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Angeliq and Alcohol/Food Interactions

There are 4 alcohol/food/lifestyle interactions with Angeliq (drospirenone / estradiol).

Moderate

Drospirenone Food

Moderate Food Interaction

Consumer information for this interaction is not currently available.

MONITOR: Grapefruit juice may increase the plasma concentrations of orally administered drugs that are substrates of the CYP450 3A4 isoenzyme. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because grapefruit juice inhibits primarily intestinal rather than hepatic CYP450 3A4, the magnitude of interaction is greatest for those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability). In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Patients who regularly consume grapefruit or grapefruit juice should be monitored for adverse effects and altered plasma concentrations of drugs that undergo significant presystemic metabolism by CYP450 3A4. Grapefruit and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact with these drugs.

References

  1. Edgar B, Bailey D, Bergstrand R, et al. (1992) "Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics on felodipine and its potential clinical relevance." Eur J Clin Pharmacol, 42, p. 313-7
  2. Jonkman JH, Sollie FA, Sauter R, Steinijans VW (1991) "The influence of caffeine on the steady-state pharmacokinetics of theophylline." Clin Pharmacol Ther, 49, p. 248-55
  3. Bailey DG, Arnold JM, Munoz C, Spence JD (1993) "Grapefruit juice--felodipine interaction: mechanism, predictability, and effect of naringin." Clin Pharmacol Ther, 53, p. 637-42
  4. Bailey DG, Arnold JMO, Spence JD (1994) "Grapefruit juice and drugs - how significant is the interaction." Clin Pharmacokinet, 26, p. 91-8
  5. Sigusch H, Hippius M, Henschel L, Kaufmann K, Hoffmann A (1994) "Influence of grapefruit juice on the pharmacokinetics of a slow release nifedipine formulation." Pharmazie, 49, p. 522-4
  6. Bailey DG, Arnold JM, Strong HA, Munoz C, Spence JD (1993) "Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics." Clin Pharmacol Ther, 54, p. 589-94
  7. Yamreudeewong W, Henann NE, Fazio A, Lower DL, Cassidy TG (1995) "Drug-food interactions in clinical practice." J Fam Pract, 40, p. 376-84
  8. (1995) "Grapefruit juice interactions with drugs." Med Lett Drugs Ther, 37, p. 73-4
  9. Hukkinen SK, Varhe A, Olkkola KT, Neuvonen PJ (1995) "Plasma concentrations of triazolam are increased by concomitant ingestion of grapefruit juice." Clin Pharmacol Ther, 58, p. 127-31
  10. Min DI, Ku YM, Geraets DR, Lee HC (1996) "Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers." J Clin Pharmacol, 36, p. 469-76
  11. Majeed A, Kareem A (1996) "Effect of grapefruit juice on cyclosporine pharmacokinetics." Pediatr Nephrol, 10, p. 395
  12. Clifford CP, Adams DA, Murray S, Taylor GW, Wilkins MR, Boobis AR, Davies DS (1996) "Pharmacokinetic and cardiac effects of terfenadine after inhibition of its metabolism by grapefruit juice." Br J Clin Pharmacol, 42, p662
  13. Josefsson M, Zackrisson AL, Ahlner J (1996) "Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers." Eur J Clin Pharmacol, 51, p. 189-93
