Drug General Information (ID: DDIWCFH7GZ)
Drug Name			Protriptyline		Drug Info		Estramustine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidepressants				Antineoplastics
Structure

Mechanism of Protriptyline-Estramustine Interaction (Severity Level: Minor)
Decreased metabolism (Unspecific) Click to Show/Hide Mechanism Graph
Drug Name		Protriptyline				Estramustine
Mechanism 1		Tricyclic antidepressants				Inhibit the metabolism of tricyclic antidepressants
Key Mechanism Factor 1
		Factor Name		Pharmacokinetics
		Factor Description		Alters the metabolism of the drug, leading to changes in the plasma concentration of the drug and affecting the pharmacological effects.
Mechanism Description		Decreased metabolism of Protriptyline caused by Estramustine
Mechanism 2		Tricyclic antidepressant				Inhibit the metabolism of tricyclic antidepressants
Key Mechanism Factor 2
		Factor Name		Pharmacokinetics
		Factor Description		Alters the metabolism of the drug, leading to changes in the plasma concentration of the drug and affecting the pharmacological effects.
Mechanism Description		Decreased metabolism of Protriptyline caused by Estramustine

Recommended Action
Management		The clinical significance of this interaction has not been established. Monitoring for altered effects may be advisable during concomitant therapy. Dose adjustments of the TCA may be required if an interaction is suspected.

References
1	Edelbroek PM, Zitman FG, Knoppert-van der Klein EA, van Putten PM, de Wolff FA "Therapeutic drug monitoring of amitriptyline: impact of age, smoking and contraceptives on drug and metabolite levels in bulimic women." Clin Chim Acta 165 (1987): 177-87. [PMID: 3652444]
2	Somani SM, Khurana RC "Mechanism of estrogen-imipramine interaction." JAMA 223 (1973): 560. [PMID: 4739153]
3	Eichling PS, Sahni J. Menopause related sleep disorders. J Clin Sleep Med. 2005 Jul 15;1(3):291-300.