Sexual Health Birth Control Prescription Options Medications That Decrease Contraception Effectiveness These Drugs Can Cause Pill Failure By Dawn Stacey, PhD, LMHC twitter linkedin Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience. Learn about our editorial process Dawn Stacey, PhD, LMHC Medically reviewed by Medically reviewed by Lyndsey Garbi, MD on July 18, 2019 linkedin Lyndsey Garbi, MD, is a pediatrician who is double board-certified in pediatrics and neonatology. Learn about our Medical Review Board Lyndsey Garbi, MD Updated on January 08, 2020 Print If you are using hormonal contraception, including oral contraceptives (birth control pills), NuvaRing, or the Ortho Evra patch, you should know that other medications and supplements you take could increase the risk of contraceptive failure. Some medications can make hormonal birth control less effective because they increase the metabolism of hormones. When the body breaks down hormones too quickly, it lowers the number of circulating hormones that are needed to provide effective pregnancy protection. Here are 10 medications that can lower the effectiveness of your hormonal birth control. 1 Antibiotics Jaromir Chalabala / EyeEm/Getty Images Despite long-held beliefs that all antibiotics interfere with the effectiveness of hormonal birth control, the only antibiotic drug that has been proven to do so is Rifadin/Rimactane (rifampin). It's commonly used to treat tuberculosis and meningitis. Rifampin may decrease the effectiveness of NuvaRing and the patch as well. If you're on birth control pills, the patch, or NuvaRing and your doctor prescribes rifampin, you will need to use a backup method of birth control such as condoms or a diaphragm. Your doctor may recommend a backup method if you're taking other antibiotics, just to be safe. 2 Anti-HIV Medications Shidlovski/Getty Images Drugs that are used to treat human immunodeficiency virus (HIV) infection, such as efavirenz, cobicistat, and rifampin, may interact with birth control. A class of drugs called protease inhibitors, which includes darunavir, nevirapine, nelfinavir, and ritonavir, may also interact with hormonal contraceptives. If you are taking medication for HIV/AIDS, ask your doctor if your treatment could have an effect on your chosen birth control method. 3 Anticonvulsants Hailshadow/Getty Images Barbiturate medicines for sleep, controlling anxiety, or treating seizures may interfere with the effectiveness of the birth control pill. Examples of barbiturates include: Felbatol (felbamate)Lamictal (lamotrigine)Luminal, Solfoton (phenobarbital)Mysoline (primidone) Medications prescribed to control seizures in certain types of epilepsy and treat nerve-related pain, as well as Topamax (topiramate), which is prescribed to prevent migraine headaches, may also affect birth control. Other medications that may also lower the effectiveness of the pill, NuvaRing, or the patch include: Trileptal (oxcarbazepine)Tegretol, Carbatrol, Equetro, Epitol (carbamazepine)Dilantin, Phenytek (phenytoin)Topamax (topiramate) While most women can take lower-estrogen birth control without compromising effectiveness, the World Health Organization (WHO) recommends that women taking anticonvulsants do not use hormonal contraception that has less than 30 micrograms (mcg) of estrogen. Some women taking these medications may also consider Depo-Provera (medroxyprogesterone acetate) or an intrauterine device, such as Mirena. 4 Antidepressants stevanovicigor/Getty Images Some medications prescribed for depression can theoretically alter hormone levels. Antidepressants may lower the number of circulating hormones in the body, which can compromise the pill's effectiveness. However, the effect varies significantly from one person to the next. A decrease in the number of circulating hormones may amount to a bigger drop in the pill's effectiveness for some people, but not in others. If you're taking an antidepressant and you're concerned about an interaction with your birth control, talk to your doctor. 5 Antifungal Medications Sinhyu/Getty Images Anti-fungal medications may also lower the effectiveness of the pill, though the World Health Organization states that women taking hormonal contraception should be able to safely use these medications. Antifungal medications that have been associated with contraceptive failure are: The oral suspension Mycostatin, Nilstat, Nystex (nystatin), which is used to treat yeast infectionsFulvicin, Grifulvin V, Gris-Peg, Grisactin (griseofulvin), which is used to treat fungus infections of the skin, hair, scalp, and nails, as well as ringworm, jock itch, and athlete's foot Make sure that your doctor knows if you are taking these medications. They can discuss the potential for decreased effectiveness of your current birth control and help you choose a backup method. 6 Diabetes Medications simpson33/Getty Images Some of the medications for diabetes, including Actos (pioglitazone) and Avandia (rosiglitazone), may interact with birth control pills. Make sure to discuss these types of medications with your healthcare provider to see if they will affect the use of your oral contraceptives. 