Drug interactions
Ethinyl estradiol-levonorgestrel + Mitotane
Severity: Major
Ethinyl estradiol-levonorgestrel and Mitotane: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Mitotane is a strong CYP3A4 inducer with a very long persistence after discontinuation, markedly lowering contraceptive hormone levels. This creates a substantial risk of contraceptive failure.
What this interaction means in plain words
Ethinyl estradiol-levonorgestrel and Mitotane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Ethinyl estradiol-levonorgestrel belongs to Endocrine; Mitotane belongs to Oncology.
Why it happens
Strong induction of CYP3A4 increases metabolism of ethinyl estradiol and levonorgestrel.
What to do
Use a non-hormonal method such as a copper IUD; avoid relying on oral hormonal contraception during and for months after mitotane therapy.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Ethinyl estradiol-levonorgestrel
- Ethinyl estradiol-levonorgestrel + Fezolinetant Contraindicated
- Ethinyl estradiol-levonorgestrel + Ombitasvir / paritaprevir / ritonavir and dasabuvir Contraindicated
- Ethinyl estradiol-levonorgestrel + Tranexamic acid Contraindicated
- Aminocaproic acid + Ethinyl estradiol-levonorgestrel Major
- Amobarbital + Ethinyl estradiol-levonorgestrel Major
- Anastrozole + Ethinyl estradiol-levonorgestrel Major
Other interactions of Mitotane
- Doravirine + Mitotane Contraindicated
- Fostemsavir + Mitotane Contraindicated
- Lorlatinib + Mitotane Contraindicated
- Abiraterone + Mitotane Major
- Apixaban + Mitotane Major
- Aprepitant + Mitotane Major
Frequently asked questions
Can I take Ethinyl estradiol-levonorgestrel with Mitotane?
MediHelp rates the interaction as major. Ethinyl estradiol-levonorgestrel and Mitotane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Mitotane is a strong CYP3A4 inducer with a very long persistence after discontinuation, markedly lowering contraceptive hormone levels. This creates a substantial risk of contraceptive failure.
How serious is the interaction between Ethinyl estradiol-levonorgestrel and Mitotane?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use a non-hormonal method such as a copper IUD; avoid relying on oral hormonal contraception during and for months after mitotane therapy.
What other medicines interact with Ethinyl estradiol-levonorgestrel?
MediHelp also lists interactions of Ethinyl estradiol-levonorgestrel with, for example, Fezolinetant, Ombitasvir / paritaprevir / ritonavir and dasabuvir, Tranexamic acid. The full list is on the Ethinyl estradiol-levonorgestrel page.
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