Drug interactions
Ethinyl estradiol-levonorgestrel + Rifampin
Severity: Major
Ethinyl estradiol-levonorgestrel and Rifampin: 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
Rifampin strongly induces hepatic enzymes and markedly lowers contraceptive hormone levels. Breakthrough bleeding and unintended pregnancies have been reported.
What this interaction means in plain words
Ethinyl estradiol-levonorgestrel and Rifampin 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.
Why it happens
Potent induction of CYP3A4 and other metabolizing enzymes increases clearance of ethinyl estradiol and levonorgestrel.
What to do
Use a non-hormonal contraceptive method such as a copper IUD during rifampin therapy and for about 4 weeks after stopping. Do not rely on combined oral contraceptives.
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
Frequently asked questions
Can I take Ethinyl estradiol-levonorgestrel with Rifampin?
MediHelp rates the interaction as major. Ethinyl estradiol-levonorgestrel and Rifampin 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. Rifampin strongly induces hepatic enzymes and markedly lowers contraceptive hormone levels. Breakthrough bleeding and unintended pregnancies have been reported.
How serious is the interaction between Ethinyl estradiol-levonorgestrel and Rifampin?
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 contraceptive method such as a copper IUD during rifampin therapy and for about 4 weeks after stopping. Do not rely on combined oral contraceptives.
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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