Nuvaring (Etonogestrel / Ethinyl Estradiol Vaginal Ring) - Drug Interactions, Contraindications, Overdosage, etc

DRUG INTERACTIONS

10. DRUG INTERACTIONS

Changes in contraceptive effectiveness associated with co-administration of other drugs:

a. Anti-infective agents and anticonvulsants

Contraceptive effectiveness may be reduced when hormonal contraceptives are co-administered with some antifungals, anticonvulsants, and other drugs that increase metabolism of contraceptive steroids. This could result in unintended pregnancy or breakthrough bleeding. Examples include barbiturates, griseofulvin, rifampin, phenylbutazone, phenytoin, carbamazepine, felbamate, oxcarbazepine, topiramate, and modafinil. Women may need to use an additional contraceptive method when taking such medications.

b. Anti-HIV protease inhibitors

Several of the anti-HIV protease inhibitors have been studied with co-administration of oral combination hormonal contraceptives; significant changes (increases and decreases) in the plasma levels of the estrogen and progestin have been noted in some cases. The efficacy and safety of hormonal contraceptive products may be affected with co-administration of anti-HIV protease inhibitors. Healthcare providers should refer to the label of the individual anti-HIV protease inhibitors for further drug-drug interaction information.

c. Herbal products

Herbal products containing St. John’s Wort (hypericum perforatum) may induce hepatic enzymes (cytochrome P450) and p-glycoprotein transporter and may reduce the effectiveness of contraceptive steroids. This may also result in breakthrough bleeding.

OVERDOSAGE

Overdosage of combination hormonal contraceptives may cause nausea, vomiting, vaginal bleeding, or other menstrual irregularities. Given the nature and design of NuvaRing® it is unlikely that overdosage will occur. If NuvaRing® is broken, it does not release a higher dose of hormones. Serious ill effects have not been reported following acute ingestion of large doses of oral contraceptives by young children. There are no antidotes and further treatment should be symptomatic.

CONTRAINDICATIONS

NuvaRing® should not be used in women who currently have the following conditions:

Thrombophlebitis or thromboembolic disordersA past history of deep vein thrombophlebitis or thromboembolic disordersCerebral vascular or coronary artery disease (current or history)Valvular heart disease with thrombogenic complicationsSevere hypertensionDiabetes with vascular involvementHeadaches with focal neurological symptomsMajor surgery with prolonged immobilizationKnown or suspected carcinoma of the breast or personal history of breast cancerCarcinoma of the endometrium or other known or suspected estrogen-dependent neoplasiaUndiagnosed abnormal genital bleedingCholestatic jaundice of pregnancy or jaundice with prior hormonal contraceptive useHepatic tumors (benign or malignant) or active liver diseaseKnown or suspected pregnancyHeavy smoking (≥15 cigarettes per day) and over age 35Hypersensitivity to any of the components of NuvaRing®

REFERENCES FURNISHED UPON REQUEST