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Drug Interactions between Estradot 50 and Ryanodex

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

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Interactions between your drugs

Major

estradiol dantrolene

Applies to: Estradot 50 (estradiol) and Ryanodex (dantrolene)

MONITOR CLOSELY: The use of estrogens may potentiate the risk of hepatotoxicity associated with dantrolene therapy. The mechanism of interaction is unknown. Fatal and non-fatal liver disorders of an idiosyncratic or hypersensitivity nature have been reported during dantrolene use. Although a definite drug interaction with estrogen therapy has not yet been established, hepatotoxicity has occurred more often in women over 35 years of age receiving concomitant estrogen therapy than in other patients treated with dantrolene.

MANAGEMENT: Dantrolene should be used with caution in patients, particularly females over 35 years of age, who are receiving concomitant estrogen therapy. Liver function tests (SGOT, SGPT, alkaline phosphatase, total bilirubin) should be performed prior to and during dantrolene therapy at appropriate intervals, and the drug should generally be withheld if significant abnormalities are observed. Patients treated with dantrolene should be advised to promptly contact their physician if they develop signs and symptoms of hepatocellular injury such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. The drug should be discontinued if hepatitis is suspected, since early detection and drug withdrawal will increase the likelihood of reversing the damage. Following resolution of clinical and laboratory abnormalities, reinstitution of dantrolene therapy should be attempted with extreme caution and only if benefit clearly outweighs the risk.

References

  1. "Product Information. Dantrium (dantrolene)." Procter and Gamble Pharmaceuticals PROD (2001):

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Drug and food interactions

Moderate

dantrolene food

Applies to: Ryanodex (dantrolene)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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Minor

estradiol food

Applies to: Estradot 50 (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

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

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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.

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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