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Interactions between Estradot 100 and Methicillin

1 drug interaction and 34 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

methicillin estradiol

Applies to: methicillin and Estradot 100 (estradiol)
Monitor

The effectiveness of estrogen-containing medications may be impaired by concomitant treatment with antimicrobial agents. During metabolism, the estrogen component is conjugated, resulting in sulfation or glucuronidation of the original estrogenic steroid. The conjugates reach the intestine via the bile duct, where hydrolytic enzymes of intestinal bacteria break them down into free, active estrogenic hormone. The active hormone is then available for enterohepatic cycling, which helps maintain estrogen levels. Notably, the progestin component of a combined hormonal product does not undergo this process. It has been suggested that broad-spectrum antibiotics may reduce the effectiveness of estrogen-containing contraceptives because they may reduce intestinal bacteria and thus interfere with enterohepatic cycling of estrogen. Most research regarding this possible interaction has been conducted with oral contraceptives, but all estrogens appear to undergo enterohepatic recirculation, so theoretically this interaction is a possibility with estrogen-containing medications that are being used for alternative purposes. However, the risk appears to be small, and supportive data are primarily limited to anecdotal evidence from case reports and findings from uncontrolled or poorly controlled studies. Further, the Centers for Disease Control and Prevention do not consider most broad-spectrum antibiotics to significantly interfere with the effectiveness of combined hormonal contraception. Most antimicrobials, with the exception of enzyme-inducing medications such as the rifamycins and possibly griseofulvin, have not been shown to significantly increase the clearance of oral contraceptive estrogens. It is possible that a small number of women may be more sensitive to the effects of antimicrobials on estrogen disposition in vivo, but risk factors or genetic predispositions have yet to be identified.

Management

If concomitant use of an estrogen-containing oral contraceptive with antibiotic therapy is necessary, some manufacturers advise using a back-up method of birth control for varying amounts of time. If estrogen is used for a purpose other than contraception, there is a theoretical possibility of lower systemic estrogen levels during antibiotic treatment. These patients should be counseled to report any changes in the efficacy of the hormonal product to their healthcare provider. Additionally, some illnesses and certain antibiotics may cause nausea, vomiting, and/or diarrhea. If vomiting occurs within a few hours of taking an oral contraceptive pill, the product labeling should be consulted for instructions on what to do in the event of a missed pill. Some authorities recommend a back-up method of birth control if an individual has persistent vomiting or diarrhea. Individual product labeling for the estrogen-containing product, particularly oral contraceptives, and antibiotic being used should be consulted for more specific guidance.

