Amitriptyline
Adverse Effect: Attenuation of antidepressant effectiveness; tricyclic toxicity (drowsiness, hypotension, akathisia) Clinical Management: If signs or symptoms of altered Amitriptyline response is noted, dose adjustment downward of either the estrogen or Amitriptyline may be successful in restoring effectiveness or resolving toxicity. However, drug withdrawal may be required.
Amoxapine
Adverse Effect: Attenuation of antidepressant effectiveness; Amoxapine toxicity (drowsiness, hypotension, akathisia) Clinical Management: If signs or symptoms of altered Amoxapine response is noted, dose adjustment downward of either the estrogen or Amoxapine may be successful in restoring effectiveness or resolving toxicity. However, drug withdrawal may be required.
Clomipramine
Adverse Effect: Attenuation of antidepressant effectiveness; tricyclic toxicity (drowsiness, hypotension, akathisia) Clinical Management: If signs or symptoms of altered Clomipramine response is noted, dose adjustment downward of either the estrogen or Clomipramine may be successful in restoring effectiveness or resolving toxicity. However, drug withdrawal may be required.
Trimipramine
Adverse Effect: Attenuation of antidepressant effectiveness; tricyclic toxicity (drowsiness, hypotension, akathisia) Clinical Management: If signs or symptoms of altered Trimipramine response is noted, dose adjustment downward of either the estrogen or Trimipramine may be successful in restoring effectiveness or resolving toxicity. However, drug withdrawal may be required.
Warfarin
Adverse Effect: decreased anticoagulant effectiveness Clinical Management: Increased monitoring of clotting times is not indicated in patients receiving conjugated estrogens and warfarin concurrently. Clinical evidence of hypercoagulability, including recurrent thrombosis, in patients on warfarin may require discontinuation of estrogen therapy and/or a higher level of anticoagulation. |