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Mirena (Levonorgestrel Intrauterine) - Drug Interactions, Contraindications, Overdosage, etc



Drugs or herbal products that induce enzymes, including CYP3A4, that metabolize progestins may decrease the serum concentrations of progestins.

Some drugs or herbal products that may decrease the serum concentration of levonorgestrel include:

  • •barbiturates
  • •bosentan
  • •carbamazepine
  • •felbamate
  • •griseofulvin
  • •oxcarbazepine
  • •phenytoin
  • •rifampin
  • •St. John’s wort
  • •topiramate.

Significant changes (increase or decrease) in the serum concentrations of the progestin have been noted in some cases of co-administration with HIV protease inhibitors or with non-nucleoside reverse transcriptase inhibitors.

Consult the labeling of all concurrently used drugs to obtain further information about interactions with Mirena or the potential for enzyme alterations.


The use of Mirena is contraindicated when one or more of the following conditions exist:

  • •Pregnancy or suspicion of pregnancy
  • •Congenital or acquired uterine anomaly including fibroids if they distort the uterine cavity
  • •Acute pelvic inflammatory disease or a history of pelvic inflammatory disease unless there has been a subsequent intrauterine pregnancy
  • •Postpartum endometritis or infected abortion in the past 3 months
  • •Known or suspected uterine or cervical neoplasia or unresolved, abnormal Pap smear
  • •Genital bleeding of unknown etiology
  • •Untreated acute cervicitis or vaginitis, including bacterial vaginosis or other lower genital tract infections until infection is controlled
  • •Acute liver disease or liver tumor (benign or malignant)
  • •Conditions associated with increased susceptibility to pelvic infections
  • •A previously inserted IUD that has not been removed
  • •Hypersensitivity to any component of this product
  • •Known or suspected carcinoma of the breast.


1Nilsson CG, Haukkamaa M, Vierola H, Luukkainen T. Tissue Concentrations of Levonorgestrel in Women Using a Levonorgestrel-releasing IUD. Clinical Endocrinol 1982;17:529-536.

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