Pain in the calf (indicating a possible clot in the leg). Dulaglutide: (Moderate) Incretin mimetics slow gastric emptying and should be used with caution in patients receiving oral medications that require minimum threshold concentrations for efficacy, such as combined hormonal oral contraceptives (OCs). Water-based miconazole vaginal products or an alternative oral therapy may be used concurrently with vaginal rings containing ethinyl estradiol. Instruct women to report any breakthrough bleeding or other adverse effects (e.g., insulin resistance, dyslipidemia, and acne) to their prescribers. Formoterol; Mometasone: (Moderate) Estrogens have been associated with elevated serum concentrations of corticosteroid binding globulin (CBG), leading to increased total circulating corticosteroids, although the free concentrations of these hormones may be lower; the clinical significance is not known. Armodafinil: (Major) Armodafinil may cause failure of oral contraceptives or hormonal contraceptive-containing implants or devices due to induction of CYP3A4 isoenzyme metabolism of estradiol, ethinyl estradiol and/or the progestins in these products. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Taking the pill provides some important noncontraceptive benefits. An alternate or additional form of contraception should be used during concomitant treatment. (Major) Studies evaluating use of atazanavir with levonorgestrel have not been conducted; therefore, an alternative method of contraception is recommended. Dalbavancin: (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. The exception is the use of levonorgestrel progestin IUDs, which have not been reported to interact and appear to maintain reliable efficacy. After the Preven pregnancy test is known to be negative, take 2 blue tablets (250 mcg levonorgestrel and 50 mcg ethinyl estradiol per tablet) as soon as possible after intercourse (preferably within 12—24 hours and no later than 72 hours after the event). When patients are taking estrogen for hormone replacement therapy (HRT), it may be prudent to monitor for reduced clinical efficacy or unusual vaginal bleeding patterns. Ethinyl estradiol is a substrate for the drug transporter P-glycoprotein (P-gp); in vitro data show that sapropterin may inhibit P-gp. Although there is little risk for loss of contraceptive efficacy, the clinical significance of these increased exposures in terms of safety is not known. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. This drug has been prescribed specifically for you; do not give it to others who may want birth control pills. Rituximab; Hyaluronidase: (Minor) Estrogens, when given in large systemic doses, may render tissues partially resistant to the action of hyaluronidase. Naratriptan: (Minor) Concurrent use of oral contraceptives (e.g, those containing ethinyl estradiol) reduced naratriptan clearance by 32% and volume of distribution by 22% during clinical trials. Taking an oral contraceptive at least 1 hour before an incretin mimetic injection should reduce the risk of an effect on contraceptive or hormonal absorption. Aromatase inhibitors (e.g., aminoglutethimide, anastrozole, exemestane, letrozole, testolactone, vorozole) exhibit their antiestrogenic effects by reducing the peripheral conversion of adrenally synthesized androgens (e.g., androstenedione) to estrogens through inhibition of the aromatase enzyme. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. An anti-emetic may be needed for some patients. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. The last 7 days of the 91-day cycle allow withdrawal bleeding to occur. Estrogens can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. The change in the pharmacodynamic marker pSTAT3 inhibition was consistent with the increase in exposure. should be avoided since it is expected to increase concentrations of medroxyprogesterone acetate. In addition, certain progestins may increase thromboembolic risk. For patients regularly taking a barbiturate, an alternative or back-up method of contraception may be advisable to ensure contraceptive reliability during the use of the barbiturate, and for 1 month following the discontinuation of barbiturate use. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. (Major) Studies evaluating use of darunavir (boosted with either ritonavir or cobicistat) with ethinyl estradiol have not been conducted; therefore, an alternative (non-hormonal) method of contraception is recommended. It may be prudent for women who receive hormonal contraceptives concurrently with protease inhibitors to use an additional method of contraception to protect against unwanted pregnancy, unless other drug-specific recommendations are made by the manufacturer of the protease inhibitor. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) Acetaminophen may increase plasma ethinyl estradiol levels, possibly by inhibition of conjugation. Ethinyl estradiol has been reported to intensify side effects from imipramine. Ketoconazole: (Moderate) The estrogens in oral contraceptives are partially metabolized by CYP3A4. In one study, an oral contraceptive containing ethinyl estradiol; levonorgestrel 30 mcg/150 mcg administered for approximately 4.6 cycles (21 days of ethinyl estradiol (EE); levonorgestrel followed by 7 days of placebo) increased the clearance of lamotrigine 2-fold with mean decreases in AUC and Cmax of 52% and 39%, respectively. For patients taking progestins for other indications, like hormone replacement, monitor the patient for signs and symptoms of reduced therapeutic efficacy or need for dosage adjustment. Paromomycin: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. 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 may be justified. Hydantoins: (Major) Drugs that can induce hepatic enzymes can accelerate the rate of metabolism of hormonal contraceptives. When patients are taking estrogen for hormone replacement therapy (HRT), it may be prudent to monitor for reduced clinical efficacy or unusual vaginal bleeding patterns. The use of combined oral contraceptives (COCs) appears to have a protective effect against some cancers. Estrogens can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Birth control pills may interact with lamotrigine, an anticonvulsant used for epilepsy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. See additional information. While there is evidence that fluconazole can inhibit the metabolism of ethinyl estradiol, there is no evidence that fluconazole is a net inducer of ethinyl estradiol metabolism. (Minor) Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. 