Chemical formula: C₂₃H₃₁Cl₂NO₃ Molecular mass: 440.403 g/mol PubChem compound: 259331
Estramustine interacts in the following cases:
Administration of live or live-attenuated vaccines in patients immunocompromised by chemotherapeutic agents including estramustine, may result in serious or fatal infections. Vaccination with a live vaccine should be avoided in patients receiving estramustine. Killed or inactivated vaccines may be administered; however, the response to such vaccines may be diminished.
Estramustine may be poorly metabolized in patients with impaired liver function and should be administered with caution in such patients. Liver function tests should be performed at regular intervals.
Note: since certain endocrine and hepatic functions are influenced by estrogen-containing drugs the corresponding laboratory test values will be affected.
Milk, milk products or drugs containing calcium, magnesium or aluminium may impair the absorption of estramustine and simultaneous intake must therefore be avoided. The mechanism behind this interaction is that estramustine forms insoluble salts with polyvalent metal ions.
An interaction between estramustine and ACE-inhibitors, possibly leading to an increased risk of angioedema cannot be excluded.
Oestrogens have been reported to increase both therapeutic activity and toxicity of tricyclic antidepressants, probably via inhibition of their metabolism.
Because hypertension may occur, blood pressure should be monitored periodically.
Caution should also be used in patients with cardiovascular disease, cerebral vascular disease and coronary artery disease.
Estramustine should be used with caution in patients with a history of thrombophlebitis, thrombosis or thromboembolic disorders, especially if associated with estrogen therapy.
Estramustine may influence the metabolism of calcium and phosphorous and should be used with caution in patients with metabolic bone diseases that are associated with hypercalcemia or in patients with renal insufficiency. Serum calcium should be performed at regular intervals.
Because glucose tolerance may be decreased, diabetic patients should be carefully followed while receiving estramustine.
Estradiol and nitrogen mustard are potentially mutagenic, and therefore males undergoing treatment with estramustine should employ contraceptive measures.
Since estramustine is indicated for carcinoma of the prostate in males, it is not indicated for women.
Estradiol and nitrogen mustard are potentially mutagenic, and therefore males undergoing treatment with estramustine should employ contraceptive measures.
Since estramustine is indicated for carcinoma of the prostate in males, it is not indicated for women.
The effect of estramustine on the ability to drive or use machinery has not been systematically evaluated.
The most common adverse reactions include gynaecomastia, nausea/vomiting and fluid retention/oedema.
The most serious reactions are embolism, myocardial ischaemia, cardiac failure congestive and angioedema.
Reported reactions arranged according to MedDRA System Organ System are the following: very common ≥1/10, common ≥1/100 to <1/10, frequency not known (cannot be estimated from available data).
Very common: Anaemia, Leukopenia
Common: Thrombocytopenia
Frequency not known: Hypersensitivity
Very common: Fluid retention
Frequency not known: Confusional state, Depression
Common: Lethargy, Headache
Very common: Cardiac failure congestive
Common: Myocardial infarction
Frequency not known: Myocardial ischaemia
Common: Embolism
Frequency not known: Hypertension
Very common: Nausea and Vomiting, Diarrhoea
Very common: Hepatic function abnormal
Frequency not known: Angioedema**, Dermatitis allergic
Frequency not known: Muscular weakness
Very common: Gynaecomastia
Frequency not known: Erectile dysfunction
Frequency not known: Injection site thrombosis (IV solution)
* Particularly during the first two weeks of treatment.
** Angioedema (Quincke oedema, larynx oedema) can occur. In many reported cases, including a fatal one, patients were concomitantly receiving ACE-inhibitors. Therapy with estramustine is to be immediately discontinued should angioedema occur.
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