Following oral administration, leflunomide is metabolized to an active metabolite, teriflunomide, which is responsible for essentially all of leflunomide's in vivo activity. Following repeated teriflunomide doses, mean ethinyl estradiol Cmax and AUC increased 1. Levonorgestrel Cmax increased 1. Hormonal contraceptives may not be reliable when coadministered with lesinurad.
Females taking hormonal-based birth control should use additional non-hormonal methods and not rely solely on hormonal contraceptive methods when taking lesinurad.
Lesinurad may also reduce the effectiveness of other estrogens or progestins. Patients taking these hormones for other indications may need to be monitored for reduced clinical effect while on lesinurad, with adjustments made based on clinical efficacy.
Levofloxacin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Linagliptin: Minor Estrogens, progestins, or oral contraceptives can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Linagliptin; Metformin: Minor Estrogens, progestins, or oral contraceptives can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Lincomycin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Lincosamides: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Linezolid: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Lomitapide: Major Concomitant use of lomitapide and oral contraceptives may significantly increase the serum concentration of lomitapide.
In addition, females of reproductive potential must use effective contraception during lomitapide therapy. Because vomiting and diarrhea have been frequently reported during lomitapide therapy and hormone absorption from oral contraceptives may be incomplete in the presence of vomiting or diarrhea, warn patients that the use of additional contraceptive methods is warranted if vomiting or diarrhea occur.
Lopinavir; Ritonavir: Moderate Many anti-retroviral protease inhibitors may interact with hormonal agents like norethindrone, due to their actions on CYP metabolism, particularly CYP3A4. Lorlatinib: Major Women taking both progestins and lorlatinib should report breakthrough bleeding to their prescribers. An alternate or additional form of contraception should be considered in patients prescribed lorlatinib.
The alternative or additional contraceptive agent may need to be continued for 1 month after discontinuation of lorlatinib. Lumacaftor; Ivacaftor: Major Avoid concomitant use of hormonal contraceptives and lumacaftor; ivacaftor, unless the benefits outweigh the risks. Lumacaftor; ivacaftor may decrease hormonal contraceptive exposure, reducing efficacy. When coadministered with lumacaftor; ivacaftor, hormonal contraceptives are not a reliable method of effective contraception; instruct patients on alternative methods of birth control.
In addition, concomitant use may increase the incidence of menstruation-associated adverse reactions e. Meglitinides: Minor Progestins can impair glucose tolerance. Mephobarbital: Moderate Barbiturates can accelerate the hepatic clearance of progestins. Meropenem: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Meropenem; Vaborbactam: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Metformin: Minor Patients receiving antidiabetic agents like metformin should be closely monitored for signs indicating changes in diabetic control when therapy with progestins is instituted or discontinued.
Metformin; Repaglinide: Minor Patients receiving antidiabetic agents like metformin should be closely monitored for signs indicating changes in diabetic control when therapy with progestins is instituted or discontinued.
Metformin; Rosiglitazone: Minor Patients receiving antidiabetic agents like metformin should be closely monitored for signs indicating changes in diabetic control when therapy with progestins is instituted or discontinued. Metformin; Saxagliptin: Minor Patients receiving antidiabetic agents like metformin should be closely monitored for signs indicating changes in diabetic control when therapy with progestins is instituted or discontinued.
Metformin; Sitagliptin: Minor Patients receiving antidiabetic agents like metformin should be closely monitored for signs indicating changes in diabetic control when therapy with progestins is instituted or discontinued.
Methohexital: Moderate Barbiturates can accelerate the hepatic clearance of progestins. Metronidazole: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Mifepristone: Contraindicated Mifepristone is a progesterone-receptor antagonist and will interfere with the effectiveness of hormonal contraceptives. Therefore, non-hormonal contraceptive methods should be used in Cushing's patients taking mifepristone.
If vomiting or diarrhea occur during miltefosine therapy, advise females to use an additional non-oral method of effective contraception. Minocycline: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Mitotane: Major Avoid coadministration of mitotane with norethindrone if used for contraception; consider an alternate or additional form of contraception.
The alternative or additional contraceptive agent may need to be continued for 1 month after discontinuation of mitotane. Patients taking hormonal replacement therapy may need to be monitored for reduced clinical effect while on mitotane, with dose adjustments made based on clinical efficacy.
Women taking hormonal replacement and mitotane should report breakthrough bleeding, hot flashes, or other symptoms to their prescribers.
