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Drug Interactions between Fematrix and Lysteda

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

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Interactions between your drugs

Major

tranexamic acid estradiol

Applies to: Lysteda (tranexamic acid) and Fematrix (estradiol)

MONITOR CLOSELY: There are no clinical data on the use of tranexamic acid in combination with estrogens or selective estrogen receptor modulators. Because tranexamic acid is an antifibrinolytic agent, concomitant use may further exacerbate the risk of thrombotic events, including venous thromboembolism as well as arterial thromboses such as stroke and myocardial infarction, associated with estrogenic therapy. During postmarketing use of tranexamic acid for the treatment of cyclic heavy menstrual bleeding, there have been reports of venous and arterial thrombotic events in women who used tranexamic acid during treatment with combination hormonal contraceptives.

MANAGEMENT: Caution and close monitoring for thromboembolic adverse effects are recommended if tranexamic acid is prescribed with estrogens or selective estrogen receptor modulators. Patients should be advised to seek medical attention immediately if they experience potential signs and symptoms of blood clots such as chest pain, shortness of breath, hemoptysis, hematuria, sudden loss of vision, and pain, redness or swelling in an extremity.

References

  1. "Product Information. Cyklokapron (tranexamic acid)." Pharmacia and Upjohn PROD (2001):
  2. van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, Doggen CJ, Rosendaal FR "The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study." BMJ 339 (2009): b2921
  3. Lidegaard O, Lokkegaard E, Svendsen AL, Agger C "Hormonal contraception and risk of venous thromboembolism: national follow-up study." BMJ 339 (2009): b2890
  4. "Product Information. Lysteda (tranexamic acid)." Xanodyne Pharmaceuticals Inc (2022):
  5. Rosendaal FR, Van Hylckama Vlieg A, Tanis BC, Helmerhorst FM "Estrogens, progestogens and thrombosis." J Thromb Haemost 1 (2003): 1371-80
  6. Gomes MP, Deitcher SR "Risk of venous thromboembolic disease associated with hormonal contraceptives and hormone replacement therapy: a clinical review." Arch Intern Med 164 (2004): 1965-76
View all 6 references

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Drug and food interactions

Minor

estradiol food

Applies to: Fematrix (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.

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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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