Drug interactions
Ethinyl estradiol-norgestimate + Mitotane
Severity: Major
Ethinyl estradiol-norgestimate 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 that can substantially lower circulating ethinyl estradiol and norgestimate-derived progestin concentrations. This may lead to contraceptive failure and breakthrough bleeding, and the induction persists for a long time after mitotane is stopped.
What this interaction means in plain words
Ethinyl estradiol-norgestimate 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-norgestimate belongs to Endocrine; Mitotane belongs to Oncology.
Why it happens
Induction of hepatic CYP3A4 increases metabolism of the estrogen and progestin components.
What to do
Use a non-hormonal or non-CYP3A4-dependent contraceptive method such as a copper IUD instead of combined oral contraceptives. Continue the alternative method for months after mitotane is discontinued.
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-norgestimate
- Ethinyl estradiol-norgestimate + Fezolinetant Contraindicated
- Ethinyl estradiol-norgestimate + Ombitasvir / paritaprevir / ritonavir and dasabuvir Contraindicated
- Ethinyl estradiol-norgestimate + Tranexamic acid Contraindicated
- Aminocaproic acid + Ethinyl estradiol-norgestimate Major
- Amobarbital + Ethinyl estradiol-norgestimate Major
- Anastrozole + Ethinyl estradiol-norgestimate 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-norgestimate with Mitotane?
MediHelp rates the interaction as major. Ethinyl estradiol-norgestimate 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 that can substantially lower circulating ethinyl estradiol and norgestimate-derived progestin concentrations. This may lead to contraceptive failure and breakthrough bleeding, and the induction persists for a long time after mitotane is stopped.
How serious is the interaction between Ethinyl estradiol-norgestimate 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 or non-CYP3A4-dependent contraceptive method such as a copper IUD instead of combined oral contraceptives. Continue the alternative method for months after mitotane is discontinued.
What other medicines interact with Ethinyl estradiol-norgestimate?
MediHelp also lists interactions of Ethinyl estradiol-norgestimate with, for example, Fezolinetant, Ombitasvir / paritaprevir / ritonavir and dasabuvir, Tranexamic acid. The full list is on the Ethinyl estradiol-norgestimate page.
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