Interactions between Colestipol and Kyleena

The levonorgestrel in Kyleena has a major potential interaction with Abnormal Uterine Bleeding.

The use of contraceptives is contraindicated when there is an undiagnosed abnormal genital bleeding. Adequate diagnostic measures should be undertaken to rule out the presence of any malignancy.

Colestipol 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 levonorgestrel in Kyleena 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.

Colestipol 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 levonorgestrel in Kyleena has a major potential interaction with Breast Cancer.

The use of progestogens is considered by manufacturers to be contraindicated in patients with existing or suspected malignancy of the breast. Some supportive data are available for medroxyprogesterone. Specifically, medroxyprogesterone treatment may be associated with breast cancer, primarily when the drug is administered intramuscularly. A pooled analysis of two case-control studies, one from the World Health Organization and the other from New Zealand, revealed a small overall relative risk of breast cancer in women who have ever used intramuscular medroxyprogesterone acetate. The relative risk was higher in the subgroup of women who had initiated therapy within the previous 5 years. Thus, an increased risk (approximately 2-fold) is associated with intramuscular medroxyprogesterone use in the first 5 years. A more recent U.S. study also found a statistically significant increase in breast cancer risk among recent users (defined as last use within the past five years) who used depo-medroxyprogesterone acetate for 12 months or longer.

The levonorgestrel in Kyleena has a moderate potential interaction with Cerebral Vascular Disorder.

The use of levonorgestrel requires careful assessment and caution in conditions of arterial disease, including stroke and myocardial infarction, and also, in patients with increased blood pressure and coagulopathies.

Colestipol 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.

Colestipol 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.

Colestipol 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 levonorgestrel in Kyleena has a moderate potential interaction with Depression.

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.

The levonorgestrel in Kyleena 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 levonorgestrel in Kyleena 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.

Colestipol 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 levonorgestrel in Kyleena 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.

Colestipol 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 levonorgestrel in Kyleena has a major potential interaction with 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.

The levonorgestrel in Kyleena has a moderate potential interaction with High Blood Pressure.

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 levonorgestrel in Kyleena has a moderate potential interaction with High Cholesterol.

Some progestogenic agents may elevate plasma LDL levels and/or lower HDL levels, although data have been inconsistent. Patients with preexisting hyperlipidemia may require closer monitoring during progestogen therapy, and adjustments made accordingly in their lipid-lowering regimen.

The levonorgestrel in Kyleena has a moderate potential interaction with History, Thrombotic/Thromboembolic Disorder.

The use of levonorgestrel requires careful assessment and caution in conditions of arterial disease, including stroke and myocardial infarction, and also, in patients with increased blood pressure and coagulopathies.

Colestipol 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 levonorgestrel in Kyleena has a major potential interaction with Liver Disease.

The use of progestogens, in general, is contraindicated in patients with impaired hepatic function or liver disease. There are little or no data concerning the pharmacokinetic disposition of the different progestogens in patients with hepatic disease. However, most hormones, including progestational hormones, are known to be extensively metabolized by the liver. Medroxyprogesterone should not be used by women with significant liver disease and should be discontinued if jaundice or disturbances of liver function occur.

The levonorgestrel in Kyleena 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.

Colestipol 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.

Colestipol 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 levonorgestrel in Kyleena 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 levonorgestrel in Kyleena 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.

Colestipol 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.

Colestipol 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 levonorgestrel in Kyleena has a moderate potential interaction with Thrombotic/Thromboembolic Disorder.

The use of levonorgestrel requires careful assessment and caution in conditions of arterial disease, including stroke and myocardial infarction, and also, in patients with increased blood pressure and coagulopathies.

The levonorgestrel in Kyleena 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.

Colestipol 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.

Colestipol 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.

Colestipol 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.

The levonorgestrel in Kyleena has a minor potential interaction with Weight Loss.

Progestogens can cause weight gain, which may be significant (as is the case with parenteral medroxyprogesterone) and undesirable in obese patients attempting to lose weight.