  14. Kantola T, Kivisto KT, Neuvonen PJ (1998) "Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid." Clin Pharmacol Ther, 63, p. 397-402
  15. Ozdemir M, Aktan Y, Boydag BS, Cingi MI, Musmul A (1998) "Interaction between grapefruit juice and diazepam in humans." Eur J Drug Metab Pharmacokinet, 23, p. 55-9
  16. Bailey DG, Malcolm J, Arnold O, Spence JD (1998) "Grapefruit juice-drug interactions." Br J Clin Pharmacol, 46, p. 101-10
  17. Bailey DG, Kreeft JH, Munoz C, Freeman DJ, Bend JR (1998) "Grapefruit juice felodipine interaction: Effect of naringin and 6',7'-dihydroxybergamottin in humans." Clin Pharmacol Ther, 64, p. 248-56
  18. Garg SK, Kumar N, Bhargava VK, Prabhakar SK (1998) "Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy." Clin Pharmacol Ther, 64, p. 286-8
  19. Lilja JJ, Kivisto KT, Neuvonen PJ (1998) "Grapefruit juice-simvastatin interaction: Effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors." Clin Pharmacol Ther, 64, p. 477-83
  20. Fuhr U, Maier-Bruggemann A, Blume H, et al. (1998) "Grapefruit juice increases oral nimodipine bioavailability." Int J Clin Pharmacol Ther, 36, p. 126-32
  21. Lilja JJ, Kivisto KT, Neuvonen PJ (1999) "Grapefruit juice increases serum concentrations of atorvastatin and has no effect on pravastatin." Clin Pharmacol Ther, 66, p. 118-27
  22. Eagling VA, Profit L, Back DJ (1999) "Inhibition of the CYP3A4-mediated metabolism and P-glycoprotein-mediated transport of the HIV-I protease inhibitor saquinavir by grapefruit juice components." Br J Clin Pharmacol, 48, p. 543-52
  23. Damkier P, Hansen LL, Brosen K (1999) "Effect of diclofenac, disulfiram, itraconazole, grapefruit juice and erythromycin on the pharmacokinetics of quinidine." Br J Clin Pharmacol, 48, p. 829-38
  24. Lee AJ, Chan WK, Harralson AF, Buffum J, Bui BCC (1999) "The effects of grapefruit juice on sertraline metabolism: An in vitro and in vivo study." Clin Ther, 21, p. 1890-9
  25. Dresser GK, Spence JD, Bailey DG (2000) "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet, 38, p. 41-57
  26. Gunston GD, Mehta U (2000) "Potentially serious drug interactions with grapefruit juice." S Afr Med J, 90, p. 41
  27. Takanaga H, Ohnishi A, Maatsuo H, et al. (2000) "Pharmacokinetic analysis of felodipine-grapefruit juice interaction based on an irreversible enzyme inhibition model." Br J Clin Pharmacol, 49, p. 49-58
  28. Libersa CC, Brique SA, Motte KB, et al. (2000) "Dramatic inhibition of amiodarone metabolism induced by grapefruit juice." Br J Clin Pharmacol, 49, p. 373-8
  29. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR (2000) "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther, 68, p. 468-77
  30. Zaidenstein R, Soback S, Gips M, Avni B, Dishi V, Weissgarten Y, Golik A, Scapa E (2001) "Effect of grapefruit juice on the pharmacokinetics of losartan and its active metabolite E3174 in healthy volunteers." Ther Drug Monit, 23, p. 369-73
  31. Sato J, Nakata H, Owada E, Kikuta T, Umetsu M, Ito K (1993) "Influence of usual intake of dietary caffeine on single-dose kinetics of theophylline in healthy human subjects." Eur J Clin Pharmacol, 44, p. 295-8
  32. Flanagan D (2005) "Understanding the grapefruit-drug interaction." Gen Dent, 53, 282-5; quiz 286
View all 32 references
Minor

