestid (brand of colestipol) contains 18.2 mg of phenylalanine per each 7.5-gram dose. WELCHOL (brand name of colesevelam) for Oral Suspension contains 13.5 mg phenylalanine per 1.875 gram dose and 27 mg phenylalanine per 3.75 gram dose. The phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics). Regular Colestid, Questran and LoCholest do not contain phenylalanine.

Cholestyramine has a moderate potential interaction with Renal Dysfunction.

Bile acid sequestrants are chloride forms of anion exchange resins and may produce hyperchloremic acidosis with chronic use. Therapy with bile acid sequestrants should be administered cautiously in patients who may be particularly susceptible, including children or smaller patients and patients with renal impairment or volume depletion.

The estradiol in Estrofem has a moderate potential interaction with Renal Dysfunction.

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.

The estradiol in Estrofem has a moderate potential interaction with 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.

Cholestyramine has a moderate potential interaction with Thrombocytopathy.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Cholestyramine has a moderate potential interaction with Thrombocytopenia.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

The estradiol in Estrofem has a major potential interaction with Thrombotic/Thromboembolic Disorder.

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic 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. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. 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 metastatic breast or prostatic malignancy.

The estradiol in Estrofem has a moderate potential interaction with 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. Patients on thyroid replacement therapy may require higher doses of thyroid hormone and appropriate monitoring. 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.

Cholestyramine has a moderate potential interaction with Vitamin A Deficiency.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Cholestyramine has a moderate potential interaction with Vitamin D Deficiency.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Cholestyramine has a moderate potential interaction with Vitamin K Deficiency.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.