Sexual Health Birth Control Prescription Options Medications That Decrease Contraception Effectiveness These Drugs Can Cause Pill Failure By Dawn Stacey, PhD, LMHC Dawn Stacey, PhD, LMHC LinkedIn Twitter 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 Updated on September 08, 2021 Medically reviewed by Mary Choy, PharmD Medically reviewed by Mary Choy, PharmD on July 21, 2021 LinkedIn Twitter Mary Choy, PharmD, is board-certified in geriatric pharmacotherapy. She currently serves as the director of pharmacy practice of the New York State Council of Health-System Pharmacists. Learn about our Medical Review Board 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 can interfere with these treatments and put you at risk of getting pregnant. Some medications can make hormonal birth control less effective by increasing hormone metabolism. When the body breaks down hormones too quickly, the remaining circulating hormones might not be enough to provide effective pregnancy protection. Here are 10 types of 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. If you're on birth control pills, the patch, or NuvaRing and your healthcare provider prescribes rifampin, you will need to use a backup method of non-hormonal birth control such as condoms or a diaphragm. A typical course of tuberculosis treatment will be around 6-9 months. Your healthcare provider may also 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 healthcare provider if your treatment could have an effect on the effectiveness of your birth control. 3 Anticonvulsants Hailshadow/Getty Images Barbiturate medicines that are prescribed for treating insomnia, controlling anxiety, or treating seizures may interfere with the effectiveness of the birth control pill. Examples of barbiturates and medications that have barbiturate actions include: Felbatol (felbamate) Lamictal (lamotrigine) Luminal, Solfoton (phenobarbital) Mysoline (primidone) Other anti-epilepsy 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) 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 consider using Depo-Provera (medroxyprogesterone acetate) or an intrauterine device, such as Mirena. 4 Antidepressants stevanovicigor/Getty Images Some medications prescribed for treating depression may alter hormone levels, 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 potential interactions with your birth control, talk to your healthcare provider. 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 infections Fulvicin, 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 healthcare provider 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 used for treating diabetes, including Actos (pioglitazone) and Avandia (rosiglitazone), may interact with birth control pills. Make sure to discuss your medications with your healthcare provider to see if they will interact with 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 the effectiveness of combination contraceptives. Ask your healthcare provider if your 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 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 risk of getting pregnant when you are using hormonal birth control. Birth control pills, shots, patches, and implants are not reliable when using Tracleer. If you have had a tubal sterilization or you have an IUD, you would not be at risk of becoming pregnant. Tracleer can cause serious birth defects. Before starting the medication, a woman must have a negative pregnancy test and must have repeat pregnancy tests before 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: These natural substances obtained from the soybean plant have been used to reduce the intensity of menopause-related hot flashes and to help maintain strong bones.St. John's wort: This herbal or dietary supplement is promoted for improving mildly depressed mood and as a sleep aid. 10 Anti-Nausea Medications Tom Merton/Getty Images Emend (aprepitant), which is used to prevent or treat nausea and vomiting can interfere with the effectiveness of oral contraceptives. Understand How Your Contraceptive Works Excessive vomiting and/or diarrhea can also lower the effectiveness of the pill. If you are experiencing these symptoms, contact your healthcare provider for advice about additional methods of birth control. If you have any questions about birth control methods or potential interactions with other medications, talk to 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. 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 13 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 May 2019. 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.