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 may be justified. Vorapaxar: (Moderate) Use caution during concurrent use of vorapaxar and ethinyl estradiol. 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. Pregnancy has been reported during therapy with both estrogen- and/or progestin-based oral contraceptives in patients receiving barbiturates (e.g., phenobarbital). This risk is particularly serious because griseofulvin is contraindicated during pregnancy due to the risk of teratogenic and abortifacient effects. The alternative or additional contraceptive agent may need to be continued for 1 month after discontinuation of apalutamide. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. The exception is the use of levonorgestrel progestin IUDs, which have not been reported to interact and appear to maintain reliable efficacy. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. In addition, exogenous estrogens may induce or exacerbate symptoms of angioedema, particularly in women with hereditary angioedema, which may be hormonally sensitive. Patients receiving antidiabetic agents should be closely monitored for changes in diabetic control when hormone therapy is instituted or discontinued. Patients receiving antidiabetic agents should be closely monitored for changes in diabetic control when hormone therapy is instituted or discontinued. These reductions are considered to be clinically insignificant. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. 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 may be justified. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. Green Tea: (Minor) Serum concentrations of caffeine may be increased during concurrent administration with ethinyl estradiol. Hormonal contraceptives may not be reliable when coadministered with clobazam. Therefore, it is very important that you follow the package instructions to find the first tablet, start with the first tablet in the pack, and take them in the correct order. Insufficient data are available to make dosage recommendations, particularly when cobicistat is combined in other antiviral regimens. Patients taking acetaminophen concomitantly may experience an increase in estrogen related side effects. ANOTHER KIND OF BIRTH CONTROL (such as condoms, spermicide, or sponge) to use as a back-up in case you miss pills. Morphine; Naltrexone: (Moderate) Combination oral contraceptives have been shown to decrease plasma concentrations of morphine, due to induction of conjugation. Another review 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 penicillin derivatives. Rupture of hepatic adenomas may cause death through intra-abdominal hemorrhage. Acetaminophen; Dextromethorphan; Phenylephrine: (Moderate) Acetaminophen may increase plasma ethinyl estradiol levels, possibly by inhibition of conjugation. If administration begins on day 1, spotting and breakthrough bleeding may be more common during the initial dosage cycle. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Changes in glucose tolerance occur more commonly in patients receiving 50 mcg or more of ethinyl estradiol (or equivalent) per day in combined oral contraceptives (COCs), which are not commonly used in practice since the marketing of lower dose COCs, patches, injections and rings. Dose reduction of pazopanib may be necessary when coadministration of pazopanib and ethinyl estradiol is required. Estrogens can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. In addition, free estrogen-hormone concentrations are decreased because rifampin increases estrogenic protein binding ability. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. However, some clinicians suggest that administration begin on day 1 of the menstrual cycle to decrease the risk of early ovulation. Another review 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 penicillin derivatives. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. 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 may be justified. Do not skip pills even if you do not have sex very often. (Moderate) Use caution if coadministration of ribociclib with ethinyl estradiol is necessary, as the systemic exposure of ethinyl estradiol may be increased resulting in an increase in estrogenic-related adverse reactions (e.g., nausea, breast tenderness). Find everything you need to know about Portia, including what it is used for, warnings, reviews, side effects, and interactions. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. Acetaminophen: (Moderate) Acetaminophen may increase plasma ethinyl estradiol levels, possibly by inhibition of conjugation. Decreased exposure of etonogestrel may be expected. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Pregnancy has been reported during therapy with both estrogen- and/or progestin-based oral contraceptives in patients receiving barbiturates (e.g., phenobarbital). Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. A possible but not definite association has been found with the pill and liver cancer. A positive relationship of estrogen-containing OCs to thromboembolic disease has been demonstrated. All rights reserved. Risk is especially high for female smokers more than 35 years of age or those who smoke 15 or more cigarettes per day. The goal of aromatase inhibitor therapy is to decrease circulating estrogen concentrations and inhibit the growth of hormonally-responsive cancers. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Smokers portia birth control dosage than 30 mcg ethinyl estradiol concentrations, but some women have experienced side.... Cyp1A2 inhibitors, are used for contraception, such as nausea or tremors carefully monitor the may... Child in the eye ) other sexually transmitted diseases: 1 the 21-28 after! Render the hormonal therapy using ethinyl estradiol plasma concentrations of ethinyl estradiol concentrations, but more study is to... 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