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Potential ARV Interactions: Hormonal Contraceptives

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Table 1. Potential ARV Interactions: Hormonal Contraceptives

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Drug interactions between oral contraceptive agents and many PIs and NNRTIs may affect the serum levels of either the hormonal agent or the ARV. In some cases, contraceptive efficacy or the potential for side effects may be affected significantly. Dosage adjustments may be required, and some combinations are contraindicated. See table below for details.

There are very few data on potential interactions between ARVs and nonoral hormonal contraceptives. Transdermal (patch) and transvaginal (intravaginal ring) contraceptive devices contain ethinyl estradiol (EE); thus caution should be used on a theoretical basis with ARVs that increase the serum estradiol levels. DMPA (Depo-Provera) is a progestin; thus, its interactions with ARVs may mirror those of norethindrone (NE). This may be cause for concern if DMPA is used with ARVs that increase NE levels, because DMPA is long-acting and has sustained serum levels.

There are no significant known interactions between hormonal contraceptives and NRTIs, integrase inhibitors, or CCR5 antagonists.

Decreased EE or NE levels
PIs:
  • ATV/r
  • DRV/r
  • LPV/r
  • NFV
  • RTV
  • TPV/r
Risk of contraceptive failure; use alternative (or additional) contraceptive method

(If oral contraceptive used with ATV/r, it should contain ≥35 mcg of EE.)
NNRTIs:
  • NVP
Risk of contraceptive failure; use alternative (or additional) contraceptive method.
Increased EE or NE levels
PIs (without RTV):
  • ATV
  • FPV
  • IDV
  • ATV: Risk of EE or NE adverse effects (eg, deep vein thrombosis). Use alternative method of contraception or lowest effective dosage with careful monitoring for adverse effects. If given concurrently, oral contraceptive should contain ≤30 mcg of EE; however, doses <25 mcg have not been studied.
  • FPV: Risk of EE or NE adverse effects; also, ↓ FPV levels; avoid, or use lowest effective dosage of EE/NE with careful monitoring for adverse effects and for ARV efficacy.
  • IDV: No dosage adjustment.
NNRTIs:
  • EFV
Risk of EE or NE adverse effects; alternative contraceptive method is recommended.
No data
PIs:
  • SQV
Alternative method of contraception is recommended.
Mixed effects
NNRTIs:
  • ETR
↑ EE, ↓ NE; no dosage adjustment.

From Women's Health
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009