Therapy/Monitor Closely.rufinamiderufinamide will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.secobarbitalsecobarbital will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.simvastatinsimvastatin will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.sirolimussirolimus will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.somapacitanestropipate decreases effects of somapacitan by Other (see comment). Modify Therapy/Monitor Closely. Comment: Oral estrogens may reduce the serum IGF-1 response to somapacitan. Patients may require higher somapacitan dosages. See drug monograph for starting dose recommendations.St John's WortSt John's Wort will decrease the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.stiripentolstiripentol, estropipate. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.stiripentol, estropipate. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.streptomycinstreptomycin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.sulfadiazinesulfadiazine will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.sulfamethoxazolesulfamethoxazole will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.sulfisoxazolesulfisoxazole will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.tacrolimustacrolimus will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.tazemetostattazemetostat will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tecovirimattecovirimat will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.teicoplaninteicoplanin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.temocillintemocillin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.teriflunomideteriflunomide decreases levels of estropipate by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.tetracyclinetetracycline will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.ticarcillinticarcillin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.tigecyclinetigecycline will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.tobramycintobramycin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.tolvaptantolvaptan will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.topiramatetopiramate will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.trazodonetrazodone will decrease the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.trimethoprimtrimethoprim will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.vancomycinvancomycin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.verapamilverapamil will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.verapamil will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.voriconazolevoriconazole will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.zafirlukastzafirlukast will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (36)acetazolamideacetazolamide will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.amitriptylineestropipate, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.amoxapineestropipate, amoxapine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.anastrozoleanastrozole will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.androstenedioneandrostenedione increases effects of estropipate by pharmacodynamic synergism. Minor/Significance Unknown.boronboron increases levels of estropipate by altering metabolism. Minor/Significance Unknown.clomipramineestropipate, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.cyanocobalaminestropipate decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.cyclophosphamidecyclophosphamide will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.desipramineestropipate, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.dosulepinestropipate, dosulepin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.doxepinestropipate, doxepin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.folic acidestropipate decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.imipramineestropipate, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.isoniazidisoniazid will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.L-methylfolateestropipate decreases levels of L-methylfolate by altering metabolism. Minor/Significance Unknown.larotrectiniblarotrectinib will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.lofepramineestropipate, lofepramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.magnesium chlorideestropipate decreases levels of magnesium chloride by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.magnesium citrateestropipate decreases levels of magnesium citrate by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.magnesium hydroxideestropipate decreases levels of magnesium hydroxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.magnesium oxideestropipate decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.magnesium sulfateestropipate decreases levels of magnesium sulfate by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.maprotilineestropipate, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.metyraponeestropipate decreases effects of metyrapone by unspecified interaction mechanism. Minor/Significance Unknown.mycophenolatemycophenolate decreases effects of estropipate by unknown mechanism. Minor/Significance Unknown. Clinical significance unclear.nortriptylineestropipate, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.phytoestrogensphytoestrogens decreases effects of estropipate by pharmacodynamic antagonism. Minor/Significance Unknown.pleurisy rootpleurisy root decreases effects of estropipate by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.protriptylineestropipate, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.pyridoxineestropipate decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.pyridoxine (Antidote)estropipate decreases levels of pyridoxine (Antidote) by altering metabolism. Minor/Significance Unknown.ropiniroleestropipate increases levels of ropinirole by unspecified interaction mechanism. Minor/Significance Unknown.rose hipsestropipate decreases levels of rose hips by increasing elimination. Minor/Significance Unknown.trazodoneestropipate, trazodone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.trimipramineestropipate, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.abametapirSerious - Use Alternative (2)abametapir will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir. abametapir will increase the level or effect of estropipate by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.acetazolamideMinor (1)acetazolamide will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.albiglutideMonitor Closely (1)estropipate decreases effects of albiglutide by pharmacodynamic antagonism. Use Caution/Monitor. Estropipate may decrease hypoglycemic effects of antidiabetics by impairing glucose tolerance. Monitor for glycemic control in diabetic patients.amikacinMonitor Closely (1)amikacin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.amiodaroneMonitor Closely (1)amiodarone will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.amitriptylineMinor (1)estropipate, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.amobarbitalMonitor Closely (1)amobarbital will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.amoxapineMinor (1)estropipate, amoxapine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.anastrozoleSerious - Use Alternative (1)estropipate decreases effects of anastrozole by pharmacodynamic antagonism. Contraindicated. Estrogen may diminish the pharmacologic action of anastrozole. Coadministration not recommended.Minor (1)anastrozole will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.androstenedioneMinor (1)androstenedione increases effects of estropipate by pharmacodynamic synergism. Minor/Significance Unknown.antithrombin alfaSerious - Use Alternative (1)estropipate decreases effects of antithrombin alfa by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.antithrombin IIISerious - Use Alternative (1)estropipate decreases effects of antithrombin III by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.apalutamideSerious - Use Alternative (1)apalutamide will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.aprepitantMonitor Closely (1)aprepitant will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.argatrobanSerious - Use Alternative (1)estropipate decreases effects of argatroban by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.armodafinilMonitor Closely (1)armodafinil will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.artemether/lumefantrineMonitor Closely (1)artemether/lumefantrine will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atazanavirMonitor Closely (1)atazanavir, estropipate. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Atazanavir may increase or decrease levels of estropipate. Use alternatives if available. .atorvastatinMonitor Closely (1)atorvastatin will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.azithromycinMonitor Closely (1)azithromycin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.aztreonamMonitor Closely (1)aztreonam will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.belzutifanMonitor Closely (1)belzutifan will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. bemiparinSerious - Use Alternative (1)estropipate decreases effects of bemiparin by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.bivalirudinSerious - Use Alternative (1)estropipate decreases effects of bivalirudin by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.boronMinor (1)boron increases levels of estropipate by altering metabolism. Minor/Significance Unknown.bosentanMonitor Closely (1)bosentan will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.budesonideMonitor Closely (1)budesonide will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.butabarbitalMonitor Closely (1)butabarbital will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.butalbitalMonitor Closely (1)butalbital will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.carbamazepineSerious - Use Alternative (1)carbamazepine will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.cefadroxilMonitor Closely (1)cefadroxil will decrease the level or effect of