Concurrent administration of mitotane with progestins, oral contraceptives, or non-oral combination contraceptives may reduce hormonal concentrations. Mivacurium: Moderate Plasma cholinesterase activity may be diminished by chronic administration of oral contraceptives; consider the possibility of prolonged neuromuscular block after administration of mivacurium in patients with reduced plasma cholinesterase activity. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Mobocertinib: Major Women taking both progestins and mobocertinib should report breakthrough bleeding to their prescribers. An alternate or additional form of contraception should be considered in patients prescribed mobocertinib. The alternative or additional contraceptive agent may need to be continued for one month after discontinuation of mobocertinib. Modafinil: Major Modafinil may cause failure of oral contraceptives or hormonal contraceptive-containing implants or devices due to induction of CYP3A4 isoenzyme metabolism of the progestins in these products.
An alternative method or an additional method of contraception should be utilized during modafinil therapy and continued for one month after modafinil discontinuation. If these drugs are used together, monitor patients for a decrease in clinical effects; patients should report breakthrough bleeding to their prescriber.
Morphine: Moderate Combination oral contraceptives have been shown to decrease plasma concentrations of morphine, due to induction of conjugation. Monitor for decreased efficacy of morphine. Morphine; Naltrexone: Moderate Combination oral contraceptives have been shown to decrease plasma concentrations of morphine, due to induction of conjugation.
Moxifloxacin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Nafcillin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Nelfinavir: Major Many anti-retroviral protease inhibitors may interact with hormonal agents like norethindrone, due to their actions on CYP metabolism, particularly CYP3A4. Women receiving hormonal contraceptives or hormone replacement with norethindrone while receiving nelfinavir should be instructed to report any breakthrough bleeding or other adverse effects to their prescribers. It may be prudent for women who receive norethindrone-containing contraceptives concurrently with nelfinavir to use an additional method of contraception to protect against unwanted pregnancy.
Neomycin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used with antibiotics.
Nevirapine: Moderate Nevirapine may decrease plasma concentrations of oral contraceptives and non-oral combination contraceptives i. However despite lower exposures, literature suggests that use of nevirapine has no effect on pregnancy rates among HIV-infected women on combined oral contraceptives. Thus, the manufacturer states that no dose adjustments are needed when these drugs are used for contraception in combination with nevirapine.
When these oral contraceptives are used for hormone replacement and given with nevirapine, the therapeutic effect of the hormonal therapy should be monitored. Nitrofurantoin: Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora.
Norfloxacin: Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. Ofloxacin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Omadacycline: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ombitasvir; Paritaprevir; Ritonavir: Moderate Many anti-retroviral protease inhibitors may interact with hormonal agents like norethindrone, due to their actions on CYP metabolism, particularly CYP3A4.
Omeprazole; Amoxicillin; Rifabutin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Oritavancin: Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora.
Oxacillin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Oxcarbazepine: Major Progestins are susceptible to drug interactions with hepatic enzyme inducing drugs such as oxcarbazepine. Concurrent administration of oxcarbazepine progestins may increase the hormone's elimination.
Patients taking these hormones for other indications may need to be monitored for reduced clinical effect while on oxcarbazepine, with dose adjustments made based on clinical efficacy. Paromomycin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Pegaspargase: Major Avoid the concomitant use of pegaspargase and oral hormonal contraceptives due to the potential for decreased contraceptive efficacy and risk of fetal harm from pegaspargase.
Women of reproductive potential should use an effective non-hormonal method of birth control during therapy and for at least 3 months after the last pegaspargase dose.
Penicillin G Benzathine: Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora.
Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillins and their derivatives.
These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use i.
Penicillin G Benzathine; Penicillin G Procaine: Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. Penicillin G Procaine: Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora.
Penicillin G: Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. Penicillin V: Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora.
Pentobarbital: Moderate Barbiturates can accelerate the hepatic clearance of progestins. Pexidartinib: Major Avoid the concomitant use of pexidartinib and hormone-containing contraceptives; the effectiveness of hormonal contraceptives may be decreased resulting in contraceptive failure. Females of reproductive potential should avoid pregnancy during and for 1 month after treatment with pexidartinib.
