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Drug Interactions between conjugated estrogens / medroxyprogesterone and hemin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

conjugated estrogens hemin

Applies to: conjugated estrogens / medroxyprogesterone and hemin

GENERALLY AVOID: Coadministration with drugs that are capable of increasing the activity of delta-aminolevulinic acid synthetase (e.g., estrogens, barbiturates, steroid metabolites, rifampin) may negate the pharmacologic effect of hemin. In the treatment of porphyria, hemin is thought to limit the rate of porphyrin/heme biosynthesis by inhibiting delta-aminolevulinic acid synthetase, thus any induction of this enzyme would be expected to counteract the therapeutic effect of hemin.

MANAGEMENT: Drugs capable of increasing the activity of delta-aminolevulinic acid synthetase should be avoided during hemin therapy.

References (5)
  1. (2001) "Product Information. Panhematin (hemin)." Recordati Rare Diseases Inc
  2. (2023) "Product Information. Normosang (hemin)." Imported (France)
  3. Pozo OJ, marcos j, Fabregat A, Ventura R, Casals G, Aguilera P, Segura J, To-Figueras J (2014) "Adrenal hormonal imbalance in acute intermittent porphyria patients: results of a case control study" Orphanet Journal of Rare Diseases, 9, p. 54
  4. anderson ke, Bloomer JR, Bonkovsky HL, Desnick RJ, kushner jp, pierach ca, pimstone nr (2005) Recommendations for the Diagnosis and Treatment of the Acute Porphyrias https://www.acpjournals.org/doi/full/10.7326/0003-4819-142-6-200503150-00010
  5. Herrick AL, mccoll ke, moore mr, Brodie MJ, Adamson AR, Goldberg A (1989) "Acute intermittent porphyria in two patients on anticonvulsant therapy and with normal erythrocyte porphobilinogen deaminase activity" Br J Clin Pharmacol, 27, 491- 497

Drug and food interactions

Minor

conjugated estrogens food

Applies to: conjugated estrogens / medroxyprogesterone

Coadministration with grapefruit juice may increase the bioavailability of oral estrogens. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits. In a small, randomized, crossover study, the administration of ethinyl estradiol with grapefruit juice (compared to herbal tea) increased peak plasma drug concentration (Cmax) by 37% and area under the concentration-time curve (AUC) by 28%. Based on these findings, grapefruit juice is unlikely to affect the overall safety profile of ethinyl estradiol. However, as with other drug interactions involving grapefruit juice, the pharmacokinetic alterations are subject to a high degree of interpatient variability. Also, the effect on other estrogens has not been studied.

References (2)
  1. Weber A, Jager R, Borner A, et al. (1996) "Can grapefruit juice influence ethinyl estradiol bioavailability?" Contraception, 53, p. 41-7
  2. Schubert W, Eriksson U, Edgar B, Cullberg G, Hedner T (1995) "Flavonoids in grapefruit juice inhibit the in vitro hepatic metabolism of 17B-estradiol." Eur J Drug Metab Pharmacokinet, 20, p. 219-24

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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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

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