References (45)
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  2. Back DJ, Breckenridge AM, MacIver M, et al. (1982) "The effects of ampicillin on oral contraceptive steroids in women." Br J Clin Pharmacol, 14, p. 43-8
  3. Neely JL, Abate M, Swinker M, D'Angio R (1991) "The effect of doxycycline on serum levels of ethinyl estradiol, norethindrone, and endogenous progesterone." Obstet Gynecol, 77, p. 416-20
  4. Joshi JV, Joshi UM, Sankholi GM, et al. (1980) "A study of interaction of low-dose combination oral contraceptive with ampicillin and metronidazole." Contraception, 22, p. 643-52
  5. Baciewicz AM (1985) "Oral contraceptive drug interactions." Ther Drug Monit, 7, p. 26-35
  6. Bint AJ, Burtt I (1980) "Adverse antibiotic drug interactions." Drugs, 20, p. 57-68
  7. Dossetor J (1975) "Drug interactions with oral contraceptives." Br Med J, 4, p. 467-8
  8. DeSano EA, Hurley SC (1982) "Possible interactions of antihistamines and antibiotics with oral contraceptive effectiveness." Fertil Steril, 37, p. 853-4
  9. Szoka PR, Edgren RA (1988) "Drug interactions with oral contraceptives: compilation and analysis of an adverse experience report database." Fertil Steril, 49(5 Suppl), s31-8
  10. Barnett ML (1985) "Inhibition of oral contraceptive effectiveness by concurrent antibiotic administration." J Periodontol, 56, p. 18-20
  11. (2001) "Product Information. Declomycin (demeclocycline)." Lederle Laboratories
  12. London BM, Lookingbill DP (1994) "Frequency of pregnancy in acne patients taking oral antibiotics and oral contraceptives." Arch Dermatol, 130, p. 392-3
  13. Bacon JF, Shenfield GM (1980) "Pregnancy attributable to interaction between tetracycline and oral contraceptives." Br Med J, 280, p. 293
  14. Fazio A (1991) "Oral contraceptive drug interactions: important considerations." South Med J, 84, p. 997-1002
  15. Back DJ, Orme ML (1990) "Pharmacokinetic drug interactions with oral contraceptives." Clin Pharmacokinet, 18, p. 472-84
  16. Back DJ, Tjia J, Martin C, Millar E, Mant T, Morrison P, Orme M (1991) "The lack of interaction between temafloxacin and combined oral contraceptive steroids." Contraception, 43, p. 317-23
  17. Orme ML, Back DJ (1986) "Interactions between oral contraceptive steroids and broad-spectrum antibiotics." Clin Exp Dermatol, 11, p. 327-31
  18. Wermeling DP, Chandler MH, Sides GD, Collins D, Muse KN (1995) "Dirithromycin increases ethinyl estradiol clearance without allowing ovulation." Obstet Gynecol, 86, p. 78-84
  19. Silber TJ (1983) "Apparent oral contraceptive failure associated with antibiotic administration." J Adolesc Health Care, 4, p. 287-9
  20. Bollen M (1995) "Use of antibiotics when taking the oral contraceptive pill." Aust Fam Physician, 24, p. 928-9
  21. Kleier DJ, Tucker JE (1987) "Oral contraceptive failure secondary to dentally prescribed drugs: fact or fiction?" J Colo Dent Assoc, 66, p. 5-6
  22. Back DJ, Breckenridge AM, Crawford FE, MacIver M, Orne ML, Rowe PH (1981) "Interindividual variation and drug interactions with hormonal steroid contraceptives." Drugs, 21, p. 46-61
  23. Helms SE, Bredle DL, Zajic J, Jarjoura D, Brodell RT, Krishnarao I (1997) "Oral contraceptive failure rates and oral antibiotics." J Am Acad Dermatol, 36, p. 705-10
  24. Weisberg E (1999) "Interactions between oral contraceptives and antifungals antibacterials - Is contraceptive failure the result?." Clin Pharmacokinet, 36, p. 309-13
  25. Burroughs KE, Chambliss ML (2000) "Antibiotics and oral contraceptive failure." Arch Fam, 9, p. 81-2
  26. Weaver K, Glasier A (1999) "Interaction between broad-spectrum antibiotics and the combined oral contraceptive pill: a literature review." Contraception, 59, p. 71-8
  27. King VJ (1997) "OC failure rates and oral antibiotics." J Fam Pract, 45, p. 104-5
  28. Zachariassen RD (1994) "Loss of oral contraceptive efficacy by concurrent antibiotic administration." Women Health, 22, p. 17-26
  29. Dickinson BD, Altman RD, Nielsen NH, Sterling ML (2001) "Drug interactions between oral contraceptives and antibiotics." Obstet Gynecol, 98(5 Pt 1), p. 853-60
  30. Archer JS, Archer DF (2002) "Oral contraceptive efficacy and antibiotic interaction: A myth debunked." J Am Acad Dermatol, 46, p. 917-23
  31. Orme M, Back DJ (1991) "Oral contraceptive steroids--pharmacological issues of interest to the prescribing physician." Adv Contracept, 7, p. 325-31
  32. DeRossi SS, Hersh EV (2002) "Antibiotics and oral contraceptives." Dent Clin North Am, 46, p. 653-64
  33. (2005) "FFPRHC Guidance (April 2005). Drug interactions with hormonal contraception." J Fam Plann Reprod Health Care, 31, p. 139-51
  34. Bauer KL, Wolf D, Patel M, Vinson DC (2005) "Clinical inquiries. Do antibiotics interfere with the efficacy of oral contraceptives?" J Fam Pract, 54, p. 1079-80
  35. Back DJ, Grimmer SF, Orme ML, Proudlove D, Mann RD, Breckenridge AM (1988) "Evaluation of Committee on Safety of Medicines yellow card reports on oral contraceptive-drug interactions with anticonvulsants and antibiotics." Br J Clin Pharmacol, 25, p. 527-32
  36. (2018) "Product Information. Arikayce (amikacin liposome)." Insmed Incorporated
  37. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
  38. (2022) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma International Pty Ltd, v 2.0
  39. Curtis KM, Tepper NK, Jatlaoui TC, et al. (2023) U.S. medical eligibility criteria (US MEC) for contraceptive use. https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/index.html
  40. Faculty of Sexual & Reproductive Healthcare (2023) FSRH CEU response to study: analysis of reports of unintended pregnancies associated with the combined use of non-enzyme inducing antibiotics and hormonal contraceptives - february 2021 https://www.fsrh.org/standards-and-guidance/documents/fsrh-ceu-respo
  41. Faculty of Sexual & Reproductive Healthcare (2023) FSRH CEU guidance: drug interactions with hormonal contraception (may 2022) https://www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-drug-interactions-with-hormonal/
  42. Simmons KB, Haddad LB, Nanda K, Curtis KM (2018) "Drug interactions between non-rifamycin antibiotics and hormonal contraception: a systemic review." Am J Obstet Gynecol, 218, 88-97.e14
  43. Zhanel GG, Siemens S, Slayter K, Mandell L (1999) "Antibiotic and oral contraceptive drug interactions: is there a need for concern?" Can J Infect Dis, 10, p. 429-33
  44. Black A, Francoeur D, Rowe T, et al. (2023) SOGC clinical practice guidelines canadian contraception consensus https://www.jogc.com/article/S1701-2163(16)30260-2/pdf
  45. Allen K (2012) "Contraception - common issues and practical suggestions." Aust Fam Physician, 41, p. 770-2

