Contraceptives & ARVs

Drug-drug interactions between Contraceptives & ARVs

 

Legend

  Potential increased exposure of the hormone  
  Potential decreased exposure of the hormone
No significant effect 
D  Potential decreased exposure of ARV drug
E  Potential elevated exposure of ARV drug

ATV/c    ATV co-formulated with COBI (300/150 mg qd);  
DRV/c    DRV co-formulated with COBI (800/150 mg qd)

Numbers refer to increased or decreased AUC as observed in drug-drug interaction studies

Es = estrogens
COC = combined oral contraceptive
EC = emergency contraception
IP = implant
IUD = intrauterine device
POI = progestin only injectable
POP = progestin only pill
TS = transdermal patch
VR = vaginal ring

Interactions with ZDV
No clinically relevant interactions expected with ZDV and contraceptives


Comments

  1. Alternative or additional contraceptive measures are recommended or, if used for hormone replacement therapy, monitor for signs of oestrogen deficiency
  2. Unboosted ATV increased ethinylestradiol AUC by 48%. Use no more than 30 μg of ethinylestradiol if co-administered with unboosted ATV and at least 35 μg of ethinylestradiol if co-administered with ATV/r
  3. Depending on the contraceptive method, ethinylestradiol concentrations are either not significantly changed (COC) or significantly decreased (VR). Levels of co-administered progestin are markedly decreased. Use with EFV is not recommended as it may impair contraceptive efficacy
  4. European SmPC states a hormonal contraceptive should contain at least 30 μg ethinylestradiol
  5. When used in a combination pill, the estrogen component is reduced to a small extent
  6. When used in a combination pill, the estrogen component is significantly reduced, caution is recommended and additional contraceptive measures should be used
  7. EFV is expected to decrease the progestin exposure and thereby impair the efficacy of the contraceptive method. A reliable method of barrier contraception must be used in addition to hormonal contraceptives
  8. Used in combination with ethinylestradiol (0.015 mg/day) which is predicted to be decreased. Since there is no possibility to adjust ethinylestradiol, caution is recommended and additional contraceptive measures should be used
  9. Unboosted ATV increased ethinylestradiol AUC by 48% and norethisterone AUC by 110%. Use no more than 30 μg of ethinylestradiol if co-administered with unboosted ATV and at least 35 μg of ethinylestradiol if co-administered with ATV/r
  10. Unlikely to have clinical consequences as hormone is administered as single dose
  11. Use 3 mg as a single dose for emergency contraception. Of note, the doubling of the standard dose is outside the product license and there is limited evidence in relation to efficacy
  12. Not recommended, non-hormonal emergency contraception (Cu-IUD) should be considered

Further Information

For additional drug-drug interactions and for more detailed pharmacokinetic interaction data and dosage adjustments, please refer to http://www.hiv-druginteractions.org (University of Liverpool).