It is possible that estrogen induced side effects could be increased in some individuals. The clinical significance of the interaction is unknown. Estrogen levels may increase by up to 30 percent with chronic use. Grapefruit juice contains a compound that inhibits CYP3A4 in enterocytes. Notes for Professionals: Grapefruit juice has been reported to decrease the metabolism of some estrogens.Report any unusual side effects, like unusual non-menstrual vaginal bleeding, promptly for evaluation. Do not significantly change your grapefruit intake while taking estrogens for hormone replacement therapy or as part of hormonal birth control products. Notes for Consumers: Grapefruit juice and grapefruit-containing foods may increase the side effects of estrogen in some females, such as nausea, breast tenderness, headache or fluid retention.Combined hormonal contraceptives are contraindicated in females who are over 35 years of age and smoke.
Cigarette smoking increases the risk of serious cardiovascular events, such as myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism. Notes for Professionals: Advise patients to avoid cigarette smoking while taking estrogen hormones.Contact your care team right away if you experience symptoms of a blood clot in your leg: pain, swelling, or warmth in the leg. You should also call emergency services right away if you experience symptoms of a stroke: sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision. You should also call emergency services right away if you experience symptoms of a heart attack: pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded. Call emergency services right away if you experience symptoms of a blood clot in your lung: shortness of breath or chest pain. Smoking while taking this medication increases the risk for serious side effects such as blood clots, heart attack, and stroke. Notes for Consumers: Do not smoke or use tobacco products while taking this medication.
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