Drug
Norgestimate-Ethinyl Estradiol
Pronounced
"proe-JES-tin/ETH-in-il ess-tra-DYE-ole"
Drug Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug include: aromatase inhibitors (such as anastrozole, exemestane), fezolinetant, ospemifene, tamoxifen, tizanidine, tranexamic acid.
Some drugs may cause hormonal birth control to work less well by decreasing the amount of birth control hormones in your body. This effect can result in pregnancy. Examples include griseofulvin, modafinil, rifamycins (such as rifampin, rifabutin), ritonavir, St. John's wort, drugs used to treat seizures (such as barbiturates, carbamazepine, felbamate, phenytoin, primidone, topiramate), HIV drugs (such as nelfinavir, nevirapine), among others.
Tell your doctor when you start any new drug, and discuss if you should use reliable backup birth control. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.
This medication may interfere with certain lab tests (such as blood clotting factors, thyroid), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
Negative Interactions
3- Potential Negative Interaction
Levonorgestrel
St. John’s Wort
Eight cases reported to the Medical Products Agency of Sweden suggest that St. John’s wort may interact with oral contraceptives and cause intramenstrual bleeding and/or changes in menstrual bleeding. One reviewer has suggested that St. John’s wort may reduce serum levels of estradiol. It should be noted, however, that only three of the eight Swedish women returned to normal menstrual cycles after stopping St. John’s wort. Women taking oral contraceptives for birth control should consult with their doctor before taking St. John’s wort.
St. John’s WortLevonorgestrel- Safety of St. John's wort (Hypericum perforatum) [letters to the editor from various authors]. Lancet 2000;355:575-7.
- Ernst E. Second thoughts about safety of St. John's wort. Lancet 1999;354:2014-6 [letter].
- Potential Negative Interaction
Levonorgestrel-Ethinyl Estrad
St. John’s Wort
Eight cases reported to the Medical Products Agency of Sweden suggest that St. John’s wort may interact with oral contraceptives and cause intramenstrual bleeding and/or changes in menstrual bleeding. One reviewer has suggested that St. John’s wort may reduce serum levels of estradiol. It should be noted, however, that only three of the eight Swedish women returned to normal menstrual cycles after stopping St. John’s wort. Women taking oral contraceptives for birth control should consult with their doctor before taking St. John’s wort.
St. John’s WortLevonorgestrel-Ethinyl Estrad- Safety of St. John's wort (Hypericum perforatum) [letters to the editor from various authors]. Lancet 2000;355:575-7.
- Ernst E. Second thoughts about safety of St. John's wort. Lancet 1999;354:2014-6 [letter].
- Potential Negative Interaction
Ethinyl Estradiol
Zinc
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
In a group of 37 postmenopausal women treated with conjugated estrogens and medroxyprogesterone for 12 months, urinary zinc and magnesium loss was reduced in those women who began the study with signs of osteoporosis and elevated zinc and magnesium excretion. The clinical significance of this interaction remains unclear.
ZincEthinyl Estradiol- Herzberg M, Lusky A, Blonder J, Frenkel. The effect of estrogen replacement therapy on zinc in serum and urine. Obstet Gynecol 1996;87:1035-40.
Supportive Interactions
17- Replenish Depleted Nutrients
Levonorgestrel
Folic Acid
Oral contraceptive use can cause folic acid depletion.
Folic AcidLevonorgestrel- Lindenbaum J, Whitehead N, Reyner F. Oral contraceptive hormones, folate metabolism, and the cervical epithelium. Am J Clin Nutr 1975;28:346-53.
- Replenish Depleted Nutrients
Levonorgestrel-Ethinyl Estrad
Folic Acid
Oral contraceptive use can cause folic acid depletion.
Folic AcidLevonorgestrel-Ethinyl Estrad- Lindenbaum J, Whitehead N, Reyner F. Oral contraceptive hormones, folate metabolism, and the cervical epithelium. Am J Clin Nutr 1975;28:346-53.
- Replenish Depleted Nutrients
Levonorgestrel-Ethinyl Estrad
Magnesium
Women using oral contraceptives were found to have significantly lower serum magnesium levels in a controlled study. In a preliminary study, blood levels of magnesium decreased in women taking an oral contraceptive containing ethinyl estradiol and levonorgestrel. Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.
MagnesiumLevonorgestrel-Ethinyl Estrad- Olatunbosum DA, Adeniyi FA, Adadevoh BK. Effect of oral contraceptives on serum magnesium levels. Int J Fertil 1974;19:224-6.
- Blum M, Kitai E, Ariel Y, et al. Oral contraceptive lowers serum magnesium. Harefuah 1991;121:363-4 [in Hebrew].
- Replenish Depleted Nutrients
Levonorgestrel-Ethinyl Estrad
Manganese
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
Oral contraceptives may interfere with manganese absorption. The clinical importance of these actions remains unclear.
ManganeseLevonorgestrel-Ethinyl Estrad- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Replenish Depleted Nutrients
Levonorgestrel
Vitamin B1
A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptives may interfere with manganese absorption. The clinical importance of these actions remains unclear.
Vitamin B1Levonorgestrel- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Replenish Depleted Nutrients
Levonorgestrel-Ethinyl Estrad
Vitamin B1
A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptives may interfere with manganese absorption. The clinical importance of these actions remains unclear.
