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Drug Interactions between Premphase and tivozanib

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

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Interactions between your drugs

Moderate

medroxyPROGESTERone tivozanib

Applies to: Premphase (conjugated estrogens / medroxyprogesterone) and tivozanib

ADDITIONAL CONTRACEPTION RECOMMENDED: Coadministration with tivozanib may decrease the efficacy of contraceptive hormones. However, the nature of the interaction has not been confirmed and clinical data are lacking.

MANAGEMENT: Until more information is known, caution is advised when tivozanib is prescribed concomitantly with hormonal contraceptives. Some authorities recommend that female patients of childbearing potential use an additional method of contraception. An acceptable barrier method (e.g., diaphragm with spermicide, cervical cap with spermicide, contraceptive sponge, male condom, female condom) in addition to the hormonal contraceptive of choice may be advisable during the duration of tivozanib therapy and for at least one month after completing therapy.

References (2)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. (2021) "Product Information. Fotivda (tivozanib)." Aveo Pharmaceuticals, Inc.

Drug and food interactions

Minor

conjugated estrogens food

Applies to: Premphase (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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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