Anticonvulsants

• For women taking anticonvulsants, see Epilepsy.

Antibiotics

• No contraceptive reduces the antibiotic effect but in certain circumstances the contraceptive effect is reduced.
• For women taking antibiotics that induce liver enzymes (rifampicin and rifabutin):
• Methods that can be used without restriction: depot medroxyprogesterone, copper intrauterine devices (IUDs), the levonorgestrel-releasing intrauterine system (IUS), barrier methods, and natural family planning methods.
• Methods that generally can be used (advantages generally outweigh the risks): progestogen-only implant or depot norethisterone enantate (the consistent use of condoms is also recommended).
• Methods that should not usually be used (risks usually outweigh the benefits): combined oral contraceptives (COCs), combined contraceptive patch, combined contraceptive vaginal ring, progestogen-only pill.
• For women taking antibiotics that do not induce liver enzymes:
• Methods that can be used without restriction: progestogen-only pill, progestogen-only injectables and implants, copper IUDs, the levonorgestrel-releasing IUS, and barrier methods.
• Methods that generally can be used (advantages generally outweigh the risks): COCs, combined contraceptive patch, and combined contraceptive vaginal ring.
• Additional protection (such as condoms) should be used for the first three weeks of a long antibiotic course, and during a short antibiotic course and for up to 7 days after stopping it.
• Note: the combined contraceptive vaginal ring can be used with amoxicillin and doxycyline without the need for additional barrier contraception.
• There are no methods that should not be used.

Antifungals

• Women taking fluconazole, itraconazole, and ketoconazole, and griseofulvin: all methods can be used without restriction. Note: antifungal pessaries may increase the risk of ring breakage if used with a combined contraceptive vaginal ring.

Antiparasitics

• All methods can be used without restriction.

Antiretroviral therapy

• Antiretroviral drugs have the potential to either decrease or increase the bioavailability of steroid hormones in hormonal contraceptives. These interactions may alter the safety and effectiveness of the hormonal contraceptive and the antiretroviral drug. Consider consulting a specialist as advances in knowledge are rapid in this area.
• If a woman on antiretroviral therapy decides to start or continue a hormonal contraceptive, the consistent use of condoms is recommended to prevent HIV transmission and to compensate for potential reductions in the effectiveness of the hormonal contraceptive.
• Nucleoside reverse transcriptase inhibitors:
• Methods that can be used without restriction: COCs, combined contraceptive patch, combined contraceptive vaginal ring, progestogen-only pill, depot medroxyprogesterone, and progestogen-only implants.
• Methods that generally can be used (advantages generally outweigh the risks): copper IUDs and the levonorgestrel-releasing IUS can be inserted or continued if the woman is clinically well on antiretroviral therapy. However, if the woman is not clinically well, a copper IUD or the levonorgestrel-releasing IUS should not usually be inserted (the risks usually outweigh the advantages). Depot norethisterone enantate can generally be used.
• Non-nucleoside reverse transcriptase inhibitors:
• Methods that can be used without restriction: depot medroxyprogesterone.
• Methods that generally can be used (advantages generally outweigh the risks): COCs, combined contraceptive patch, combined contraceptive vaginal ring, progestogen-only pill, progestogen-only implants, depot norethisterone enantate. Copper IUDs and the levonorgestrel-releasing IUS can be inserted or continued if the woman is clinically well on antiretroviral therapy. However, if the woman is not clinically well, a copper IUD or the levonorgestrel-releasing IUS should not usually be inserted (the risks usually outweigh the advantages).
• Ritonavir-boosted protease inhibitors:
• Methods that can be used without restriction: depot medroxyprogesterone.
• Methods that generally can be used (advantages generally outweigh the risks): progestogen-only implants, depot norethisterone enantate. Copper IUDs and the levonorgestrel-releasing IUS can be inserted or continued if the woman is clinically well on antiretroviral therapy. However, if the woman is not clinically well, a copper IUD or the levonorgestrel-releasing IUS should not usually be inserted (the risks usually outweigh the advantages).
• Methods that should not usually be used (risks usually outweigh the benefits): combined oral contraceptives (COCs), combined contraceptive patch, combined contraceptive vaginal ring, and progestogen-only pills.
• Sterilization can be done with extra precautions, and the procedure may need to be delayed if the woman has an AIDS-related illness. The consistent use of condoms is recommended after sterilization.

St John's wort

• Methods that can be used without restriction: progestogen-only injectables, copper IUDs, levonorgestrel-releasing IUS, barrier methods, natural family planning methods, and sterilization.
• Methods that should not usually be used (risks usually outweigh the benefits): COCs, combined contraceptive patch, combined contraceptive vaginal ring, progestogen-only pill, and progestogen-only implants.

In depth