Sexual Health Birth Control Prescription Options Print 10 Medications That Decrease Your Hormonal Contraception Effectiveness These Drugs Can Cause Pill Failure By Dawn Stacey, PhD, LMHC Updated July 23, 2019 Medically reviewed by Lyndsey Garbi More in Birth Control Prescription Options How to Choose Contraception Using the Pill Over-the-Counter Types of IUDs Hormonal Methods Permanent Methods Emergency Contraception Condoms When Birth Control Fails Talking About Birth Control View All If you're on hormonal contraception, including oral contraceptives (birth control pills), NuvaRing, or the Ortho Evra patch, you should be aware that certain medications and supplements can increase the chances of contraception failure. These medications may make hormonal birth control less effective because they increase the metabolism of hormones. This means that the hormones may be broken down too quickly by your body, thus lowering the number of hormones necessary for 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 previous beliefs that many antibiotics may interfere with the effectiveness of hormonal birth control, the only one that has been proven to cause problems is Rifadin/Rimactane (rifampin), which is used to treat tuberculosis or 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 when you're on other kinds of antibiotics as well, just to be safe. 2 Anti-HIV Medications Shidlovski/Getty Images Efavirenz, cobicistat, and rifamin—as well as protease inhibitors including darunavir. nevirapine, nelfinavir, and ritonavir—are drugs that are used to treat human immunodeficiency virus (HIV) infection. If you are using these or another medication for the treatment of the HIV virus or AIDS, ask your healthcare provider if your specific medication will decrease the effectiveness of your birth control pill or other combination hormone contraceptives. 3 Anticonvulsants Hailshadow/Getty Images Barbiturate medicines for producing sleep, controlling anxiety, or treating seizures (convulsions) could interfere with the effectiveness of the birth control pill. Examples of these types of medications include: Felbatol (felbamate)Lamictal (lamotrigine)Luminal, Solfoton (phenobarbital)Mysoline (primidone) The following medications can also help with seizure (convulsion) control in certain types of epilepsy and also treat nerve-related pain. Additionally, Topamax (topiramate) may also be prescribed to help prevent migraine headaches. These medications may also lower the pill, NuvaRing, or the patch's effectiveness: Trileptal (oxcarbazepine)Tegretol, Carbatrol, Equetro, Epitol (carbamazepine)Dilantin, Phenytek (phenytoin)Topamax (topiramate) The World Health Organization (WHO) recommends that women taking anticonvulsants not use hormonal contraception, with the exception of Depo-Provera (medroxyprogesterone acetate). Talk to your doctor about the risks. 4 Antidepressants stevanovicigor/Getty Images Some medicines prescribed for depression can theoretically alter hormone levels. Antidepressants may lower the number of hormones (estrogen and/or progestin) circulating in your body, which can compromise the pill's effectiveness. This can vary significantly from woman to woman, so a decrease in the number of circulating hormones may equal a bigger drop in the pill's effectiveness for some women than for others. On the flip slide, research has also suggested that the estrogen in the pill may decrease the effectiveness of the antidepressant. To avoid any possible drug interactions, make sure you talk to your doctor if you're currently being treated with a specific antidepressant and you're also using a combination birth control method. 5 Antifungal Medications Sinhyu/Getty Images Anti-fungal medications may also lower the effectiveness of the pill. The two types that are problematic include: 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 If you are using one of these types of medications, talk to your healthcare provider about the potential of decreasing the effectiveness of the pill, ring, or patch. You may need to use a backup birth control 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 Ask your health care provider if your specific anti-anxiety medication will decrease the effectiveness of the pill. Certain medicines used to treat anxiety, muscle spasms, or sleeping problems, such as Valium, Diastat (diazepam), or Restoril (temazepam) may potentially interfere with successful combination contraceptive use. 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 if it's taken during pregnancy. This is such a concern that women taking this medication must have a negative pregnancy test before starting it, as well as each month during treatment with this drug. 9 Natural Supplements Steve Gorton/Getty Images In addition to prescription medications, certain supplements have been shown to lower the effectiveness of hormonal contraception. These include: 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 herb or dietary supplement that is promoted for its ability to improve mildly depressed moods 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. Although not a medication, excessive vomiting and/or diarrhea may 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 healthcare provider for advice. Understand How Your Contraceptive Works If you have any questions about birth control methods or potential interactions with other medications, contact your healthcare provider. 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. Email Address Sign Up There was an error. Please try again. Thank you, , for signing up. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources 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 Bolt HM. Interactions between clinically used drugs and oral contraceptives. Environ Health Perspect. 1994;102 Suppl 9:35-8. doi:10.1289/ehp.94102s935 Rosenfeld WE, Doose DR, Walker SA, Nayak RK. Effect of topiramate on the pharmacokinetics of an oral contraceptive containing norethindrone and ethinyl estradiol in patients with epilepsy. Epilepsia. 1997;38(3):317-23. D'arcy PF. Drug interactions with oral contraceptives. Drug Intell Clin Pharm. 1986;20(5):353-62. doi:10.2165/00003088-199936050-00001 Oral contraceptives and drug interactions. Patient guide. Female Patient. 1992;17(4):107-8. Van giersbergen PL, Halabi A, Dingemanse J. Pharmacokinetic interaction between bosentan and the oral contraceptives norethisterone and ethinyl estradiol. Int J Clin Pharmacol Ther. 2006;44(3):113-8. doi:10.5414/cpp44113 DailyMed - BOSENTAN- bosentan tablet, film coated. U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=dc117215-2304-41c1-ad3c-31d5e1029657 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.