{"id":632406,"date":"2025-06-02T12:58:08","date_gmt":"2025-06-02T16:58:08","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=632406"},"modified":"2026-01-28T14:12:55","modified_gmt":"2026-01-28T19:12:55","slug":"estradiol-interactions","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/estradiol-interactions\/","title":{"rendered":"Estradiol interactions to avoid"},"content":{"rendered":"

Estradiol<\/span><\/a> is a prescription drug containing a form of the female hormone, estrogen. Estradiol comes in several different forms\u2014oral tablets, injections, topical cream, topical patches, and vaginal creams. It\u2019s also sold in various brand names, such as<\/span> Estrace<\/span><\/a>,<\/span> Estring<\/span><\/a>, and<\/span> Vivelle dot<\/span><\/a>. Estradiol is prescribed for people who aren\u2019t producing enough estrogen, such as perimenopausal or postmenopausal women, or women who\u2019ve had their ovaries removed. Estradiol may also be prescribed for gender affirming care for male to female transgender individuals.<\/span><\/p>\n

Estradiol can interact with other medications, such as CYP3A4 inducers and inhibitors, seizure medications, thyroid medications, and benzodiazepines. While most foods are safe to consume while taking estradiol, doctors agree that people taking estradiol should stay away from grapefruit.<\/span><\/p>\n

Overall, most medicines and foods pose little risk while you\u2019re taking estradiol. Still, it\u2019s important to be aware of any possible interactions, and exercise caution when needed.<\/span><\/p>\n

Estradiol drug interactions<\/span><\/h2>\n

Most medications are fine to take while you are taking estradiol. That\u2019s because estradiol is a synthetic form of the hormone estrogen. \u201cIt’s important to remember that estradiol is a hormone naturally produced by the body for the majority of a woman’s life\u2014it’s not a foreign substance,\u201d says Suzanne Gilberg, MD, OB-GYN and author of<\/span> Menopause Bootcamp<\/span><\/a>.<\/span><\/p>\n

Not only that, but as Dr. Gilberg points out, \u201cthe amounts [of estradiol] prescribed during perimenopause or menopause are typically much lower than what the body produces during reproductive years, pregnancy, or even normal menstrual cycles.\u201d<\/span><\/p>\n

It\u2019s also important to note which<\/span> form of estradiol<\/span><\/a> you are taking. Research has found that topical estrogen\u2014patches, gels, and creams typically have fewer side effects or interactions with drugs than oral or injectable forms of estradiol. As such, using a topical estrogen (patch or cream) is a good alternative to an oral or injection estrogen.<\/span><\/p>\n

Here\u2019s what to know about estradiol interactions.<\/span>\u00a0<\/span><\/p>\n\n\n\n\n\n\n\n\n
Drug class or group name<\/b><\/td>\nDrug name<\/b><\/td>\nInteractions\/side effects<\/b><\/td>\n<\/tr>\n
CYP3A4 inducers<\/span><\/td>\n\n
    \n
  • St. John\u2019s Wort<\/span><\/li>\n
  • Tegretol, Tegretol XR, (carbamazepine)<\/span><\/li>\n
  • Luminal (phenobarbital)<\/span><\/li>\n
  • Rifadin, Rimactane (rifampin)<\/span><\/li>\n<\/ul>\n<\/td>\n
Can make estradiol less effective<\/span><\/td>\n<\/tr>\n
CYP3A4 inhibitors<\/span><\/td>\n\n
    \n
  • Ery-tab (erythromycin)<\/span><\/li>\n
  • Nizoral (ketoconazole)<\/span><\/li>\n
  • Biaxin (clarithromycin)<\/span><\/li>\n
  • Sporanox (itraconazole)<\/span><\/li>\n<\/ul>\n<\/td>\n
Can make estradiol less effective<\/span><\/td>\n<\/tr>\n
Benzodiazepines<\/span><\/td>\n\n
    \n
  • Valium (diazepam)<\/span><\/li>\n
  • Ativan (lorazepam)<\/span><\/li>\n
  • Restoril (temazepam)<\/span><\/li>\n
  • Halcion (triazolam)<\/span><\/li>\n<\/ul>\n<\/td>\n
Estradiol may increase or decrease the effects of these medications<\/span><\/td>\n<\/tr>\n
Anticonvulsants<\/span><\/td>\n\n
    \n
  • Lamictal and Lamictal XR (lamotrigine)<\/span><\/li>\n<\/ul>\n<\/td>\n
Estradiol may decrease the effectiveness of lamotrigine<\/span><\/td>\n<\/tr>\n
Thyroid medications<\/span><\/td>\n\n
    \n
  • Synthroid, Levoxyl, Unithroid, Tirosint (levothyroxine)<\/span><\/li>\n<\/ul>\n<\/td>\n
Estradiol may decrease levothyroxine absorption<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

