Estradiol vaginal cream interactions: A detailed guide

This article describes possible interactions with estradiol vaginal cream. Interactions can cause a drug to have a different effect on the body than expected. Interactions can occur due to medications, alcohol, or certain health conditions.

To find coupon options for estradiol and to learn more about the drug, including its uses, see this article.

Estradiol comes as a vaginal cream, which is applied inside your vagina using an applicator. It’s also available in several other forms, including an oral tablet, transdermal patch (skin patch), and others. Interactions of estradiol may vary depending on the form of estradiol you’re prescribed.

Boxed warnings

This drug has boxed warnings about the following risks. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

Risk of certain types of cancer. Estradiol vaginal cream may increase the risk of certain types of cancer, including endometrial (uterine) cancer.

Risk of dementia. Estrogen medications, including estradiol, should not be used to prevent dementia (difficulty thinking, remembering, and communicating). Using estrogen drugs may increase the risk of dementia.

Risk of serious heart and blood vessel conditions. Estrogen therapy, including estradiol, can increase the risk of serious heart and blood vessel conditions. These include blood clots, heart attack, and stroke.

See the end of this article for more information about these warnings.

Other drugs and estradiol

Drugs that may interact with estradiol vaginal cream are listed below. This article doesn’t include all drugs that may interact with estradiol.

Drugs that may interact with estradiol vaginal cream include:

• aromatase inhibitors:
  • drug examples: anastrozole (Arimidex), exemestane (Aromasin)
  • what might happen: can make the aromatase inhibitor less effective
• certain antibiotics:
  • drug examples: clarithromycin, erythromycin (Eryc, Ery-Tab)
  • what might happen: can increase the risk of side effects from estradiol
• certain antifungals:
  • drug examples: ketoconazole, itraconazole (Sporanox, Tolsura)
  • what might happen: can increase the risk of side effects from estradiol
• certain antiepileptic drugs:
  • drug examples: carbamazepine (Tegretol, others), phenytoin (Dilantin, Phenytek)
  • what might happen: can make estradiol less effective
• certain antiretrovirals:
  • drug examples: ritonavir (Norvir), nelfinavir (Viracept)
  • what might happen: can increase the risk of side effects from estradiol
• corticosteroids:
  • drug examples: dexamethasone (Hemady), prednisone (Rayos)
  • what might happen: may increase the effect of and risk of side effects from corticosteroids
• ceritinib (Zykadia):
  • what might happen: can increase the risk of side effects from estradiol
• cyclosporine (Gengraf, Neoral):
  • what might happen: can increase the risk of side effects from estradiol and cyclosporine

Other interactions and estradiol

Interactions can occur with foods, supplements, vaccines, and some lab tests. Below you can learn whether estradiol vaginal cream has these interactions.

The information below doesn’t include all other possible interactions with estradiol.

Estradiol and food

Estradiol vaginal cream may interact with grapefruit and grapefruit juice. Consuming grapefruit may increase the risk of side effects from estradiol.

Because of this, talk with your doctor or pharmacist about what foods to avoid while taking estradiol vaginal cream.

Estradiol and supplements

Before using estradiol vaginal cream, tell your doctor and pharmacist about any herbs you take, as well as vitamins and supplements. Doing so may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Estradiol interactions with herbs

Estradiol vaginal cream may interact with St. John’s wort. This herb is often used for supporting mood and relieving symptoms related to depression.

Using estradiol and St. John’s wort may make estradiol less effective.

Because of this, ask your doctor or pharmacist before taking any herbs during treatment with estradiol vaginal cream.

Estradiol interactions with vitamins

Estradiol vaginal cream isn’t known to interact with any vitamins. But this doesn’t mean interactions with vitamins can’t happen or won’t be identified later.

Because of this, ask your doctor or pharmacist before taking any of these products during treatment with estradiol vaginal cream.

Estradiol and vaccines

Estradiol vaginal cream isn’t known to interact with any vaccines. But this doesn’t mean interactions with vaccines can’t happen or won’t be identified later.

Because of this, talk with your doctor or pharmacist before receiving any vaccines during treatment with estradiol vaginal cream.

Estradiol and lab tests

Estradiol vaginal cream isn’t known to interact with lab tests. But this doesn’t mean interactions with lab tests can’t happen or won’t be identified later.

Because of this, talk with your doctor or pharmacist before having any tests during treatment with estradiol vaginal cream.

Estradiol and cannabis or CBD

Estradiol vaginal cream isn’t known to interact with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But this doesn’t mean interactions can’t happen or won’t be identified later.

As with any drug or supplement, tell your doctor before taking cannabis with estradiol.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

When to avoid estradiol

Certain health conditions or other factors could increase some risks with estradiol vaginal cream. Because of this, doctors may not prescribe estradiol in these cases. These health conditions or other factors are called contraindications.

Here’s a list of contraindications for estradiol vaginal cream:

• Unusual genital bleeding of unknown cause. If you have unusual genital bleeding of unknown cause, using estradiol vaginal cream may worsen the bleeding.
• Suspected or known breast cancer or other estrogen-dependent cancer. If you have suspected or known breast cancer or estrogen-dependent cancer,* using estradiol vaginal cream may worsen the cancer.
• Active or past blood clot. If you have a blood clot* or have had one in the past, using estradiol vaginal cream may cause a new or worsened blood clot.
• Past heart attack or stroke. If you have had a heart attack or stroke* in the past, you may have a higher risk of experiencing another heart attack or stroke if you use estradiol vaginal cream.
• Liver condition. If you have a liver condition, using estradiol vaginal cream may worsen your condition.
• Problems with clotting. If you have certain clotting problems, you may have a higher risk of developing blood clots if you use estradiol vaginal cream.
• Past allergic reaction to estradiol. If you’ve had an allergic reaction to estradiol vaginal cream in the past, using it may cause another allergic reaction.