7 Anxiety Treatments BSIP/UIG/Getty Images While the research is ongoing, certain medicines used to treat anxiety, muscle spasms, and sleeping problems, such as Valium, Diastat (diazepam), or Restoril (temazepam) may potentially interfere with successful combination contraceptive use. Ask your healthcare provider if your specific anti-anxiety medication will decrease the effectiveness of the pill. 8 Pulmonary Hypertension Treatments Srisakorn/Getty Images Tracleer (bosentan) is a dual endothelin receptor antagonist used to treat people with certain types of pulmonary arterial hypertension (PAH)—which is high blood pressure in the vessels of the lungs. Tracleer has been shown to decrease hormone concentrations in the bloodstream which can put you at more at risk for getting pregnant. Birth control pills, shots, patches, and implants should not be used alone because they are not reliable when using Tracleer. You must choose and use two reliable forms of birth control at the same time. If you have had a tubal sterilization or you have an IUD, these methods can be used alone. Tracleer can cause serious birth defects. Before starting the medication, a woman must have a negative pregnancy test and must continue to be tested for pregnancy for each month of treatment with Tracleer. 9 Natural Supplements Steve Gorton/Getty Images In addition to prescription medications, certain supplements have been shown to lower the effectiveness of hormonal contraception. Soy isoflavones: Natural substances obtained from the soybean plant which claim to reduce the intensity of menopause-related hot flashes and to help maintain strong bonesSt. John's wort: An herbal or dietary supplement that is promoted for its ability to improve mildly depressed mood 10 Anti-Nausea Medications Tom Merton/Getty Images Emend (aprepitant), which is used to prevent or treat nausea and vomiting can also interfere with oral contraceptive effectiveness. While it's not a medication, excessive vomiting and/or diarrhea can also lower the effectiveness of the pill. If you are experiencing these symptoms or taking Emend, use an additional method of birth control and contact your health care provider for advice. Understand How Your Contraceptive Works If you have any questions about birth control methods or potential interactions with other medications, talk to your doctor. You will lower your chances of birth control failure if you have a proper and thorough understanding of how to use your contraceptive. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Lee CR. Drug Interactions and Hormonal Contraception. Trends in Urology, Gynaecology & Sexual Health. 2009;14(3):23-26. doi:10.1002/tre.107 Simmons KB, Haddad LB, Nanda K, Curtis KM. Drug interactions between non-rifamycin antibiotics and hormonal contraception: a systematic review. Am J Obstet Gynecol. 2018;218(1):88-97.e14. doi:10.1016/j.ajog.2017.07.003 Nanda K, Stuart GS, Robinson J, Gray AL, Tepper NK, Gaffield ME. Drug interactions between hormonal contraceptives and antiretrovirals. AIDS. 2017;31(7):917-952. doi:10.1097/QAD.0000000000001392 Centers for Disease Control and Prevention (CDC). Combined Hormonal Contraceptives - USMEC - Reproductive Health. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. Updated June 2017. U.S. Food and Drug Administration (FDA). Topamax Medication Guide (PDF). Updated March 2014. Bonnema R, McNamara M, Spencer A. Contraception Choices In Women With Underlying Medical Conditions. Am Fam Physician. 2010 Sep 15;82(6):621-628. Berry-Bibee EN, Kim M-J, Simmons KB, et al. Drug interactions between hormonal contraceptives and psychotropic drugs: a systematic review. Contraception. 2016;94(6):650-667. doi:10.1016/j.contraception.2016.07.011 Department of Reproductive Health, World Health Organization (WHO). Medical Eligibility Criteria for Contraceptive Use Fifth Edition - Executive Summary.; 2015. May M, Schindler C. Clinically and pharmacologically relevant interactions of antidiabetic drugs. Ther Adv Endocrinol Metab. 2016;7(2):69–83. doi:10.1177/2042018816638050 U.S. Food And Drug Administration (FDA). Tracleer (Bosentan): Highlights of Prescribing Information (PDF). Updated September 2017. U.S. National Library of Medicine. DailyMed - BOSENTAN- bosentan tablet, film-coated. Updated June 2019. Murphy PA, Kern SE, Stanczyk FZ, Westhoff CL. Interaction of St. John's Wort with oral contraceptives: effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding. Contraception. 2005;71(6):402-8. doi:10.1016/j.contraception.2004.11.004 Bailard N, Rebello E. Aprepitant and fosaprepitant decrease the effectiveness of hormonal contraceptives. Br J Clin Pharmacol. 2018;84(3):602-603. doi:10.1111/bcp.13472 Additional Reading Lee CR. Drug Interactions and Hormonal Contraception. Trends in Urology, Gynaecology & Sexual Health. 2009;14(3):23-26. doi:10.1002/tre.107. Martin KA, Barbieri RL. Overview of the Use of Estrogen-Progestin Contraceptives. UpToDate. Updated August 17, 2016. Medline Plus. Estrogen and Progestin (Oral Contraceptives). U.S. National Library of Medicine. Updated September 15, 2015. Medline Plus. Bosentan. U.S. National Library of Medicine. Updated March 15, 2017.