Prempro
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied Health
• Avoid salt and salt-laden foods if water retention is an issue.1
• Excess vitamin C may result in increased estrogen effects.2
• Talk to your doctor about calcium supplementation, exercise, periodic bone density screenings, and height measurement.3
• Avoid alcohol.4
• Avoid caffeine.5
• Two months of conjugated estrogen therapy in women with surgically induced menopause decreased urinary calcium loss and increased serum vitamin D levels.1 In a six-month placebo-controlled study of 21 women with postmenopausal osteoporosis, conjugated estrogens increased both calcium absorption and vitamin D blood levels.2 While estrogen may improve calcium absorption, it remains important for women taking estrogen to maintain adequate calcium intake through diet and supplementation. Many doctors recommend 800–1,200 mg of supplemental calcium in addition to the several hundred milligrams found in a typical daily diet.6
• Ipriflavone, a synthetic variation of isoflavones found in soy, is available as a supplement. In a controlled trial, ipriflavone (400 mg per day) plus conjugated estrogens increased vertebral bone density, while calcium (500 mg per day) plus conjugated estrogens could not prevent a decrease in bone density in postmenopausal women.3 Similarly, a double-blind trial found ipriflavone (600 mg per day) plus conjugated estrogens and calcium (1 gram per day) increased bone density, while calcium with or without conjugated estrogens could not prevent bone loss.4 While low doses of estrogens can counteract some menopausal symptoms, higher doses are required to prevent bone loss in postmenopausal women. However, the addition of ipriflavone to low-dose estrogen therapy has been shown in a controlled trial to preserve bone mass in postmenopausal women.57
• A preliminary trial found that osteoporotic postmenopausal women with elevated urinary zinc and magnesium excretion experienced reduced losses of these minerals after being treated with conjugated estrogens and medroxyprogesterone.6 More research is needed to determine the significance of this finding.8
• A small preliminary trial found most women taking conjugated estrogens therapy without a progestin to have lower levels or a deficiency of vitamin B6.7 Numerous studies have found negative effects of oral contraceptives (OCs) on vitamin B6 status,8 9 10 although some studies suggest that vitamin B6 deficiency does not occur when low-dose OCs are used.11 While OCs contain different forms of estrogen than conjugated estrogens, there is a possibility of a similar problem when any form of estrogen is supplemented, but more research is needed.9
• A controlled trial found two months of conjugated estrogens therapy in women with surgically induced menopause increased blood levels of vitamin D and decreased urinary calcium loss.12 In a controlled study of women with postmenopausal osteoporosis, conjugated estrogens therapy was associated with increased blood levels of vitamin D and increased calcium absorption.13 While conjugated estrogens appear to improve vitamin D metabolism, it remains important for women taking such hormones to consume adequate levels of vitamin D through diet and supplements. One controlled study showed that taking 300 IU of vitamin D per day with estradiol, an estrogen related to conjugated estrogens, plus a progestin led to greater improvement in bone density compared with estradiol/progestin alone.14 Further controlled studies are needed to determine whether taking conjugated estrogens and vitamin D together might also increase bone strength and prevent fractures. In contrast to the beneficial effects on bone, the study also revealed that supplementing vitamin D together with estradiol/progestin tended to reduce beneficial HDL cholesterol levels, unlike estradiol/progestin alone. These undesirable results were confirmed by two additional studies.15 1610
• Prempro may affect absorption of the certain B vitamins, magnesium, and zinc. Supplementation of these nutrients is suggested.11
• The following herbs may affect hormone levels: Agnus Castus (Vitex), Black Cohosh, Bugleweed, Burning Bush, Dong Quai, Saw Palmetto, Tobacco, Vervain and Wild Yam. Many herbs may interact with hormone replacement. Consult your pharmacist for more information.12
• Avoid cola, cocoa, guarana and mate due to their caffeine content with premarin.13
• Herbal sources of isoflavones, such as red clover, may interfere with or even have an additive effect with conjugated estrogens.17 Further studies are needed to establish the potential interaction of isoflavone supplements from red clover and soy with conjugated estrogens. Consult with your healthcare professional if you are currently taking estrogen replacement therapy and wish to take a supplement high in isoflavones.14
• Conjugated estrogens therapy in postmenopausal women has been reported to decrease LDL (“bad”) cholesterol levels and to increase HDL (“good”) cholesterol levels. However, despite the positive changes in blood levels of LDL and HDL cholesterol, there is evidence that conjugated estrogens do not reduce the risk of heart disease.18 Nonetheless, smoking offsets the cholesterol changes induced by taking conjugated estrogens,19 and this interference is likely to be detrimental. Women taking conjugated estrogens who do not smoke should avoid starting, and those who do smoke should talk with their doctor about quitting.15
References1 Rybacki, JM. The Concise Guide to Prescription Drugs. Harper, 1997.
2 Rybacki, JM. The Concise Guide to Prescription Drugs. Harper, 1997.
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
3 Rybacki, JM. The Concise Guide to Prescription Drugs. Harper, 1997.
3 Pronsky, Z Food Medication Interactions, 11th edition, 1999
4 Pronsky, Z Food Medication Interactions, 11th edition, 1999
5 Pronsky, Z Food Medication Interactions, 11th edition, 1999
6 1. Lobo RA, Roy S, Shoupe D, et al. Estrogen and progestin effects on urinary calcium and calciotropic hormones in surgically-induced postmenopausal women. Horm Metab Res 1985;17:370–3.
6 1. Lobo RA, Roy S, Shoupe D, et al. Estrogen and progestin effects on urinary calcium and calciotropic hormones in surgically-induced postmenopausal women. Horm Metab Res 1985;17:370–3.
