Drospirenone, Ethinyl Estradiol And Levomefolate Calcium And Levomefolate Calcium

May increase plasma ethinyl estradiol concentrations, possibly through inhibition of conjugation.

May increase plasma ethinyl estradiol concentrations, possibly through inhibition of conjugation.

Co-administration increases ethinyl estradiol AUC by approximately 20%.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

Concomitant administration of moderate or strong CYP3A4 inhibitors such as azole antifungals (e.g., ketoconazole, itraconazole, voriconazole, fluconazole), verapamil, macrolides (e.g., clarithromycin, erythromycin), diltiazem, and grapefruit juice can increase the plasma concentrations of the estrogen or the progestin or both.

Moderate or strong CYP3A4 inhibitor that can increase plasma concentrations of estrogen or progestin or both.

Concomitant administration of moderate or strong CYP3A4 inhibitors such as azole antifungals (e.g., ketoconazole, itraconazole, voriconazole, fluconazole), verapamil, macrolides (e.g., clarithromycin, erythromycin), diltiazem, and grapefruit juice can increase the plasma concentrations of the estrogen or the progestin or both.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

Concomitant administration of moderate or strong CYP3A4 inhibitors such as azole antifungals (e.g., ketoconazole, itraconazole, voriconazole, fluconazole), verapamil, macrolides (e.g., clarithromycin, erythromycin), diltiazem, and grapefruit juice can increase the plasma concentrations of the estrogen or the progestin or both.

CYP3A4 inhibitor that can increase plasma concentrations of estrogen or progestin or both.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

Concomitant administration of moderate or strong CYP3A4 inhibitors such as azole antifungals (e.g., ketoconazole, itraconazole, voriconazole, fluconazole), verapamil, macrolides (e.g., clarithromycin, erythromycin), diltiazem, and grapefruit juice can increase the plasma concentrations of the estrogen or the progestin or both.

Concomitant administration of moderate or strong CYP3A4 inhibitors such as azole antifungals (e.g., ketoconazole, itraconazole, voriconazole, fluconazole), verapamil, macrolides (e.g., clarithromycin, erythromycin), diltiazem, and grapefruit juice can increase the plasma concentrations of the estrogen or the progestin or both. In a clinical drug-drug interaction study conducted in premenopausal women, once daily co-administration of DRSP 3 mg/EE 0.02 mg containing tablets with strong CYP3A4 inhibitor, ketoconazole 200 mg twice daily for 10 days resulted in a moderate increase of DRSP systemic exposure.

Significant changes (increase or decrease) in plasma concentrations of estrogen and progestin have been noted in some cases.

COCs Increasing the Plasma Concentrations of CYP450 Enzymes : In clinical studies, administration of a hormonal contraceptive containing EE did not lead to any increase or only to a weak increase in plasma concentrations of CYP3A4 substrates (e.g., midazolam) while plasma concentrations of CYP2C19 substrates (e.g., omeprazole and voriconazole) and CYP1A2 substrates (e.g., theophylline and tizanidine) can have a weak or moderate increase.

COCs Increasing the Plasma Concentrations of CYP450 Enzymes : In clinical studies, administration of a hormonal contraceptive containing EE did not lead to any increase or only to a weak increase in plasma concentrations of CYP3A4 substrates (e.g., midazolam) while plasma concentrations of CYP2C19 substrates (e.g., omeprazole and voriconazole) and CYP1A2 substrates (e.g., theophylline and tizanidine) can have a weak or moderate increase.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

Significant changes (increase or decrease) in plasma concentrations of estrogen and progestin have been noted in some cases.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

Moderate or strong CYP3A4 inhibitor that can increase plasma concentrations of estrogen or progestin or both.

Concomitant administration of moderate or strong CYP3A4 inhibitors such as azole antifungals (e.g., ketoconazole, itraconazole, voriconazole, fluconazole), verapamil, macrolides (e.g., clarithromycin, erythromycin), diltiazem, and grapefruit juice can increase the plasma concentrations of the estrogen or the progestin or both. COCs Increasing the Plasma Concentrations of CYP450 Enzymes : In clinical studies, administration of a hormonal contraceptive containing EE did not lead to any increase or only to a weak increase in plasma concentrations of CYP3A4 substrates (e.g., midazolam) while plasma concentrations of CYP2C19 substrates (e.g., omeprazole and voriconazole) and CYP1A2 substrates (e.g., theophylline and tizanidine) can have a weak or moderate increase.

DRSP causes an increase in plasma renin activity and plasma aldosterone induced by its mild anti-mineralocorticoid activity.

7.3 Concomitant Use of HCV Combination Therapy – Liver Enzyme Elevation Do not co-administer Tydemy with HCV drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, due to potential for ALT elevations [see Warnings and Precautions ( 5.5 )] .

7.3 Concomitant Use of HCV Combination Therapy – Liver Enzyme Elevation Do not co-administer Tydemy with HCV drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, due to potential for ALT elevations [see Warnings and Precautions ( 5.5 )] .

7.3 Concomitant Use of HCV Combination Therapy – Liver Enzyme Elevation Do not co-administer Tydemy with HCV drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, due to potential for ALT elevations [see Warnings and Precautions ( 5.5 )] .

7.3 Concomitant Use of HCV Combination Therapy – Liver Enzyme Elevation Do not co-administer Tydemy with HCV drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, due to potential for ALT elevations [see Warnings and Precautions ( 5.5 )] .