Food/lifestyle interactions

Minor food/lifestyle interactions

Minor:

estradiol Food/Lifestyle

Applies to: Estradot 100 (estradiol)

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

Disease interactions

33 potential interactions Applies to: 28 conditions, including High Blood Pressure, High Cholesterol, Migraine, Heart Failure, and Asthma.

Abnormal Uterine Bleeding

Major:

Estradot 100

The estradiol in Estradot 100 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.

Angioedema

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Asthma

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Breast Cancer

Major:

Estradot 100

The estradiol in Estradot 100 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.

Cerebral Vascular Disorder

Major:

Estradot 100

The estradiol in Estradot 100 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.

Cystic Fibrosis

Moderate:

methicillin

Methicillin has a moderate potential interaction with Cystic Fibrosis.

The penicillinase-resistant penicillins, dicloxacillin and methicillin, are both eliminated by the kidney. Renal elimination of these penicillins has been shown to increase in patients with cystic fibrosis, resulting in decreased peak serum drug concentrations and AUCs. Clinicians should be cognizant of these effects when prescribing or administering the antibiotics to patients with cystic fibrosis.

Diabetes Mellitus

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Fluid Retention

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Moderate:

methicillin

Methicillin has a moderate potential interaction with Fluid Retention.

Each gram of parenteral methicillin sodium contains approximately 60 to 71 mg (2.6 to 3.1 mEq) of sodium and is buffered with 50 mg of sodium citrate. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention. In addition, hypokalemia has been reported rarely during therapy with the penicillinase-resistant penicillins, which may be particularly important to bear in mind when treating patients with low potassium reserves or fluid and electrolyte imbalance. Clinical monitoring of electrolytes is recommended if these agents are used for prolonged periods.

Gallbladder Disease

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Heart Failure

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Moderate:

methicillin

Methicillin has a moderate potential interaction with Heart Failure.

Each gram of parenteral methicillin sodium contains approximately 60 to 71 mg (2.6 to 3.1 mEq) of sodium and is buffered with 50 mg of sodium citrate. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention. In addition, hypokalemia has been reported rarely during therapy with the penicillinase-resistant penicillins, which may be particularly important to bear in mind when treating patients with low potassium reserves or fluid and electrolyte imbalance. Clinical monitoring of electrolytes is recommended if these agents are used for prolonged periods.

High Blood Pressure

Major:

Estradot 100

The estradiol in Estradot 100 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.

Moderate:

methicillin

Methicillin has a moderate potential interaction with High Blood Pressure.

Each gram of parenteral methicillin sodium contains approximately 60 to 71 mg (2.6 to 3.1 mEq) of sodium and is buffered with 50 mg of sodium citrate. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention. In addition, hypokalemia has been reported rarely during therapy with the penicillinase-resistant penicillins, which may be particularly important to bear in mind when treating patients with low potassium reserves or fluid and electrolyte imbalance. Clinical monitoring of electrolytes is recommended if these agents are used for prolonged periods.

