Annovera interactions: Alcohol, medications, and other factors

Annovera interactions with other medications  

Before you start treatment with Annovera, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Annovera interacts with supplements, herbs, or vitamins, see the “Annovera and other interactions” section.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Annovera. Keep in mind that this table doesn’t include all drugs that may interact with Annovera. Some of these interactions are described in detail in “Drug interactions in depth.”

When to avoid Annovera

In some cases, factors or conditions could prevent your doctor from prescribing Annovera due to the risk of harm. These are known as contraindications. The contraindications of Annovera include:

Having factors that increase the risk of blood clots

Doctors typically won’t prescribe Annovera for people with health factors that increase the risk of blood clots. This is because using Annovera may increase the risk of blood clots, and certain factors may further increase this risk.

These factors include:

• being over 35 years old and smoking cigarettes*
• having a history of blood clots in a deep vein or lung
• having certain genetic (inherited) conditions, irregular heart rhythms, or heart valve problems
• having diabetes for more than 20 years
• having both diabetes and high blood pressure, or having diabetes along with damage to your eyes, kidneys, blood vessels, or nerves
• having cerebrovascular disease or coronary artery disease
• having high blood pressure that occurs with blood vessel problems or isn’t well managed
• having migraine episodes or certain other headaches

Before using Annovera, talk with your doctor about your health history. They can help decide whether Annovera or a different type of birth control may be the right treatment option for you.

* Annovera has a boxed warning about the risk of serious cardiovascular problems with cigarette smoking. A boxed warning is the most serious warning from the FDA. For details, see “Boxed warning” at the beginning of this article.

Having liver tumors or certain liver conditions

Doctors typically won’t prescribe Annovera for people with liver tumors or certain liver problems, including acute (sudden) hepatitis or decompensated cirrhosis. This is because using Annovera may lead to rare cases of liver cancer or liver disease. Having these liver conditions may further increase these risks.

If you have liver tumors or liver disease, talk with your doctor before using Annovera. They’ll likely prescribe a different birth control option.

Having breast cancer

Doctors typically won’t prescribe Annovera for people who have had breast cancer. This is because Annovera contains hormones that may encourage the cancer to grow or come back.

If you’ve ever had breast cancer, talk with your doctor before using Annovera. They can recommend other types of birth control that do not have this risk.

Having dysfunctional uterine bleeding without a known cause

Doctors typically won’t prescribe Annovera for people with dysfunctional uterine bleeding (DUB) that does not have a known cause. With DUB, you have bleeding that occurs outside of the typical menstrual cycle.

Because Annovera may cause irregular periods as a side effect, having this condition could make it difficult to tell whether Annovera or another factor is the cause.

If you have DUB, talk with your doctor before using Annovera. They can recommend other options for birth control.

Having had an allergic reaction to Annovera or any of its ingredients

If you have had an allergic reaction to Annovera or any of its ingredients, your doctor will likely not prescribe Annovera. Using the vaginal ring could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Annovera, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Annovera.

Annovera and alcohol

There aren’t any known interactions between Annovera and alcohol. However, drinking alcohol while using the vaginal ring may worsen some of Annovera’s side effects. For example, you may have worsened headache, nausea, or vomiting.

In addition, consuming large amounts of alcohol can cause liver damage. In rare cases, Annovera may also cause liver problems as a side effect. This means that drinking large amounts of alcohol during Annovera treatment may increase the risk of liver problems.

If you have questions about drinking alcohol while using Annovera, talk with your doctor.

Drug interactions in depth

Here’s a closer look at certain drug interactions of Annovera.

Thyroid hormone drugs

Thyroid hormone drugs are prescribed for certain thyroid conditions, including underactive thyroid.

Interaction result: Taking a thyroid hormone drug while using Annovera could make the thyroid hormone drug less effective.

Interaction explained: The hormones in Annovera may increase the level of a protein in your blood that’s related to thyroid conditions. Taking a thyroid hormone drug while using Annovera could affect the thyroid hormone drug’s ability to work properly.

Examples of thyroid hormone drugs: Here are some thyroid hormone drugs that may interact with Annovera:

• desiccated thyroid (Armour Thyroid, NP Thyroid, others)
• levothyroxine (Synthroid, Unithroid, others)
• liothyronine (Cytomel)

Steps you or your doctor may take: Before using Annovera, tell your doctor if you take a thyroid hormone drug. They’ll recommend whether it’s safe to use these treatments together.

If your doctor prescribes Annovera with a thyroid hormone drug, they may give you a blood test to check the level of the thyroid protein affected. They’ll use these test results to decide whether they should adjust the dosage of your thyroid hormone drug.

