Estrapatch Disease Interactions, Estrapatch


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Estrapatch (estradiol) Disease Interactions

Estrogens (Includes Estrapatch) ↔ Abnormal Vaginal Bleeding

Severe Potential Hazard, High plausibility

Applies to: Abnormal Uterine Bleeding

The use of estrogens is contraindicated in patients with undiagnosed, abnormal vaginal bleeding. Prolonged (> 1 year), unopposed estrogen use (i. e. estrogen without concomitant progestin therapy) has been associated with a significant, dose-related risk of endometrial carcinoma. The risk may be offset substantially by the addition of a progestin but may not be completely abolished. Prior to initiating estrogen therapy, appropriate diagnostic tests should be performed in patients with abnormal vaginal bleeding to rule out endometrial malignancy. The same applies if recurrent or persistent bleeding develops during estrogen therapy.

References

Buring JE, Bain CJ, Ehrmann RL "Conjugated estrogen use and risk of endometrial cancer." Am J Epidemiol 124 (1986): 434-41

Spengler RF, Clarke EA, Woolever CA, Newman AM, Osborn RW "Exogenous estrogens and endometrial cancer: a case-control study and assessment of potential biases." Am J Epidemiol 114 (1981): 497-506

"Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho Pharmaceutical Corporation, Raritan, NJ.

View all 28 references

Estrogens (Includes Estrapatch) ↔ Carcinomas (Estrogenic)

Severe Potential Hazard, High plausibility

Applies to: Neoplasia -- Estrogen Dependent

The use of estrogens is generally contraindicated in patients with known or suspected estrogen-dependent neoplasia such as breast and endometrial cancer, since it may stimulate tumor proliferation. High dosages of estrogens may be used for the palliative treatment of inoperable, metastatic breast cancer, but only in appropriately selected men and postmenopausal women.

References

"Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories, Philadelphia, PA.

"Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical, Raritan, NJ.

Schlesselman JJ "Oral contraceptives and breast cancer." Am J Obstet Gynecol 163 (1990): 1379-87

View all 57 references

Estrogens (Includes Estrapatch) ↔ Hypercalcemia In Breast Cancer

Severe Potential Hazard, Moderate plausibility

Applies to: Breast Cancer

When treated with an estrogen, patients with breast cancer and bone metastases may develop severe hypercalcemia, in which case the drug should be stopped and measures be taken to reduce serum calcium levels.

References

"Product Information. Climara (estradiol)." Berlex, Richmond, CA.

"Product Information. Ogen (estropipate topical)" Pharmacia and Upjohn, Kalamazoo, MI.

"Product Information. Estrace (estradiol)." Bristol-Myers Squibb, Princeton, NJ.

View all 11 references

Estrogens (Includes Estrapatch) ↔ Hypertension

Severe Potential Hazard, High plausibility

Applies to: 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 also 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

"Product Information. Climara (estradiol)." Berlex, Richmond, CA.

"Product Information. Ogen (estropipate topical)" Pharmacia and Upjohn, Kalamazoo, MI.

Crane MG, Harris JJ, Winsor W 3d "Hypertension, oral contraceptive agents, and conjugated estrogens." Ann Intern Med 74 (1971): 13-21

View all 52 references

Estrogens (Includes Estrapatch) ↔ Thromboembolism/Cardiovascular

Severe Potential Hazard, High plausibility

Applies to: Thrombotic/Thromboembolic Disorder, Cerebral Vascular Disorder, History - Thrombotic/Thromboembolic Disorder, Ischemic Heart Disease

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic or thromboembolic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Although the clinical significance of these effects is unknown, epidemiological data suggest it may be dose-dependent. The risk is probably slight with the use of newer, low-dose oral contraceptives in the absence of known risk factors (e. g. smoker, particularly over the age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40). However, a much more significant risk has been reported with higher dosages, such as those used to treat prostate or metastatic breast cancer or those used in older formulations of birth control pills. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of breast or prostatic malignancy.

References

Thorogood M, Mann J, Murphy M, Vessey M "Fatal stroke and use of oral contraceptives: findings from a case - control study." Am J Epidemiol 136 (1992): 35-45

Thorogood M "Risk of stroke in users of oral contraceptives." JAMA 281 (1999): 1255-6

Mishell DR "Contraception." N Engl J Med 320 (1989): 777-85

View all 60 references

Estrogens/Progestogens (Includes Estrapatch) ↔ Hepatic Neoplasms

Severe Potential Hazard, High plausibility

Applies to: Hepatic Tumor

The use of oral contraceptives is contraindicated in patients with liver tumors. An increased risk of benign hepatic adenomas and hepatocellular carcinomas has been associated with long-term, oral estrogen-progestin contraceptive use of at least 4 years and 8 years, respectively. Although these tumors are rare and have not been reported with other types of estrogen or progestogen therapies, any preparation containing estrogens and/or progestogens should probably be avoided in patients with existing tumors of the liver. Hepatic hemangiomas and nodular hyperplasia of the liver have been reported with isolated estrogen therapy.

References

Palmer JR, Rosenberg L, Kaufman DW, Warshauer ME, Stolley P, Shapiro S "Oral contraceptive use and liver cancer." Am J Epidemiol 130 (1989): 878-82

"Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories, Philadelphia, PA.

