FemSeven Sequi Phase I and Alcohol/Food Interactions
There are 4 alcohol/food/lifestyle interactions with FemSeven Sequi Phase I (estradiol).
Nicotine Estradiol
Moderate Drug Interaction
MONITOR: Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.
MANAGEMENT: Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.
References (4)
- (2024) "Product Information. Cytisine (cytisinicline)." Consilient Health Ltd
- jeong sh, Newcombe D, sheridan j, Tingle M (2015) "Pharmacokinetics of cytisine, an a4 b2 nicotinic receptor partial agonist, in healthy smokers following a single dose." Drug Test Anal, 7, p. 475-82
- Vaughan DP, Beckett AH, Robbie DS (1976) "The influence of smoking on the intersubject variation in pentazocine elimination." Br J Clin Pharmacol, 3, p. 279-83
- Zevin S, Benowitz NL (1999) "Drug interactions with tobacco smoking: an update" Clin Pharmacokinet, 36, p. 425-38
Estradiol Food
Minor Food Interaction
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)
- Weber A, Jager R, Borner A, et al. (1996) "Can grapefruit juice influence ethinyl estradiol bioavailability?" Contraception, 53, p. 41-7
- 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
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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 (53)
- 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
- Williams RS (1992) "Benefits and risks of oral contraceptive use." Postgrad Med, 92, p. 155-7
- 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
- Crane MG, Harris JJ, Winsor W 3d (1971) "Hypertension, oral contraceptive agents, and conjugated estrogens." Ann Intern Med, 74, p. 13-21
- 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
- Jick H, Dinan B, Rothman KJ (1978) "Noncontraceptive estrogens and nonfatal myocardial infarction." JAMA, 239, p. 1407-8
- Wren BG, Routledge DA (1981) "Blood pressure changes: oestrogens in climacteric women." Med J Aust, 2, p. 528-31
- 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
- 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
- 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
- Thorneycroft IH (1990) "Oral contraceptives and myocardial infarction." Am J Obstet Gynecol, 163, p. 1393-7
- Lidegaard O (1993) "Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study." BMJ, 306, p. 956-63
- Derman RJ (1990) "Oral contraceptives and cardiovascular risk. Taking a safe course of action." Postgrad Med, 88, p. 119-22
- 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
- Steinberg WM (1989) "Oral contraception: risks and benefits." Adv Contracept, 5, p. 219-28
- Peterson HB, Lee NC (1990) "Long-term health risks and benefits of oral contraceptive use." Obstet Gynecol Clin North Am, 17, p. 775-88
- Derman R (1989) "Oral contraceptives: a reassessment." Obstet Gynecol Surv, 44, p. 662-8
- Belchetz PE (1994) "Hormonal treatment of postmenopausal women." N Engl J Med, 330, p. 1062-71
- 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
- Barrett-Connor E, Bush TL (1991) "Estrogen and coronary heart disease in women." JAMA, 265, p. 1861-7
- 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
- Mishell DR (1989) "Contraception." N Engl J Med, 320, p. 777-85
- (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
- 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
- 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
- (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
- (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
- (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
- (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
- 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
- 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
- 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
- Speroff L (1996) "Oral contraceptives and venous thromboembolism." Int J Gynaecol Obstet, 54, p. 45-50
- 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
- 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
- Piegsa K, Guillebaud J (1996) "Oral contraceptives and the risk of DVT." Practitioner, 240, p. 544
- 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
- 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
- "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
- (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
- "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
- (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
- (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
- (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
- "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
- 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
- (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
- Thorogood M (1999) "Risk of stroke in users of oral contraceptives." JAMA, 281, p. 1255-6
- "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
- (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
- "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
- (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
- (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
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 (25)
- Molitch ME, Oill P, Odell WD (1974) "Massive hyperlipemia during estrogen therapy." JAMA, 227, p. 522-5
- 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
- Steinberg WM (1989) "Oral contraception: risks and benefits." Adv Contracept, 5, p. 219-28
- 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
- Derman R (1989) "Oral contraceptives: a reassessment." Obstet Gynecol Surv, 44, p. 662-8
- 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
- (2001) "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories
- (2001) "Product Information. Climara (estradiol)." Berlex Laboratories
- (2001) "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories
- (2001) "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals
- (2001) "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals
- "Product Information. Ortho-Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
- (2001) "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical
- "Product Information. Demulen 1/50 (ethinyl estradiol-ethynodiol)." Searle
- (2001) "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories
- (2001) "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical
- (2001) "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories
- "Product Information. Ortho-Novum 1/50 (mestranol-norethindrone)." Ortho McNeil Pharmaceutical
- 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
- (2001) "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical
- "Product Information. Ortho Dienestrol (dienestrol topical)." Ortho McNeil Pharmaceutical
- (2001) "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn
- "Product Information. Estinyl (ethinyl estradiol)." Schering Corporation
- (2001) "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc
- (2021) "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma
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FemSeven Sequi Phase I drug interactions
There are 374 drug interactions with FemSeven Sequi Phase I (estradiol).
FemSeven Sequi Phase I disease interactions
There are 17 disease interactions with FemSeven Sequi Phase I (estradiol) which include:
- abnormal vaginal bleeding
- carcinomas (estrogenic)
- hypercalcemia in breast cancer
- hypertension
- thromboembolism/cardiovascular
- hepatic neoplasms
- angioedema
- gallbladder disease
- hypercalcemia
- hyperlipidemia
- liver disease
- melasma
- depression
- fluid retention
- glucose intolerance
- retinal thrombosis
- thyroid function tests
More about FemSeven Sequi Phase I (estradiol)
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Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.