Advise these patients to use an effective, non-hormonal method of contraception. Phenobarbital: Moderate Barbiturates can accelerate the hepatic clearance of progestins. Phenobarbital; Hyoscyamine; Atropine; Scopolamine: Moderate Barbiturates can accelerate the hepatic clearance of progestins. Phentermine; Topiramate: Moderate Topiramate may increase the clearance and compromise the efficacy of progestins used in contraception or hormone replacement therapies.
Norethindrone pharmacokinetics were not significantly affected. However, pregnancy has been reported in patients who are using hormonal-containing contraceptives and taking hepatic enzyme inducers like topiramate. Patients taking progestin-containing contraceptives or patients taking progestins for hormone replacement therapy HRT should report changes in their bleeding patterns to their prescribers. Reduced contraceptive efficacy can occur even in the absence of breakthrough bleeding. Dosages of hormone replacement products may need adjustment.
Different or additional forms of contraception may also be needed. Pioglitazone: Minor Progestins can impair glucose tolerance. Pioglitazone; Glimepiride: Minor Progestins can impair glucose tolerance. Pioglitazone; Metformin: Minor Patients receiving antidiabetic agents like metformin should be closely monitored for signs indicating changes in diabetic control when therapy with progestins is instituted or discontinued.
Piperacillin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Piperacillin; Tazobactam: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Pitolisant: Major Advise patients to use an alternative, non-hormonal contraceptive during and for at least 21 days after discontinuation of pitolisant. Pitolisant is a weak CYP3A4 inducer and may decrease the plasma exposure of hormonal contraceptives resulting in decreased efficacy. Plazomicin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Polymyxin B: Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. Polymyxins: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Pramlintide: Minor Progestins can impair glucose tolerance. Prasterone, Dehydroepiandrosterone, DHEA Dietary Supplements : Moderate Either additive or antagonistic effects could potentially occur if prasterone is combined with progestins. Primidone: Moderate Barbiturates can accelerate the hepatic clearance of progestins. Pyrimethamine; Sulfadoxine: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Rifampin: Major Women taking both progestins and rifampin should report breakthrough bleeding to their prescribers. Rifapentine: Major Women taking both progestins and rifapentine should report breakthrough bleeding to their prescribers. An alternate or additional form of contraception should be considered in patients prescribed rifapentine.
The alternative or additional contraceptive agent may need to be continued for one month after discontinuation of rifapentine. Riluzole: Moderate Monitor patients for increased riluzole-related adverse events, such as gastrointestinal symptoms and elevated hepatic enzymes, when hormonal contraceptives are prescribed concurrently.
In vitro findings suggest an increase in riluzole exposure is likely when a CYP1A2 inhibitor is given. Ritonavir: Moderate Many anti-retroviral protease inhibitors may interact with hormonal agents like norethindrone, due to their actions on CYP metabolism, particularly CYP3A4.
Roflumilast: Moderate Coadminister oral contraceptives containing gestodene and ethinyl estradiol and roflumilast cautiously, as the combination has resulted in increased drug exposure to roflumilast in pharmacokinetic study. In an open-label crossover study in 20 healthy adult volunteers, coadministration of a single dose of oral roflumilast mcg with repeated doses of a fixed combination oral contraceptive containing 0.
A similar interaction is expected with oral contraceptives and ethinyl estradiol; etonogestrel. Rosiglitazone: Minor Progestins can impair glucose tolerance. Rufinamide: Major Coadministration of hormonal contraceptives with rufinamide may reduce hormone concentrations and therefore reduce the clinical efficacy of hormonal contraceptives.
If coadministration is necessary, recommend patients use additional non-hormonal forms of contraception. Sarilumab: Moderate Utilize caution with concomitant use of sarilumab and CYP3A4 substrate drugs, such as combined hormonal oral contraceptives, where a decrease in effectiveness is undesirable. Inhibition of IL-6 signaling by sarilumab may restore CYP activities to higher levels leading to increased metabolism of drugs that are CYP substrates as compared to metabolism prior to treatment.
This effect on CYP enzyme activity may persist for several weeks after stopping sarilumab. Saxagliptin: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Secobarbital: Moderate Barbiturates can accelerate the hepatic clearance of progestins. Siltuximab: Moderate Caution is warranted when siltuximab is used in patients taking CYP3A4 substrates, such as oral contraceptives, in which a decreased effect would be undesirable.