High Cholesterol

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

History, Thrombotic/Thromboembolic Disorder

Major:

Estradot 100

The estradiol in Estradot 100 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.

Hypernatremia

Moderate:

methicillin

Methicillin has a moderate potential interaction with Hypernatremia.

Each gram of parenteral methicillin sodium contains approximately 60 to 71 mg (2.6 to 3.1 mEq) of sodium and is buffered with 50 mg of sodium citrate. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention. In addition, hypokalemia has been reported rarely during therapy with the penicillinase-resistant penicillins, which may be particularly important to bear in mind when treating patients with low potassium reserves or fluid and electrolyte imbalance. Clinical monitoring of electrolytes is recommended if these agents are used for prolonged periods.

Hypokalemia

Moderate:

methicillin

Methicillin has a moderate potential interaction with Hypokalemia.

Each gram of parenteral methicillin sodium contains approximately 60 to 71 mg (2.6 to 3.1 mEq) of sodium and is buffered with 50 mg of sodium citrate. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention. In addition, hypokalemia has been reported rarely during therapy with the penicillinase-resistant penicillins, which may be particularly important to bear in mind when treating patients with low potassium reserves or fluid and electrolyte imbalance. Clinical monitoring of electrolytes is recommended if these agents are used for prolonged periods.

Hypoparathyroidism

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Ischemic Heart Disease

Major:

Estradot 100

The estradiol in Estradot 100 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.

Liver Disease

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Migraine

Major:

Estradot 100

The estradiol in Estradot 100 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.

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Neoplasia, Estrogen Dependent

Major:

Estradot 100

The estradiol in Estradot 100 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.

Neutropenia

Major:

methicillin

Methicillin has a major potential interaction with Neutropenia.

The use of penicillinase-resistant penicillins has been associated with adverse hematologic effects, including neutropenia, leukopenia, granulocytopenia and thrombocytopenia, particularly when given in high parenteral dosages. Agranulocytosis and prolonged bleeding time have been reported rarely. Therapy with penicillinase-resistant penicillins should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow depression, and hematopoietic function should be monitored. Blood counts with differential should be performed prior to initiation of therapy and 1 to 3 times weekly during therapy. Hematologic abnormalities are generally reversible and resolve within several days to two weeks following discontinuation of therapy.

Noninfectious Colitis

Major:

methicillin

Methicillin has a major potential interaction with Noninfectious Colitis.

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

Pancreatitis

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Renal Dysfunction

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Moderate:

methicillin

Methicillin has a moderate potential interaction with Renal Dysfunction.

Most beta-lactam antibacterial agents are eliminated by the kidney as unchanged drug and, in some cases, also as metabolites. The serum concentrations of beta-lactam antibacterial agents and their metabolites may be increased, and the half-lives prolonged, in patients with impaired renal function. Neurotoxic reactions (e.g., encephalopathy, aphasia, asterixis, myoclonus, seizures, nonconvulsive status epilepticus, coma) have been reported in such patients treated parenterally with these agents. Dosage adjustments may be necessary, and modifications should be based on the degree of renal dysfunction as well as severity of infection in accordance with the individual manufacturer product information. Renal function tests should be performed periodically during prolonged and/or high-dose therapy since nephrotoxicity and alterations in renal function have occasionally been associated with the use of these drugs.

Seizures

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

Thrombocytopenia

Major:

methicillin

Methicillin has a major potential interaction with Thrombocytopenia.

The use of penicillinase-resistant penicillins has been associated with adverse hematologic effects, including neutropenia, leukopenia, granulocytopenia and thrombocytopenia, particularly when given in high parenteral dosages. Agranulocytosis and prolonged bleeding time have been reported rarely. Therapy with penicillinase-resistant penicillins should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow depression, and hematopoietic function should be monitored. Blood counts with differential should be performed prior to initiation of therapy and 1 to 3 times weekly during therapy. Hematologic abnormalities are generally reversible and resolve within several days to two weeks following discontinuation of therapy.

Thrombotic/Thromboembolic Disorder

Major:

Estradot 100

The estradiol in Estradot 100 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.

Thyroid Disease

Moderate:

Estradot 100

The estradiol in Estradot 100 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.

More resources

Estradot 100

A total of 446 drugs are known to interact with Estradot 100.

methicillin

A total of 61 drugs are known to interact with methicillin.

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.