To learn more about Annovera and thyroid hormone drugs, talk with your doctor or pharmacist.

Certain antifungals

Antifungals are prescribed to treat fungal infections.

Interaction result: Taking certain antifungals while using Annovera can increase the risk of Annovera’s side effects.

Interaction explained: Certain antifungals may slow down the activity of an enzyme (protein) that helps break down the hormones in Annovera. Taking these antifungals while you’re using Annovera could cause the hormones to leave your body more slowly than they should. This can raise the level of the hormones in your system, increasing your risk of side effects from Annovera.

Examples of antifungal drugs: Here are some antifungals that may interact with Annovera:

• fluconazole (Diflucan)
• itraconazole (Sporanox, Tolsura)
• ketoconazole
• miconazole (Monistat, Oravig)

Steps you or your doctor may take: If you are prescribed an antifungal while using Annovera, your doctor can tell you whether it may interact with Annovera. Be sure to also talk with them before using any over-the-counter antifungals, such as vaginal creams or suppositories.

If you’re prescribed an antifungal that interacts with Annovera, your doctor may advise you to watch for side effects from Annovera. Examples include headache, diarrhea, and abdominal pain. Your doctor can recommend what to do if you have side effects while taking an antifungal with Annovera.

To learn more about Annovera and antifungal drugs, talk with your doctor or pharmacist.

Acetaminophen

Acetaminophen (Tylenol) is used to ease pain and fever. The drug is available over the counter (OTC), meaning you don’t need a prescription to purchase it.

Interaction result: Taking acetaminophen while using Annovera could increase the risk of side effects of Annovera. Using them together could also make acetaminophen less effective.

Interaction explained: Acetaminophen may affect your body’s ability to get rid of the hormones in Annovera. Taking these drugs together could result in a higher level of the hormones in your system. Having a high level of these hormones could increase your risk of side effects from Annovera.

On the other hand, Annovera may lower the level of acetaminophen in your system. This lower level could mean that acetaminophen is less effective for easing pain or fever.

Steps you or your doctor may take: Before taking any OTC pain reliever with Annovera, talk with your doctor or pharmacist. They can advise you on which OTC products are safe to take with this drug. They’ll likely recommend a product that does not contain acetaminophen.

To learn more about Annovera and acetaminophen, talk with your doctor or pharmacist.

Annovera and other interactions

Annovera may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Annovera.

Annovera interactions with supplements

Before you start treatment with Annovera, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Annovera interactions with herbs

Doctors may recommend that you avoid taking St. John’s wort with Annovera. St. John’s wort is an herbal supplement that some people take for depression and other conditions.

St. John’s wort may speed up the activity of an enzyme (protein) in your body that helps break down the hormones in Annovera. By speeding up this enzyme, St. John’s wort can cause the hormones to break down more quickly. This may lead to a low level of the hormones in your system, making Annovera less effective.

If your doctor prescribes Annovera with St. John’s wort, tell them if you have breakthrough bleeding. This could be a sign that Annovera isn’t working as it should. Your doctor may advise you to stop taking St. John’s wort. They may also recommend using a backup method of birth control with St. John’s wort and for at least 28 days after stopping the herb.

Your doctor may be able to suggest a treatment option other than St. John’s wort.

Annovera interactions with vitamins

Vitamin C may prevent your body from breaking down the hormones in Annovera as well as it should. This could raise the level of the hormones in your system, which increases your risk of side effects from Annovera.

Before you start treatment with Annovera, tell your doctor and pharmacist which vitamins you take. They can advise you on whether Annovera may interact with any of them.

Annovera interactions with food

Grapefruit products can slow the breakdown of the hormones in Annovera. This may raise the level of the hormones in your body, which increases your risk of side effects from Annovera. Due to this risk, your doctor may recommend avoiding grapefruit and grapefruit juice while using Annovera.

Although vitamin C may interact with Annovera, the amount in foods and drinks is usually much less than what’s in a vitamin C supplement.

If you have additional questions or want more information about eating certain foods while using Annovera, talk with your doctor.

Annovera and vaccines

There aren’t any known interactions between Annovera and vaccines. Talk with your doctor or pharmacist to see whether you’re due for any vaccines.

Annovera interactions with lab tests

Annovera may interact with certain lab tests. These include:

• blood clotting test
• cholesterol test
• glucose tolerance test
• tests for certain binding proteins, such as thyroid-binding globulin

Because of this, it’s important to tell the person giving you the test that you’re prescribed Annovera. For additional information, talk with your doctor or pharmacist.

