Ethinyl Estradiol; Norethindrone with Ginseng Interaction Details
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 12, 2023
Interaction Effect
Additive estrogenic effects
Interaction Summary
Case reports suggest estrogen-like activity of ginseng. The exact type of ginseng (i.e. Panax, Siberian, American, etc) was not reported. Concomitant use of ginseng with conjugated estrogens may result in symptoms of estrogen excess or interference. Avoid concomitant use if possible until further information characterizing this interaction is available.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Since estrogenic effects have been noted with topical and oral estrogen, either dosage form should be treated with the same caution when coadministered with ginseng. If estrogenic symptoms such as mastalgia and breakthrough menstrual bleeding occur, decreased the ginseng dosage. Because of the apparent estrogen-like effect, avoid ginseng in patients with breast cancer, undiagnosed abnormal genital bleeding, active thrombophlebitis or thromboembolic disorders, or if the woman is pregnant.
Mechanism Of Interaction
Saponin glycoside constituents of ginseng may stimulate liver RNA and protein synthesis mimicking the effect of ovarian steroids
Literature Reports
A) A 72-year-old woman ingested one tablet daily of a Swiss-Austrian geriatric formula which contained 200 mg of ginseng (Geriatric Pharmaton, Bernardgass, Austria). This resulted in vaginal bleeding and what was described as a "moderate estrogen effect" .
B) A 70-year-old woman experienced swollen tender breasts with diffuse nodularity after 3 weeks of "regular" ingestion of ginseng powder. The breast symptoms resolved upon discontinuation of the ginseng powder, although a time period is not provided. With two subsequent rechallenges, the symptoms reappeared. Neither dose nor time period were provided in the case report. Serum prolactin levels were measured both during ginseng powder use as well as when the patient was not using the powder; these levels were reported as normal although exact levels were not provided .
C) Five women aged 25 to 40 who had been taking ginseng for varying periods reported to their doctor the development of breast symptoms, including nipple enlargement, and an increased sexual responsiveness .
D) A 62-year-old woman (14 years post-menopausal) had a vaginal smear exhibiting a strong estrogenic effect with a maturation index of 0/65/35 (parabasal/intermediate/superficial cells) which was attributed to her intake of "Rumanian ginseng in an unspecified dose. The ginseng product was analyzed and was shown not to contain any estrogen, nor was the woman taking any estrogen product. Within 3 weeks of discontinuing the ginseng use, the vaginal smear displayed a maturation index of 9/95/5. Within 2 weeks of ginseng rechallenge, the vaginal smear maturation index was 0/90/10. Throughout periods of ginseng use and abstinence, the serum concentrations of estrone, estradiol, and estriol remained essentially unchanged within the normal range (0.32 nanomoles/liter (nmol/L), 0.03 nmol/L and less than 0.01 nmol/L, respectively). The authors theorize the saponin content of ginseng interacts with estrogen receptor proteins in a manner similar to ovarian steroids .
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
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