Estradiol Food

Minor Food Interaction

Information for this minor interaction is available on the professional version.

Major

Estradiol High Blood Pressure (Hypertension)

Major Potential Hazard, High plausibility

estrogens - hypertension

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. 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.

References

  1. Leiman G (1972) "Depo-medroxyprogesterone acetate as a contraceptive agent: its effect on weight and blood pressure." Am J Obstet Gynecol, 114, p. 97-102
  2. Williams RS (1992) "Benefits and risks of oral contraceptive use." Postgrad Med, 92, p. 155-7
  3. Crane MG, Harris JJ (1978) "Estrogens and hypertension: effect of discontinuing estrogens on blood pressure, exchangeable sodium, and the renin-aldosterone system." Am J Med Sci, 276, p. 33-55
  4. Crane MG, Harris JJ, Winsor W 3d (1971) "Hypertension, oral contraceptive agents, and conjugated estrogens." Ann Intern Med, 74, p. 13-21
  5. Rosenberg L, Slone D, Shapiro S, Kaufman D, Stolley PD, Miettinen OS (1980) "Noncontraceptive estrogens and myocardial infarction in young women." JAMA, 244, p. 339-42
  6. Jick H, Dinan B, Rothman KJ (1978) "Noncontraceptive estrogens and nonfatal myocardial infarction." JAMA, 239, p. 1407-8
  7. Wren BG, Routledge DA (1981) "Blood pressure changes: oestrogens in climacteric women." Med J Aust, 2, p. 528-31
  8. Rosenberg L, Palmer JR, Lesko SM, Shapiro S (1990) "Oral contraceptive use and the risk of myocardial infarction." Am J Epidemiol, 131, p. 1009-16
  9. Thorogood M, Mann J, Murphy M, Vessey M (1992) "Fatal stroke and use of oral contraceptives: findings from a case- control study." Am J Epidemiol, 136, p. 35-45
  10. Leaf DA, Bland D, Schaad D, Neighbor WE, Scott CS (1991) "Oral contraceptive use and coronary risk factors in women." Am J Med Sci, 301, p. 365-8
  11. Thorneycroft IH (1990) "Oral contraceptives and myocardial infarction." Am J Obstet Gynecol, 163, p. 1393-7
  12. Lidegaard O (1993) "Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study." BMJ, 306, p. 956-63
  13. Derman RJ (1990) "Oral contraceptives and cardiovascular risk. Taking a safe course of action." Postgrad Med, 88, p. 119-22
  14. Hannaford PC, Croft PR, Kay CR (1994) "Oral contraception and stroke. Evidence from the Royal College of General Practitioners' Oral Contraception Study." Stroke, 25, p. 935-42
  15. Steinberg WM (1989) "Oral contraception: risks and benefits." Adv Contracept, 5, p. 219-28
  16. Peterson HB, Lee NC (1990) "Long-term health risks and benefits of oral contraceptive use." Obstet Gynecol Clin North Am, 17, p. 775-88
  17. Derman R (1989) "Oral contraceptives: a reassessment." Obstet Gynecol Surv, 44, p. 662-8
  18. Belchetz PE (1994) "Hormonal treatment of postmenopausal women." N Engl J Med, 330, p. 1062-71
  19. Stampfer MJ, Colditz GA, Willett WC, et al. (1991) "Postmenopausal estrogen and cardiovascular disease. Ten-year follow-up from the Nurses' Health Study." N Engl J Med, 325, p. 756-62
  20. Barrett-Connor E, Bush TL (1991) "Estrogen and coronary heart disease in women." JAMA, 265, p. 1861-7
  21. Barrett-Connor E, Wingard DL, Criqui MH (1989) "Postmenopausal estrogen use and heart disease risk factors in the 1980s. Rancho Bernardo, Calif, revisited." JAMA, 261, p. 1095-2100
  22. Mishell DR (1989) "Contraception." N Engl J Med, 320, p. 777-85
  23. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  24. Schwartz J, Freeman R, Frishman W (1995) "Clinical pharmacology of estrogens: cardiovascular actions and cardioprotective benefits of replacement therapy in postmenopausal women." J Clin Pharmacol, 35, p. 1-16
  25. The Writing Group for the PEPI Trial (1995) "Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial." JAMA, 273, p. 199-208
  26. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  27. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  28. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  29. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  30. Norris LA, Bonnar J (1996) "The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives." Br J Obstet Gynaecol, 103, p. 261-7
  31. Levine AB, Teppa J, Mcgough B, Cowchock FS (1996) "Evaluation of the prethrombotic state in pregnancy and in women using oral contraceptives." Contraception, 53, p. 255-7
  32. Petitti DB, Sidney S, Bernstein A, Wolf S, Quesenberry C, Ziel HK (1996) "Stroke in users of low-dose oral contraceptives." N Engl J Med, 335, p. 8-15
  33. Speroff L (1996) "Oral contraceptives and venous thromboembolism." Int J Gynaecol Obstet, 54, p. 45-50
  34. Poulter NR, Chang CL, Farley TMM, Meirik O, Marmot MG, Debertribeiro M, Medina E, Artigas J, Shen H, Zhong YH, Zhang DW, (1996) "Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case-control study." Lancet, 348, p. 498-505
  35. Poulter NR, Chang CL, Farley TMM, Meirik O, Marmot MG (1996) "Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study." Lancet, 348, p. 505-10
  36. Piegsa K, Guillebaud J (1996) "Oral contraceptives and the risk of DVT." Practitioner, 240, p. 544
  37. Martinelli I, Rosendaal FR, Vandenbroucke JP, Mannucci PM (1996) "Oral contraceptives are a risk factor for cerebral vein thrombosis." Thromb Haemost, 76, p. 477-8
  38. Farley TMM, Meirik O, Poulter NR, Chang CL, Marmot MG (1996) "Oral contraceptives and thrombotic diseases: impact of new epidemiological studies." Contraception, 54, p. 193-5
  39. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  40. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  41. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  42. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  43. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  44. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  45. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  46. Sidney S, Petitti DB, Quesenberry CP (1997) "Myocardial infarction and the use of estrogen and estrogen-progestogen in postmenopausal women." Ann Intern Med, 127, p. 501-8
  47. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  48. Thorogood M (1999) "Risk of stroke in users of oral contraceptives." JAMA, 281, p. 1255-6
  49. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  50. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  51. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  52. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  53. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 53 references
Moderate