ANNOVERA AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Annovera. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Annovera. The impact of cannabis may affect how well you stick to your Annovera treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Annovera and health-related interactions

Certain medical conditions and other factors may increase the risk of interactions with Annovera. Before you take this drug, be sure to talk with your doctor about your health history. Annovera may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Annovera include:

• Planned surgery or procedure: Talk with your doctor about any planned surgeries or procedures you have. Annovera may increase the risk of blood clots after surgery. To reduce this risk, your doctor may advise you not to use Annovera for at least 4 weeks before and 2 weeks after the procedure. They can recommend other birth control options to use during this time and tell you when it’s safe to restart Annovera.
• High triglycerides or cholesterol: Annovera may increase your triglyceride and cholesterol levels. If you already have high triglycerides or cholesterol, your doctor can recommend whether Annovera is a safe birth control option for you.
• High blood pressure: Annovera may increase your blood pressure. If you already have high blood pressure, your doctor can recommend whether Annovera is a safe birth control option for you.
• Depression: Before using Annovera, tell your doctor if you’ve ever had depression. Annovera may cause worsened depression for people who have had this condition. Your doctor can tell you whether Annovera is a safe birth control option for you.
• Kidney failure: If you have kidney failure, talk with your doctor before using Annovera. It isn’t known whether Annovera is safe for people with this condition. Your doctor can recommend the right birth control option for you.
• BMI greater than 29: If your body mass index (BMI) is greater than 29, talk with your doctor before using Annovera. It isn’t known whether Annovera is effective for people with this BMI. Your doctor can advise you on the right birth control option for you.
• Chloasma during pregnancy: Before using Annovera, tell your doctor if you’ve ever had chloasma during pregnancy. Annovera may cause skin sensitivity to sunlight or UV light. This risk may be greater for people who have had chloasma during pregnancy. Your doctor can recommend whether Annovera is the right birth control option for you.
• Gallbladder problems during pregnancy: Before using Annovera, tell your doctor if you’ve ever had gallbladder problems during pregnancy. Annovera may cause gallbladder problems as a side effect. This risk may be greater for people who have had gallbladder problems during pregnancy. Your doctor can recommend whether Annovera is the right birth control option for you.
• Factors that increase the risk of vaginal ulcers or irritation: If you have factors that increase your risk of vaginal ulcers or irritation, talk with your doctor before using Annovera. An example is having a sexually transmitted infection (STI). Using Annovera may further increase the risk of ulcers or irritation. Your doctor can recommend the right type of birth control for you.
• Factors that increase the risk of blood clots: Doctors typically won’t prescribe Annovera for people with health factors that increase the risk of blood clots. These factors include having any history of blood clots in a deep vein or lung and having certain genetic (inherited) conditions. For details, see the “When to avoid Annovera” section.
• Liver tumors or certain liver conditions: Doctors typically won’t prescribe Annovera for people with liver tumors, acute (sudden) hepatitis, or decompensated cirrhosis. For details, see the “When to avoid Annovera” section.
• Breast cancer: Doctors typically won’t prescribe Annovera for people who have ever had breast cancer. For details, see the “When to avoid Annovera” section.
• Dysfunctional urine bleeding: Doctors typically won’t prescribe Annovera for people with dysfunctional uterine bleeding that does not have a known cause. For details, see the “When to avoid Annovera” section.
• Allergic reaction: If you’ve had an allergic reaction to Annovera or any of its ingredients, your doctor will likely not prescribe Annovera. Using the vaginal ring could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
• Breastfeeding: Doctors typically won’t prescribe Annovera while you’re breastfeeding. This is because the hormones in Annovera may pass into breast milk, and it isn’t known what effects they may have on a child who is breastfed. The hormones in Annovera may also reduce the amount of breast milk your body produces. If you’re breastfeeding or planning to, talk with your doctor before using Annovera. They can talk with you about birth control options and ways to feed your child.
• Pregnancy: Annovera is prescribed to help prevent pregnancy. Doctors won’t prescribe Annovera during pregnancy. If you’re pregnant or planning to become pregnant, tell your doctor before starting Annovera.
• Risk of serious cardiovascular problems with cigarette smoking: Annovera has a boxed warning about the risk of serious cardiovascular problems with cigarette smoking. This is a serious warning from the FDA. A boxed warning alerts doctors and patients about drug effects that may be dangerous. For details, see the boxed warning at the top of this article.

Preventing interactions

You can take certain steps to help prevent interactions with Annovera. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Annovera label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Annovera doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Annovera by using it exactly as your doctor prescribes.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.