The presence or absence of a concomitant progestin may influence the significance of any hormonal effect on glucose homeostasis. Armodafinil: (Major) Armodafinil may cause failure of oral contraceptives or hormonal contraceptive-containing implants or devices due to induction of CYP3A4 isoenzyme metabolism of estradiol, ethinyl estradiol and/or the progestins in these products. Estrogen therapy may cause an exacerbation of migraine or a change in headache patterns and should be used with caution in women with migraine. Fluticasone; Vilanterol: (Moderate) Estrogens have been associated with elevated serum concentrations of corticosteroid binding globulin (CBG), leading to increased total circulating corticosteroids, although the free concentrations of these hormones may be lower; the clinical significance is not known. Hydrochlorothiazide, HCTZ; Quinapril: (Minor) Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormonal contraceptives should be monitored for antihypertensive effectiveness. Liraglutide: (Moderate) Incretin mimetics slow gastric emptying and should be used with caution in patients receiving oral medications that require minimum threshold concentrations for efficacy, such as combined hormonal oral contraceptives (OCs). The North American Menopause Society (NAMS) Guidelines support the initiation of hormone replacement therapy (HRT) around the time of menopause if no contraindications to use exist and use is acceptable to the individual patient, as hormone therapy is the most effective treatment for vasomotor and genitourinary symptoms and has been shown to prevent bone loss and fracture. Toremifene exerts its effects by blocking estrogen receptors. Patients dependent on thyroid hormone replacement therapy who are also receiving estrogens may require increased doses of their thyroid replacement therapy. Patients should be instructed to lie on their back with their knees drawn up, gently insert the applicator deeply into the vagina, and, once inserted, press the plunger downward to its original position. Topical gel, Divigel:Instruct patient on proper application.Apply the gel to clean, dry, unbroken skin. Generally, when used in a postmenopausal woman with an intact uterus, a progestin should also be considered to reduce the risk of endometrial hyperplasia. Some incretin mimetics make specific recommendations to reduce the risk for interaction. (Minor) Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormone therapy should be monitored for antihypertensive effectiveness. Estradiol topical gels and sprays are alcohol-based and thus are potentially flammable. Azelastine; Fluticasone: (Moderate) Estrogens have been associated with elevated serum concentrations of corticosteroid binding globulin (CBG), leading to increased total circulating corticosteroids, although the free concentrations of these hormones may be lower; the clinical significance is not known. Events have developed in minutes and have required emergency medical treatment. If you are 65 or older, use estradiol vaginal cream with care. Reevaluate periodically as clinically indicated to determine if use is still appropriate. Different vaginal ring devices are not interchangeable due to differences in dosage and efficacy in symptom control. Estrogens are CYP3A4 substrates and cenobamate is a moderate CYP3A4 inducer. Risk is especially high for female smokers 35 years of age or older or those who smoke >= 15 cigarettes per day. Changes in glucose tolerance occur more commonly in patients receiving 50 mcg or more of ethinyl estradiol (or equivalent) per day in combined oral contraceptives (COCs), which are not commonly used in practice since the marketing of lower dose COCs, patches, injections and rings. Estrogens are CYP3A4 substrates and dexamethasone is a CYP3A4 inducer; concomitant use may decrease the clinical efficacy of estrogens. Ritonavir is a substrate and inhibitor of CYP3A4. An alternate or additional form of contraception should be considered in patients prescribed concomitant therapy with enzyme-inducing anticonvulsants, or higher-dose hormonal regimens may be indicated where acceptable or applicable. Circulating estrogens exist in a dynamic equilibrium of metabolic interconversions. Inducers of CYP3A4, such as St. John's Wort (Hypericum perforatum) preparations, may reduce plasma concentrations of estrogens, possibly resulting in a decrease in therapeutic effects and/or changes in the uterine bleeding profile. Fludrocortisone: (Moderate) Estrogens have been associated with elevated serum concentrations of corticosteroid binding globulin (CBG), leading to increased total circulating