Vitamin B1Levonorgestrel-Ethinyl Estrad- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Replenish Depleted Nutrients
Levonorgestrel-Ethinyl Estrad
Vitamin B12
A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptives use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptivess may interfere with manganese absorption. The clinical importance of these actions remains unclear.
Vitamin B12Levonorgestrel-Ethinyl Estrad- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Replenish Depleted Nutrients
Levonorgestrel-Ethinyl Estrad
Vitamin B2
A review of literature suggests that women who use oral contraceptivess may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptives use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptivess may interfere with manganese absorption. The clinical importance of these actions remains unclear.
Vitamin B2Levonorgestrel-Ethinyl Estrad- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Replenish Depleted Nutrients
Levonorgestrel
Vitamin B3 (Niacin)
A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptives may interfere with manganese absorption. The clinical importance of these actions remains unclear.
Vitamin B3 (Niacin)Levonorgestrel- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Replenish Depleted Nutrients
Levonorgestrel-Ethinyl Estrad
Vitamin B3 (Niacin)
A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptives may interfere with manganese absorption. The clinical importance of these actions remains unclear.
Vitamin B3 (Niacin)Levonorgestrel-Ethinyl Estrad- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Replenish Depleted Nutrients
Levonorgestrel-Ethinyl Estrad
Vitamin B6
Laboratory evidence of vitamin B6 deficiency is common in women taking oral contraceptives.Vitamin B6Levonorgestrel-Ethinyl Estrad- Adams PW, Folkard J, Wynn V, Seed M. Influence of oral contraceptives, pyridoxine (vitamin B6), and tryptophan on carbohydrate metabolism. Lancet 1976;1:759-64.
- Replenish Depleted Nutrients
Levonorgestrel-Ethinyl Estrad
Vitamin C
A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptives may interfere with manganese absorption. The clinical importance of these actions remains unclear.
Vitamin CLevonorgestrel-Ethinyl Estrad- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Replenish Depleted Nutrients
Levonorgestrel
Zinc
A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptives may interfere with manganese absorption. The clinical importance of these actions remains unclear.
ZincLevonorgestrel- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Replenish Depleted Nutrients
Levonorgestrel-Ethinyl Estrad
Zinc
A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptives may interfere with manganese absorption. The clinical importance of these actions remains unclear.
ZincLevonorgestrel-Ethinyl Estrad- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Reduce Side Effects
Levonorgestrel
Folic Acid
In a double-blind trial of oral contraceptive users with cervical dysplasia, supplementation with very large amounts (10 mg per day) of folic acid improved cervical health. Women with cervical dysplasia diagnosed while they are taking oral contraceptives should consult a doctor. Mega-folate supplementation should not be attempted without a doctor’s supervision, nor is there any reason to believe that folic acid supplementation would help people with cervical cancer.
Folic AcidLevonorgestrel- Butterworth CE Jr, Hatch KD, Gore H, et al. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82.
- Reduce Side Effects
Levonorgestrel-Ethinyl Estrad
Folic Acid
In a double-blind trial of oral contraceptive users with cervical dysplasia, supplementation with very large amounts (10 mg per day) of folic acid improved cervical health. Women with cervical dysplasia diagnosed while they are taking oral contraceptives should consult a doctor. Mega-folate supplementation should not be attempted without a doctor’s supervision, nor is there any reason to believe that folic acid supplementation would help people with cervical cancer.
Folic AcidLevonorgestrel-Ethinyl Estrad- Butterworth CE Jr, Hatch KD, Gore H, et al. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82.
- Reduce Side Effects
Levonorgestrel-Ethinyl Estrad
Vitamin B6
Oral contraceptives have been associated with vitamin B6 depletion and clinical depression. In a small, double-blind study of women with depression taking oral contraceptivess, vitamin B6 (20 mg twice per day) improved depression. Half of the women in the study showed laboratory evidence of vitamin B6 deficiency.
Vitamin B6Levonorgestrel-Ethinyl Estrad- Adams PW, Wynn V, Rose DP, et al. Effect of pyridoxine hydrochloride (vitamin B6) upon depression associated with oral contraception. Lancet 1973;I:897-904.
Explanation Required
3- Needs Explanation
Levonorgestrel-Ethinyl Estrad
Iron
Menstrual blood loss is typically reduced with use of oral contraceptives. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women. Premenopausal women taking oral contraceptives should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.
IronLevonorgestrel-Ethinyl Estrad- Frassinelli-Gunderson EP, Margen S, Brown JR. Iron stores in users of oral contraceptive agents. Am J Clin Nutr 1985;41(4):703.
- Needs Explanation
Levonorgestrel-Ethinyl Estrad
Manganese
A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptives may interfere with manganese absorption. The clinical importance of these actions remains unclear.
ManganeseLevonorgestrel-Ethinyl Estrad- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711-5.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.
- Needs Explanation
Levonorgestrel-Ethinyl Estrad
Vitamin A
A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1, B2, B3, B12, C, and zinc levels. Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A. Oral contraceptives may interfere with manganese absorption. The clinical importance of these actions remains unclear.
Vitamin ALevonorgestrel-Ethinyl Estrad- Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-1 [review].
- Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-4.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-8.
- Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711-5.
- Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.