Cytochrome Ps in the liver are down regulated by infection and inflammation stimuli, including cytokines such as interleukin-6 IL Inhibition of IL-6 signaling by siltuximab may restore CYP activities to higher levels leading to increased metabolism of drugs that are CYP substrates as compared to metabolism prior to treatment. The effect of siltuximab on CYP enzyme activity can persist for several weeks after stopping therapy.
Simvastatin; Sitagliptin: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Sitagliptin: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. John's Wort could reduce the therapeutic efficacy of progestin-only contraceptives. Women should report irregular menstrual bleeding or other hormone-related symptoms to their health care providers if they are taking St.
John's Wort concurrently with their hormones. Avoidance of these combinations is recommended. Streptogramins: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Additionally, dalfopristin; quinupristin is a major inhibitor of cytochrome P 3A4 and may decrease the elimination of drugs metabolized by this enzyme including ethinyl estradiol and norethindrone.
Streptomycin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Succinylcholine: Moderate Plasma cholinesterase activity may be diminished by chronic administration of oral contraceptives; consider the possibility of prolonged neuromuscular block after administration of succinylcholine in patients with reduced plasma cholinesterase activity.
Sugammadex: Major If an oral contraceptive is taken the same day sugammadex is administered, the patient must use an additional, non-hormonal contraceptive method or back-up method of contraception for the next 7 days.
Sugammadex may bind to progestogen, resulting in a decrease in progestogen exposure. The administration of a bolus dose of sugammadex results in actions that are essentially equivalent to missing one or more doses of contraceptives containing estrogen or progestogen, including combination oral contraceptives, non-oral combination contraceptives, or progestins. Sulfadiazine: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Sulfasalazine: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Sulfisoxazole: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Sulfonamides: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Sulfonylureas: Minor Progestins can impair glucose tolerance. Tazemetostat: Major Women taking both progestins and tazemetostat should report breakthrough bleeding to their prescribers. An alternate or additional form of contraception should be considered in patients prescribed tazemetostat. The alternative or additional contraceptive agent may need to be continued for 1 month after discontinuation of tazemetostat. Tedizolid: Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora.
Telaprevir: Major Close clinical monitoring for contraception failure is advised when coadministering norethindrone with telaprevir. It is not known if telaprevir reduces the efffectiveness of progestin-only contraception. Two effective non-hormonal methods of contraception should be used during treatment with telaprevir. Telavancin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Telithromycin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. The pharmacokinetics of ethinyl estradiol were not altered when low dose triphasic oral contraceptives containing ethinyl estradiol; levonorgestrel were administered to women of child-bearing potential also receiving telithromycin.
Plasma concentrations of levonorgestrel were increased by telithromycin. Drospirenone has antimineralocorticoid effects; the progestin may increase serum potassium. Strong CYP3A4 inhibitors include telithromycin. Teriflunomide: Moderate Teriflunomide may increase the effects of oral contraceptives. Following consecutive teriflunomide doses, mean ethinyl estradiol Cmax and AUC increased 1. Use caution when selecting the type and dose of oral contraceptives in patients taking teriflunomide.
Tetracycline: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Thalidomide: Moderate Thalidomide and hormone contraceptives should be used cautiously due an increased risk of thromboembolism. Thiazolidinediones: Minor Progestins can impair glucose tolerance.
Thiopental: Moderate Barbiturates can accelerate the hepatic clearance of progestins. Ticarcillin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Ticarcillin; Clavulanic Acid: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Tigecycline: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Tinidazole: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Tipranavir: Major It is not known if tipranavir alters the metabolism of norethindrone-only contraception; tipranavir has been reported to reduce efficacy of other hormonal contraceptives. Women receiving norethindrone hormone replacement or contraceptives with tipranavir should be instructed to report any breakthrough bleeding or other adverse effects to their prescribers. Alternate methods of non-hormonal contraception are recommended in patients receiving tipranavir. Tizanidine: Major If possible, avoid the concurrent use of tizanidine with oral contraceptives OC , as concurrent use could lead to substantial increases in tizanidine blood concentrations.
Combined OCs increased tizanidine AUC by 4-fold and the mean Cmax by 3-fold in a parallel-group study in healthy women. Increased hypotensive effects were also noted in women taking tizanidine and OCs. If concurrent use cannot be avoided, initiate tizanidine therapy with the 2 mg dose and increase in 2 to 4 mg increments daily based on patient response to therapy.
