World Health Organization medical eligibility for contraceptive use: Drug interactions

Condition	COC	CIC	P/R	POP	DMPA NET-EN	LNG/ETG Implants	Cu-IUD	LNG-IUD
Drugs which affect liver enzymes
Rifampicin or rifabutin	3	2	3	3	DMPA 1 NET-EN 2	2	1	1
Certain antiseizure medications (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)	3	2	3	3	DMPA 1 NET-EN 2	2	1	1
Lamotrigine	3	3	3	1	1	1	1	1
Antimicrobials (excluding rifampicin)
Broad spectrum antibiotics	1	1	1	1	1	1	1	1
Antifungals and Antiparasites	1	1	1	1	1	1	1	1
Antiretroviral therapy
Nucleoside reverse transcriptase inhibitors	1	1	1	1	DMPA 1 NET-EN 1	1	Initiation: 2/3 Continuation: 2	Initiation: 2/3 Continuation: 2
Non-nucleoside reverse transcriptase inhibitors	2	2	2	2	DMPA 1 NET-EN 2	2	Initiation: 2/3 Continuation: 2	Initiation: 2/3 Continuation: 2
Ritonavir-boosted protease inhibitors	3	3	3	3	DMPA 1 NET-EN 2	2	Initiation: 2/3 Continuation: 2	Initiation: 2/3 Continuation: 2

WHO comments: Although the interaction of rifampicin or rifabutin with POPs, NET-EN and LNG/ETG implants is not harmful to women, it is likely to reduce the effectiveness of POPs, NET-EN and LNG/ETG implants. Use of other contraceptives should be encouraged for women who are long-term users of any of these drugs.Whether increasing the hormone dose of POPs alleviates this concern remains unclear.
Use of DMPA is a Category 1 because its effectiveness is not decreased by the use of rifampicin or rifabutin.

1: A condition for which there is no restriction for the use of the contraceptive method.
2: A condition where the advantages of using the method generally outweigh the theoretical or proven risks.
3: A condition where the theoretical or proven risks usually outweigh the advantages of using the method.
4: A condition which represents an unacceptable health risk if the contraceptive method is used.
COC: low-dose combined oral contraceptive; CIC: combined injectable contraceptives; P: combined patch; R: combined vaginal ring; POP: progestogen-only pill; DMPA: depot medroxyprogesterone acetate; NET-EN: norethisterone enantate; LNG: levonorgestrel; ETG: etonogestrel; ECP: emergency contraceptive pill; Cu-IUD: copper intrauterine device; LNG-IUD: levonorgestrel-releasing IUDs; E-IUD: copper-IUD for emergency contraception; BARR: barrier methods; FAB: fertility awareness-based methods; LAM: lactational amenorrhoea method; CI: coitus interruptus; STER: female and male sterilization.

Reproduced with permission from: Medical Eligibility Criteria for Contraceptive Use - 3rd Ed. Available at: http://www.who.int/reproductive-health/publications/mec/summary.html. Copyright ©2006 World Health Organization. Revised from: Medical Eligibility Criteria for Contraceptive Use, 2008 update. Available at: http://www.who.int/reproductive-health/publications/mec/.

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World Health Organization medical eligibility for contraceptive use: Drug interactions