CYP3A4 inducers or inhibitors<\/span><\/h3>\n

CYP3A4 inducers or inhibitors are drugs that impact your body\u2019s metabolism of the enzyme CYP3A4. According to the FDA, CYP3A4 inducers or inhibitors can affect the way your body metabolizes estrogen, which can result in decreased levels of estrogen in your body. This means that estradiol medication may be less effective. Examples of estradiol inducers that may affect estradiol potency include <\/span>St. John\u2019s Wort<\/span><\/a>, carbamazepine, phenobarbital, and rifampin. CYP3A4 inhibitors that can reduce estradiol effectiveness include <\/span>erythromycin<\/span><\/a>, ketoconazole, clarithromycin, and itraconazole.<\/span><\/p>\n

Benzodiazepines<\/span><\/h3>\n

Benzodiazepines<\/span><\/a> are a family of medicines that slow down your central nervous system.<\/span><\/p>\n

Mitchell Kramer<\/span><\/a>, MD, OB-GYN, chairman of the department of obstetrics and gynecology at Huntington Hospital says that <\/span>diazepam (Valium), lorazepam (Ativan), temazepam (Restoril), and triazolam (Halcion) are benzodiazepines to be cautious with if you are taking estradiol. \u201cEffects of these meds can be increased or decreased when taken with estradiol,\u201d he says. It\u2019s important to keep in touch with your healthcare provider, who may need to adjust your benzodiazepines dose, switch to a different medication, or try a different estradiol formulation.<\/span><\/p>\n

Anticonvulsants<\/span><\/h3>\n

Anticonvulsants<\/span><\/a> are medications used to treat seizures or mood disorders.<\/span> Lamotrigine<\/span><\/a> is an anticonvulsant often sold under the brand names Lamictal and Lamictal XR. It\u2019s also sometimes prescribed to treat bipolar disorder. According to Erika Gray, Pharm.D., founder and chief medical officer at<\/span> MyToolBox Genomics<\/span><\/a>, lamotrigine is one medication that may interact poorly with estradiol, especially if you\u2019re taking oral estradiol. Estradiol \u201ccan also lower lamotrigine levels, which raises seizure risk,\u201d she warns. Using topical estrogens may be a good alternative for some people.<\/span><\/p>\n

Thyroid medications<\/span><\/h3>\n

Thyroid<\/span><\/a> medications are used for people who either do not produce enough thyroid hormone (hypothyroid) or too much thyroid hormone (hyperthyroid).<\/span> Levothyroxine<\/span><\/a> (brand names: Synthroid, Levoxyl, Unithroid, and Tirosint) is used to treat hypothyroidism, which is when you have an underactive thyroid. According to Dr. Kramer, if you\u2019re taking estradiol with levothyroxine, absorption of levothyroxine may be reduced, leading to decreased effectiveness. Some people may need to adjust their levothyroxine levels if this becomes a concern. Levothyroxine should be taken on an empty stomach and not with any other medications. Wait to eat or drink for 30 minutes after levothyroxine is taken. If you\u2019re concerned about interaction between levothyroxine and estradiol, have your provider order and review TSH lab work 6 weeks after estradiol started.\u00a0<\/span><\/p>\n\t\t

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Estradiol food interactions<\/span><\/h2>\n

As was the case with medication interactions, there are few<\/span> food interactions<\/span><\/a> to be concerned with when you\u2019re taking estradiol. \u201cIt’s important to emphasize that women taking estradiol don’t need to unnecessarily restrict their diet,\u201d Dr. Gilberg emphasizes. \u201cYou can continue enjoying your normal food choices while on estradiol replacement therapy.\u201d<\/span><\/p>\n

Dr. Kramer recommends an overall healthy diet pattern when taking estradiol. Here\u2019s what he recommends:<\/span><\/p>\n