7 3. M, Ciaponi M, Cappagli B, et al. Effects of combined low dose of the isoflavone derivative ipriflavone and estrogen replacement on bone mineral density and metabolism in postmenopausal women. Maturitas 1997;28:75–81.
7 4. Melis GB, Paoletti AM, Bartolini R, et al. Ipriflavone and low doses of estrogens in the prevention of bone mineral loss in climacterium. Bone Miner Oct 1992;19 suppl 1:S49–56.
7 5. Agnusdei D, Gennari C, Bufalino L. Prevention of early postmenopausal bone loss using low doses of conjugated estrogens and the non-hormonal, bone-active drug ipriflavone. Osteoporos Int 1995;5:462–6.
8 6. Herzberg M, Lusky A, Blonder J, et al. The effect of estrogen replacement therapy on zinc in serum and urine. Obstet Gynecol 1996;87:1035–40.
9 7. Haspels AA, Bennink HJ, Schreurs WH. Disturbance of tryptophan metabolism and its correction during oestrogen treatment in postmenopausal women. Maturitas 1978;1:15–20.
9 8. Lubby AL, Brin M, Gordon M, et al. Vitamin B6 metabolism in users of oral contraceptive agents. I. Abnormal urinary xanthurenic acid excretion and its correction by pyridoxine. Am J Clin Nutr 1971;24:684–93.
9 9. Adams PW, Rose DP, Folkard J, et al. Effect of pyridoxine hydrochloride (vitamin B6) upon depression associated with oral contraception. Lancet 1973;1:897–904.
9 10. Larsson-Cohn U. Oral contraceptives and vitamins: a review. Am J Obstet Gynecol 1975;121:84–90 [review].
9 11. Massé PG, van den Berg H, Duguay C, et al. Early effect of a low dose (30 mcg) ethinyl estradiol-containing Triphasil® on vitamin B6 status. Int J Vit Nutr Res 1996;66:46–54.
10 12. Lobo RA, Roy S, Shoupe D, et al. Estrogen and progestin effects on urinary calcium and calciotropic hormones in surgically-induced postmenopausal women. Horm Metab Res 1985;17:370–3.
10 13. Gallagher JC, Riggs BL, DeLuca HF. Effect of estrogen on calcium absorption and serum vitamin D metabolites in postmenopausal osteoporosis. J Clin Endocrinol Metab 1980;51:1359–64.
10 14. Tuppurainen MT, Komulainen M, Kröger H, et al. Does vitamin D strengthen the increase in femoral neck BMD in osteoporotic women treated with estrogen? Osteoporosis Int 1998;7:32–8.
10 15. Myrup B, Hensen GF, McNair P. Cardiovascular risk factors during estrogen-norethindrone and cholecalciferol treatment. Arch Intern Med 1992;152:2265–8.
10 16. Heikkinen A-M, Tuppurainen MT, Niskanen L, et al. Long-term vitamin D3 supplementation may have adverse effects on serum lipids during postmenopausal hormone replacement therapy. Eur J Endocrinol 1997;137:495–502.
11 Zava, DT: Estrogen and progestin bioactivity of foods, herbs and spices. Proc. Soc. Exp. Biol. Med. 1998, 217:369-378.
11 Adams PW, Wynn V, Rose DP, et al. Effect of pyridoxine hydrochloride (vitamin B6) upon depression associated with oral contraception. Lancet 1973;I:897-904.
11 Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-98.
11 Blum M, Kitai E, Ariel Y, Et Al: Oral Contraceptive Lowers Serum Magnesium, Harefuah, 1991, 121 (10):363-4.
11 Seelig Ms, Interrelationship Of Magnesium And Estrogen In Cardiovascular And Bone Disorders, Eclampsia, Migraine, And Premenstrual Syndrome, J Am Coll Nutr, 1993, 12(4):442-58.
11 Webb JL, Nutritional effects of oral contraceptive use, a review, J Reprod Med, 1980, 25 (4): 150-6.
11 Pronsky, Z Food Medication Interactions, 11th edition, 1999
12 Zava, DT: Estrogen and progestin bioactivity of foods, herbs and spices. Proc. Soc. Exp. Biol. Med. 1998, 217:369-378.
12 Ferguson T: The Smoker’s Book of Health, G.P. Putnam’s Sons, New York, 1987.
12 PDR for Herbal Medicines, 2nd edition, Medical Economics Company, 2000
12 Facts and Comparisons, Review of Natural Products, Clinisphere 2.0, Wolters Kluwer Company, 2000
12 Foster S, Tyler VE. Tyler's Honest Herbal, fourth ed., Binghamton, NY: Haworth Herbal Press, 1999.
13 Brinker, F Herb Contraindications and Drug Interactions, Eclectic Medical Publications, 1998
14 17. Collins BM, McLachlan JA, Arnold SF. The estrogenic and antiestrogenic activities of phytochemicals with the human estrogen receptor expressed in yeast. Steroids 1997;62:365–72.
15 18. Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998;280:605–13.
15 19. Krauss RM, Perlman JA, Ray R, Petitti D. Effects of estrogen dose and smoking on lipid and lipoprotein levels in postmenopausal women. Am J Obstet Gynecol 1988;158:1606–11.
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Disclaimers
The information in Drug Watch is provided as a courtesy to NewsTarget readers by Applied Health Solutions in cooperation with Healthway Solutions. Although the information is presented with scientific references, we do not wish to imply that this represents a comprehensive list of considerations about any specific drug, herb or nutrient. Nor should this information be considered a substitute for the advice of your doctor, pharmacist, or other healthcare practitioner. Please read the disclaimer about the intentions and limitations of the information provided on these pages. It is important to tell your doctor and pharmacist about all other drugs and nutritional supplements that you are taking if they are recommending a new medication. Copyright © 2007 by Applied Health Solutions, Inc. All rights reserved.
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