Tavani A, Negri E, Parazzini F, Franceschi S, La Vecchia C "Female hormone utilisation and risk of hepatocellular carcinoma." Br J Cancer 67 (1993): 635-7

View all 32 references

Estrogens (Includes Estrapatch) ↔ Gallbladder Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Gallbladder Disease

A two - to four-fold increase in risk of gallbladder disease has been noted in women receiving postmenopausal estrogen therapy. The risk for gallbladder disease may be less for premenopausal women using oral contraceptives containing low-dose estrogens and/or progestins. Therapy with estrogens should be administered cautiously in patients with preexisting gallbladder disease.

References

"Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho Pharmaceutical Corporation, Raritan, NJ.

"Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho Pharmaceutical Corporation, Raritan, NJ.

"Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.

View all 18 references

Estrogens (Includes Estrapatch) ↔ Hypercalcemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperparathyroidism, Renal Dysfunction, Hypercalcemia

Estrogens influence the metabolism of calcium and phosphorus. Intestinal absorption and retention of calcium are increased, which may occasionally result in hypercalcemia. Therapy with estrogens should be administered cautiously in patients with preexisting hypercalcemia, renal dysfunction, or metabolic bone diseases that are associated with hypercalcemia.

References

"Product Information. Estrace (estradiol)." Bristol-Myers Squibb, Princeton, NJ.

"Product Information. Climara (estradiol)." Berlex, Richmond, CA.

"Product Information. Estraderm (estradiol)." Ciba Pharmaceuticals, Summit, NJ.

View all 6 references

Estrogens (Includes Estrapatch) ↔ Hyperlipidemia

Moderate Potential Hazard, Moderate plausibility

Applies to: 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

Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E "Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women." JAMA 280 (1998): 605-13

"Product Information. Estrace (estradiol)." Bristol-Myers Squibb, Princeton, NJ.

"Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho Pharmaceutical Corporation, Raritan, NJ.

View all 24 references

Estrogens (Includes Estrapatch) ↔ Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease

Estrogens are primarily metabolized by the liver. Patients with impaired hepatic function may be at increased risk for adverse effects associated with estrogen administration due to decreased drug clearance. Therapy with estrogens should be administered cautiously in patients with liver disease. In addition, clinicians should be aware that estrogen therapy may affect liver function tests. Increased sulfobromophthalein retention has been reported with the use of estrogen-containing oral contraceptives and may be expected with larger doses of estrogens.

References

"Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.

"Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.

"Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories, Philadelphia, PA.

View all 22 references

Estrogens/Progestogens (Includes Estrapatch) ↔ Depression

Moderate Potential Hazard, Moderate plausibility

Applies to: Depression

The use of oral contraceptives has been associated with an increased incidence of depression. It is uncertain whether this effect is related to the estrogenic or the progestogenic component of the contraceptive, although excess progesterone activity is associated with depression. Patients with a history of depression receiving estrogen and/or progestogen therapy should be followed closely.

References

"Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.

"Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories, Philadelphia, PA.

"Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical, Raritan, NJ.

View all 22 references

Estrogens/Progestogens (Includes Estrapatch) ↔ Fluid Retention

Moderate Potential Hazard, Moderate plausibility

Applies to: Fluid Retention, Asthma, Renal Dysfunction, Seizures, Congestive Heart Failure, Migraine

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

References

"Product Information. Estrace (estradiol)." Bristol-Myers Squibb, Princeton, NJ.

"Product Information. Micronor (norethindrone)" Ortho McNeil Pharmaceutical, Raritan, NJ.

"Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.

View all 25 references

Estrogens/Progestogens (Includes Estrapatch) ↔ Glucose Intolerance

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

Impaired glucose tolerance has been observed in some patients administered oral contraceptives and appears to be related primarily to the estrogen dose. However, progestogens can increase insulin secretion and produce insulin resistance to varying degrees, depending on the agent. Patients with diabetes mellitus should be monitored more closely during therapy with estrogens and/or progestogens, and adjustments made accordingly in their antidiabetic regimen.

References

"Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho Pharmaceutical Corporation, Raritan, NJ.

Hannaford PC, Kay CR "Oral contraceptives and diabetes mellitus." BMJ 299 (1989): 1315-6

Stubblefield PG "Choosing the best oral contraceptive." Clin Obstet Gynecol 32 (1989): 316-28

View all 23 references

Estrogens/Progestogens (Includes Estrapatch) ↔ Thyroid Function Tests

Moderate Potential Hazard, Moderate plausibility

Applies to: Thyroid Disease

When administering estrogen and/or progestogen therapy in patients with thyroid disorders, clinicians should be aware that these hormones may affect thyroid function tests. Changes have mostly been reported with the use of combination oral contraceptives. Specifically, thyroid-binding globulin (TBG) may be increased, resulting in elevated circulating total thyroid hormone, as measured by PBI (protein-bound iodine), T4 by column or radioimmunoassay, or T3 by radioimmunoassay. Free T3 resin uptake may be decreased. On the contrary, a decrease in TBG and, consequently, thyroxine concentration, has been reported by the manufacturers of the progestin-only (norethindrone) oral contraceptives.

References

"Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical, Raritan, NJ.

"Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.

"Product Information. Estratab (esterified estrogens)" Solvay Pharmaceuticals Inc, Marietta, GA.

View all 24 references

Estrapatch (estradiol) drug Interactions

There are 244 drug interactions with Estrapatch (estradiol)

Estrapatch (estradiol) alcohol/food Interactions

There are 3 alcohol/food interactions with Estrapatch (estradiol)

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