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Drug Interactions between Duavee and estradiol / norethindrone topical

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

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Interactions between your drugs

Moderate

norethindrone topical bazedoxifene

Applies to: estradiol / norethindrone topical and Duavee (bazedoxifene / conjugated estrogens)

GENERALLY AVOID: The use of bazedoxifene-conjugated estrogens in combination with progestins has not been evaluated. Safety and efficacy of this combination are unknown.

MANAGEMENT: Women treated with bazedoxifene-conjugated estrogens should not receive progestins, which have often been used to mitigate the risk of endometrial cancer associated with estrogen therapy in patients with an intact uterus. Since the bazedoxifene component is intended to reduce the risk of endometrial hyperplasia, a possible precursor to endometrial cancer, there should be no need for progestin therapy under such circumstances.

References

  1. (2013) "Product Information. Duavee (bazedoxifene-conjugated estrogens)." Pfizer U.S. Pharmaceuticals Group

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Drug and food interactions

Minor

conjugated estrogens food

Applies to: Duavee (bazedoxifene / conjugated estrogens)

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

  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

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Estrogens

Therapeutic duplication

The recommended maximum number of medicines in the 'estrogens' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'estrogens' category:

  • Duavee (bazedoxifene/conjugated estrogens)
  • estradiol/norethindrone topical

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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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.

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