Estradiol High Cholesterol (Hyperlipoproteinemia, Hypertriglyceridemia, Sitosterolemia)

Moderate Potential Hazard, Moderate plausibility

estrogens - hyperlipidemia

Although estrogens have generally favorable effects on plasma lipids, including increases in HDL and decreases in total cholesterol and LDL, they have also been associated with significant elevations in triglyceride levels, particularly when high dosages are used. Severe hyperlipidemia is known to sometimes cause pancreatitis. Patients with preexisting hyperlipidemia may require closer monitoring during estrogen therapy, and adjustments made accordingly in their lipid-lowering regimen.

References

  1. Molitch ME, Oill P, Odell WD (1974) "Massive hyperlipemia during estrogen therapy." JAMA, 227, p. 522-5
  2. Janaud A, Rouffy J, Upmalis D, Dain MP (1992) "A comparison study of lipid and androgen metabolism with triphasic oral contraceptive formulations containing norgestimate or levonorgestrel." Acta Obstet Gynecol Scand Suppl, 156, p. 33-8
  3. Steinberg WM (1989) "Oral contraception: risks and benefits." Adv Contracept, 5, p. 219-28
  4. Burkman RT, Zacur HA, Kimball AW, Kwiterovich P, Bell WR (1989) "Oral contraceptives and lipids and lipoproteins: Part I--Variations in mean levels by oral contraceptive type." Contraception, 40, p. 553-61
  5. Derman R (1989) "Oral contraceptives: a reassessment." Obstet Gynecol Surv, 44, p. 662-8
  6. Godsland IF, Crook D (1994) "Update on the metabolic effects of steroidal contraceptives and their relationship to cardiovascular disease risk." Am J Obstet Gynecol, 170, p. 1528-36
  7. (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
  9. (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
  10. (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
  11. (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
  12. "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  13. (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
  14. "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
  15. (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
  16. (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
  17. (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
  18. "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
  19. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E (1998) "Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women." JAMA, 280, p. 605-13
  20. (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
  21. "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
  22. (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
  23. "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
  24. (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
  25. (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
View all 25 references

Angeliq drug interactions

There are 505 drug interactions with Angeliq (drospirenone / estradiol).

Angeliq disease interactions

There are 18 disease interactions with Angeliq (drospirenone / estradiol) which include:


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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.