corticosteroids, although the free concentrations of these hormones may be lower; the clinical significance is not known. Minoxidil: (Minor) Estrogens can cause fluid retention, increasing blood pressure and thereby antagonizing the antihypertensive effects of minoxidil. Amiodarone: (Minor) Amiodarone inhibits CYP3A4, and may increase serum estrogen concentrations and estrogenic-related side effects (e.g., nausea, breast tenderness) if coadministered. The use of estrogens may aggravate conditions for which toremifene is prescribed. Letrozole: (Contraindicated) Estrogens, including hormonal contraceptives, could interfere competitively with the pharmacologic action of the aromatase inhibitors. Pubertal induction can be accomplished with transdermal estradiol at an off-label dose as low as 3.1 to 6.2 mcg/24 hours; however, such dosage forms are not commercially available. Itraconazole: (Minor) As itraconazole inhibits CYP3A4 activity, serum estrogen concentrations and estrogenic-related side effects (e.g., nausea, breast tenderness) may potentially increase when coadministered with either estrogens or combined hormonal contraceptives. If significant depression occurs, estradiol should be discontinued. Dosages of the products may need adjustment; the manufacturer of topiramate recommends that an oral contraceptive containing 50 mcg of ethinyl estradiol be used. The presence or absence of a concomitant progestin may influence the significance of any hormonal effect on glucose homeostasis. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Dose is then increased over time to meet the goals of the individual patient based on age, sexual development, bone age and height, and other treatment goals. 25, 37.5, 50, 75, 100 mcg/day estradiol delivered via patch) to adult dose for female hypogonadism. Ertugliflozin; Sitagliptin: (Minor) Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Use lowest effective dose. 1 patch (delivering 0.025 mg, 0.0375 mg, 0.05 mg, 0.075 mg, or 0.1 mg per day) replaced twice weekly (every 3 to 4 days); start therapy with 0.025 mg/day dose and adjust as needed. Types & Formulations of Bioidentical Estrogens. Alternatively, a cyclic schedule of 3 weeks on drug and 1 week off drug may be used. Some hypothyroid patients on estrogen may require larger doses of thyroid hormones. Indinavir: (Moderate) Indinavir has been shown to decrease the metabolism of ethinyl estradiol; a similar interaction may occur with other estrogens used for hormone replacement therapy. Decisions regarding whether to continue systemic HRT in women aged older than 60 years should be made on an individual basis for quality of life, persistent vasomotor symptoms, or prevention of bone loss and fracture, with consideration given to alternative treatments for prevention of bone loss and other health issues. Coadministration may decrease the concentrations of hormonal contraceptives. Changes in glucose tolerance occur more commonly in patients receiving 50 mcg or more of ethinyl estradiol (or equivalent) per day in combined oral contraceptives (COCs), which are not commonly used in practice since the marketing of lower dose COCs, patches, injections and rings. Saquinavir: (Moderate) Saquinavir has been shown to increase the metabolism of ethinyl estradiol; a similar interaction may occur with other estrogens used for hormone replacement therapy. The increase in VTE risk was demonstrated during the first year and persisted. Amlodipine: (Minor) Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormonal contraceptives should be monitored for antihypertensive effectiveness. Higher-dose hormonal regimens may be indicated where acceptable or applicable. Metolazone: (Minor) Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormone therapy should be monitored for antihypertensive effectiveness. Drugs that inhibit CYP3A4 such as chloramphenicol may increase plasma concentrations of estrogens and cause estrogen-related side effects such as nausea and breast tenderness. Gradually increase dose over about 2 years to usual adult maintenance dose for female hypogonadism, i.e., estradiol cypionate 1.5 mg to 2 mg IM every 4 weeks. The presence or absence of a concomitant progestin may influence the significance of any hormonal effect on glucose homeostasis. Additionally, although not specifically studied, because estrogens are CYP3A4 substrates, the efficacy of estrogens or progestins when used for hormone replacement may also be reduced. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Minimal fluctuations in estradiol concentrations are seen with transdermal application. Accordingly, hormone replacement therapy (HRT) has been reported to induce, unmask, and exacerbate lupus; case reports, anecdotal data, and the prospective Nurses Health Study indicate that a temporal relationship between HRT and lupus exist. Proper intake of folic acid should also be ensured. These transformations take place mainly in the liver. A decrease in estrogen concentrations, and thus efficacy, may occur in patients taking estrogens for hormone replacement therapy. Consider each woman's net balance of individual benefits and harms. Patients should be monitored for signs of decreased clinical effects of estrogens (e.g., menopausal symptoms, breakthrough bleeding, reduced efficacy) if these drugs are used together. Additionally, the Beers expert panel recommends avoiding oral or transdermal estrogen in elderly women with any type of urinary incontinence due to lack of efficacy. Darunavir: (Moderate) Darunavir is expected to increase the metabolism of estradiol. The Beers expert panel considers use of vaginal estrogens acceptable for the management of dyspareunia, recurrent lower urinary tract infections, and other vaginal/vulvar symptoms. Minocycline: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. Treatment continues for reproductive life, but choices of treatment often change from intramuscular depot dosing to other dosage forms as the adolescent matures. Pramlintide: (Minor) Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Hemin: (Moderate) Hemin works by inhibiting aminolevulinic acid synthetase. Nicardipine: (Minor) Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormonal contraceptives should be monitored for antihypertensive effectiveness. The compound contains estradiol 0.01% in vaginal versabase cream. An alternate or additional form of contraception should be considered in patients prescribed concomitant therapy with enzyme-inducing anticonvulsants, or higher-dose hormonal regimens may be indicated where acceptable or applicable. Enalapril; Hydrochlorothiazide, HCTZ: (Minor) Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormonal contraceptives should be monitored for antihypertensive effectiveness. Approximately 85% of patients diagnosed with systemic lupus erythematosus (SLE) are females, giving support to the notion that hormonal influences, especially estrogen, contribute to the pathophysiology of SLE. Compounded estrogen formulations for menopause contain estradiol, estrone and/or estriol. containing estradiol and progesterone. Acetaminophen; Propoxyphene: (Minor) Estrogens are partially metabolized by CYP3A4. Estrogens, Excluding Hormonal Contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. NOTE: The number of doses per tube will vary with dosage requirements and patient handling. Reevaluate periodically as clinically indicated to determine if use is still appropriate. Estrogens and progestins can cause amenorrhea and, therefore, counteract the desired effects of bromocriptine. Budesonide; Formoterol: (Moderate) Estrogens have been associated with elevated serum concentrations of corticosteroid binding globulin (CBG), leading to increased total circulating corticosteroids, although the free concentrations of these hormones may be lower; the clinical significance is not known. Do not apply the emulsion to skin that is red or irritated.Each dose requires 2 foil packages. Levothyroxine; Liothyronine (Synthetic): (Minor) The administration of estrogens can increase circulating concentrations of thyroxine-binding globulin. Changes in glucose tolerance occur more commonly in patients receiving 50 mcg or more of ethinyl estradiol (or equivalent) per day in combined oral contraceptives (COCs), which are not commonly used in practice since the marketing of lower dose COCs, patches, injections and rings. The presence or absence of a concomitant progestin may influence the significance of any hormonal effect on glucose homeostasis. Bioidentical creams can help to offer the patient lower doses of hormones. 1 patch (delivering 0.025 mg, 0.0375 mg, 0.05 mg, 0.075 mg, or 0.1 mg per day); replace twice weekly (every 3 to 4 days). Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines and penicillin derivatives. The efficacy of estradiol may be reduced when coadministered with aprepitant, fosaprepitant and for 28 days after the last dose. Estrogens also undergo enterohepatic recirculation via sulfate and glucuronide conjugation in the liver, biliary secretion of conjugates into the intestine, and hydrolysis in the gut followed by reabsorption. Estrogens can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. 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