Discontinue tizanidine if hypotension, bradycardia, or excessive drowsiness occur. Tobramycin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Tocilizumab: Moderate Utilize caution with concomitant use of tocilizumab and CYP3A4 substrate drugs, such as combined hormonal oral contraceptives, where a decrease in effectiveness is undesirable. Inhibition of IL-6 signaling by tocilizumab may restore CYP activities to higher levels leading to increased metabolism of drugs that are CYP substrates as compared to metabolism prior to treatment.
This effect on CYP enzyme activity may persist for several weeks after stopping tocilizumab. Tolazamide: Minor Progestins can impair glucose tolerance. Tolbutamide: Minor Progestins can impair glucose tolerance. Topiramate: Moderate Topiramate may increase the clearance and compromise the efficacy of progestins used in contraception or hormone replacement therapies. Trimethoprim: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Ulipristal: Major Avoid concurrent use of ulipristal and progestin-containing hormonal contraceptives or other progestins. Hormonal contraceptives may be started or resumed no sooner than 5 days after ulipristal treatment. Also, a reliable barrier method of contraception should be used during the same menstrual cycle in which ulipristal was administered until the next menstrual period.
Progestin-containing contraceptives may impair the ability of ulipristal to delay ovulation. Ulipristal may may reduce the effectiveness of progestin-containing hormonal contraceptives by competitively binding at the progesterone receptor. Vancomycin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Voriconazole: Moderate Ethinyl estradiol and norethindrone increases the Cmax and AUC of voriconazole and voriconazole increases the Cmax and AUC of both ethinyl estradiol and norethindrone.
The primary contraceptive effect of progestins involves the suppression of the midcycle surge of luteinizing hormone LH. The exact mechanism of action, however, is unknown. At the cellular level, progestins diffuse freely into target cells and bind to the progesterone receptor. Target cells include the female reproductive tract, the mammary gland, the hypothalamus, and the pituitary. Once bound to the receptor, progestins slow the frequency of release of gonadotropin releasing hormone GnRH from the hypothalamus and blunt the pre-ovulatory LH surge, thereby preventing follicular maturation and ovulation.
Additional mechanisms may be involved. Other actions of norethindrone include alterations in the endometrium that can impair implantation and an increase in cervical mucus viscosity which inhibits sperm migration into the uterus.
The administration of norethindrone to women with adequate estrogen production transforms the uterus from a proliferative to a secretory phase.
Norethindrone has minimal estrogenic, androgenic, and anabolic activity. When there is perfect adherence to proper oral dosing, the first-year failure rate for progestin-only oral contraceptives is 0. Norethindrone is administered orally. Pharmacokinetic parameters for norethindrone are poorly understood.
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Sections for Minipill progestin-only birth control pill About. Overview The minipill norethindrone is an oral contraceptive that contains the hormone progestin. Request an Appointment at Mayo Clinic.
Share on: Facebook Twitter. Show references Hatcher RA, et al. In: Managing Contraception Tiger, Ga. Frequently asked questions.
Contraception FAQ Progestin-only hormonal birth control: Pill and injection. American College of Obstetricians and Gynecologists. Accessed Oct. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor. It is important to take this medication exactly as prescribed by your doctor. The effectiveness of this medication depends on taking the medication at the same time each day.
If you forget to take a pill, refer to the package insert for information on how to proceed. If you miss pills at any time, the risk of becoming pregnant increases. Refer to your package insert information for instruction on when you will need to use a second method of birth control. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Do not dispose of medications in wastewater e. Ask your pharmacist how to dispose of medications that are no longer needed or have expired. Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
Many of these side effects can be managed, and some may go away on their own over time. Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Stop taking the medication and seek immediate medical attention if any of the following occur:. Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication. Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnancy or breast-feeding, and any other significant facts about your health.
These factors may affect how you should take this medication. Breast cancer: Some studies have suggested the possibility of a link between birth control pills and breast cancer, but nothing conclusive has been found involving this medication.
Women with breast cancer should not use birth control pills, as the role of female sex hormones in breast cancer has not been fully determined. Cervical cancer: Some studies have suggested the possibility of a link between birth control pills and cervical cancer, but nothing conclusive has been found involving this medication.
Women with cervical cancer should not use birth control pills, as the role of female sex hormones in cervical cancer has not been fully determined. Depression: Women with a history of depression may be more likely to have a recurrence while taking birth control pills. If you have a history of depression or other mental health conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Diabetes: Norethindrone may cause slight increases in blood sugar levels may cause a loss of blood glucose control and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.
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