Drug interactions
Ethinyl estradiol-levonorgestrel + Tacrolimus
Severity: Moderate
Ethinyl estradiol-levonorgestrel and Tacrolimus: moderate interaction.
Last updated
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
Ethinyl estradiol may reduce CYP3A4-mediated tacrolimus clearance, and raised tacrolimus levels have been reported with oral contraceptives. Tacrolimus has a narrow therapeutic index, with risk of nephrotoxicity and neurotoxicity at high concentrations. Estrogen-containing contraceptives are also often avoided in transplant patients because of hypertension and thrombotic risk.
What this interaction means in plain words
Ethinyl estradiol-levonorgestrel and Tacrolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Ethinyl estradiol-levonorgestrel belongs to Endocrine; Tacrolimus belongs to Miscellaneous.
Why it happens
Inhibition of CYP3A4 metabolism of tacrolimus by ethinyl estradiol.
What to do
Measure tacrolimus trough levels and renal function after starting or stopping the contraceptive and adjust the dose. Consider a progestin-only or intrauterine method instead.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Tacrolimus
- Adenovirus types 4 and 7 live + Tacrolimus Contraindicated
- Bcg vaccine live + Tacrolimus Contraindicated
- Cidofovir + Tacrolimus Contraindicated
- Cyclosporin + Tacrolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Tacrolimus Contraindicated
- Measles mumps and rubella vaccine live + Tacrolimus Contraindicated
Frequently asked questions
Can I take Ethinyl estradiol-levonorgestrel with Tacrolimus?
MediHelp rates the interaction as moderate. Ethinyl estradiol-levonorgestrel and Tacrolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Ethinyl estradiol may reduce CYP3A4-mediated tacrolimus clearance, and raised tacrolimus levels have been reported with oral contraceptives. Tacrolimus has a narrow therapeutic index, with risk of nephrotoxicity and neurotoxicity at high concentrations. Estrogen-containing contraceptives are also often avoided in transplant patients because of hypertension and thrombotic risk.
How serious is the interaction between Ethinyl estradiol-levonorgestrel and Tacrolimus?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Measure tacrolimus trough levels and renal function after starting or stopping the contraceptive and adjust the dose. Consider a progestin-only or intrauterine method instead.
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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