Drug Interaction Report

MONITOR: The concurrent or sequential use of two or more potentially nephrotoxic or neurotoxic drugs may increase the risk of toxicity. Patients who are elderly, debilitated, dehydrated, or who have preexisting renal dysfunction may have a higher risk of developing adverse reactions.

MANAGEMENT: Close clinical and laboratory monitoring of renal and neurologic function and drug serum concentrations (if clinically appropriate) is recommended.

ADJUST DOSING INTERVAL: Food and milk may significantly decrease serum concentrations of estramustine. The mechanism of the interaction is not known.

MANAGEMENT: It is recommended that estramustine be taken at least 1 hour before or 2 hours after meals, and that it not be coadministered with milk, or calcium containing products.