Before starting treatment with estradiol, tell your doctor if anything listed above relates to you. They can recommend whether you should use estradiol.

* Estradiol has a boxed warning for the risk of cancer and risk of serious heart and blood vessel conditions, including blot clots, heart attack, and stroke. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For more details, see the “Boxed warnings for estradiol” section below.

Alcohol and estradiol

Estradiol vaginal cream is not known to interact with alcohol.

However, estradiol vaginal cream has a boxed warning about the risk of breast cancer. And research has shown consuming alcohol may also increase the risk of breast cancer. Because of this risk, your doctor may suggest avoiding or reducing alcohol consumption if you’re using estradiol vaginal cream.

If you drink alcohol, talk with your doctor about whether it’s safe to consume it during your treatment with estradiol vaginal cream. For more details about estradiol’s boxed warnings, see the “Boxed warnings for estradiol” section below.

Health factors and estradiol

Certain medical conditions or other health factors may increase the risk of interactions with estradiol vaginal cream. Before using estradiol, tell your doctor about your health history. They’ll determine whether estradiol is right for you.

Here’s a list of health conditions or other factors that might interact with estradiol vaginal cream:

• breathing conditions, such as asthma
• epilepsy or seizures
• type 1 or 2 diabetes
• endometriosis
• lupus
• heart conditions, such as heart failure
• kidney conditions, such as chronic kidney disease
• thyroid conditions, such as low thyroid hormone level
• high blood calcium level
• pregnancy or breastfeeding
• past allergic reaction to estradiol

Questions about estradiol and interactions

Here you’ll find answers to some common questions about estradiol and possible interactions.

Does estradiol vaginal cream have different interactions than estradiol oral tablet?

No, the interactions of estradiol vaginal cream and estradiol oral tablet are expected to be the same.

Some vaginal drugs aren’t absorbed by your entire body or aren’t absorbed enough. So they may have different interactions compared to when the drug is taken by mouth. But this isn’t the case with estradiol vaginal cream. Your body absorbs enough of the medication that interactions are the same as taking estradiol by mouth.

Talk with your doctor or pharmacist to learn more about how different forms of estradiol compare.

Are there foods I should avoid eating while taking estradiol besides grapefruit?

No, unless your doctor tells you otherwise. There aren’t other foods known to interact with estradiol.

That said, certain foods may worsen symptoms of menopause. (Estradiol vaginal cream is prescribed to treat symptoms of menopause). These foods can vary from person to person. Some examples of foods that may worsen menopause symptoms include high-sugar and processed foods, such as white bread and baked goods. Other examples include spicy foods and caffeine.

Talk with your doctor to learn more about foods that may worsen your menopause symptoms and ways to avoid them. To learn more about estradiol’s interaction with grapefruit, see the “Other interactions” section above.

Preventing estradiol interactions

You may be able to help avoid certain interactions with estradiol vaginal cream. Before using this drug, you may want to discuss possible interactions with your doctor and pharmacist.

Things to consider include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you’re prescribed a new drug during your estradiol vaginal cream treatment.

Using estradiol exactly as prescribed can also help prevent interactions.

What to ask your doctor

If you have questions about estradiol and possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• If I use estradiol vaginal cream and have certain health conditions, will I be monitored more closely during treatment?
• Do other drugs that could treat my symptoms have similar interactions?
• Should I let you know if I make lifestyle changes, such as changes to my diet or exercise routine?
• Does my risk of interactions change over time as I continue treatment with estradiol vaginal cream?

Boxed warnings for estradiol

This drug has boxed warnings about the following risks. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

Risk of certain types of cancer. Treatments that only contain estrogen, such as estradiol, may raise the risk of certain types of cancer, including endometrial (uterine) cancer. (Estrogen is a type of hormone.) Estrogen drugs may also raise the risk of certain breast cancers if they’re prescribed with a progestin drug. (Progestin is a chemical that your body converts to the hormone progesterone.)

Due to this risk, doctors typically won’t prescribe estradiol if you have or ever had a type of breast cancer that depends on estrogen to grow. They can discuss other treatments for your condition that are safer for you.

Risk of dementia. Estradiol is not meant to help prevent dementia (difficulty thinking, remembering, and communicating). Using an estrogen drug, such as estradiol, may increase the risk of dementia. This risk also applies when estrogen is used with progestin. Due to this risk, doctors prescribe estradiol treatment for the shortest time necessary and at the lowest dose needed to work effectively.

Risk of serious heart and blood vessel conditions. Estrogen drugs, including estradiol, should not be taken alone or with progestin drugs to lower the risk of heart disease, heart attack, or stroke. Using estrogen alone may raise your risk of blood clots or stroke. Using an estrogen drug with a progestin drug may increase your risk of serious heart and blood vessel conditions. This includes blood clots, heart attack, and stroke.

Due to this risk, doctors prescribe estradiol treatment for the shortest time necessary and at the lowest dose needed to work effectively. They typically avoid prescribing estradiol if you’ve had a blood clot, heart attack, or stroke in the past.

To learn more about these risks, including symptoms to watch for, talk with your doctor.

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.