Table 1. Effects of Coadministration of Antiretroviral Therapy and Combined Oral Contraceptives

Antiretroviral Agent

Overall Effect or Recommendation

NRTIs

No effect

NNRTIs

 

  • [drug: Efavirenz]

Progestin levels markedly decreased

Effectiveness of emergency contraception may be diminished

Barrier method should be used in addition to this method

  • [Etravirine]

No dose adjustment needed

No additional contraceptive protection needed

  • [Nevirapine]

No dose adjustment needed

No additional contraceptive protection needed

  • [Rilpivirine]

No dose adjustment needed

No additional contraceptive protection needed

PIs

 

  • [Atazanavir]

COC should contain no more than 30 µg of ethinyl estradiol

No additional contraceptive protection needed

  • [drug: Atazanavir/cobicistat]

Decreases in ethinyl estradiol and marked increases in [drug: drospirenone] progestin

Contraindicated with [drug: drospirenone]-containing hormonal contraceptive due to potential for hyperkalemia

Consider alternative or additional contraceptive method

  • [Atazanavir]/[ritonavir]

[drug: Ritonavir] inhibits CYP3A4, which may increase contraceptive hormone levels

No additional contraceptive protection needed

  • [drug: Cobicistat-darunavir:Cobicistat/darunavir]

Decreases in ethinyl estradiol and marked increases in [drug: drospirenone] progestin

Clinical monitoring recommended with [drug: drospirenone]-containing hormonal contraceptive due to potential for hyperkalemia

Consider alternative or additional contraceptive method

  • [Darunavir]/[ritonavir]

Small decrease in progestin levels

Additional or alternative method recommended

  • [Fosamprenavir]

Reduced amprenavir levels when fosamprenavir coadministered with ethinyl estradiol/norethindrone; may lead to loss of virologic response

Use alternative contraceptive method

  • [drug: Fosamprenavir]/[drug: ritonavir]

Additional or alternative method recommended

  • [Drug: Indinavir]

Small increases in ethinyl estradiol and progestin

No additional contraceptive protection needed

  • [Lopinavir/ritonavir]

Decreases in ethinyl estradiol and progestin

No additional contraceptive protection needed

  • [Nelfinavir]

Decrease in ethinyl estradiol

Additional or alternative method recommended

  • [Drug: Saquinavir]/[drug: ritonavir]

Decrease in ethinyl estradiol

Additional or alternative method recommended

  • [Drug: Tipranavir]/[drug: ritonavir]

Decrease in ethinyl estradiol

Additional or alternative method recommended

Integrase Inhibitors

 

  • [Raltegravir]

No additional contraceptive protection needed

  • Cobicistat/elvitegravir

Ethinyl estradiol levels decreased

Progestin levels increased

No additional contraceptive protection needed

  • [drug: Dolutegravir]

No additional contraceptive protection needed

CCR5 Antagonist

 

  • [drug: Maraviroc]

No additional contraceptive protection needed

COC, combined oral contraceptives; DMPA, depot medroxyprogesterone acetate.