التداخل بين إيفافيرينز ولاميفودين وتينوفوفير وليفونورجيستريل وإيثينيل إستراديول

Enzyme inducers (e.g., CYP3A4) : May decrease the effectiveness of TYBLUME or increase breakthrough bleeding.

Metabolic Enzyme Inducers Clinical effect Concomitant use of CHCs with metabolic enzyme inducers may decrease the plasma concentrations of the estrogen and/or progestin component of CHCs [see Clinical Pharmacology (12.3) ] .

CYP3A inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice The effect of grapefruit juice on CYP3A4 enzymes (e.g., strong vs. moderate inhibition) depends on its brand, concentration, and preparation. , or ketoconazole may increase systemic exposure of the estrogen and/or progestin component of CHCs.

Examples Aprepitant, barbiturates, bosentan, carbamazepine, efavirenz, felbamate, griseofulvin, oxcarbazepine, phenytoin, rifampin, primidone, phenylbutazone, rifabutin, rufinamide, topiramate, products containing St.

Counsel patients to use a back-up or alternative method of contraception when enzyme inducers are used with TYBLUME.

Hormonal contraceptives: Oral Ethinyl estradiol/ Norgestimate ↓ active metabolites of norgestimate A reliable method of barrier contraception should be used in addition to hormonal contraceptives.

Implant Etonogestrel ↓ etonogestrel A reliable method of barrier contraception should be used in addition to hormonal contraceptives.

There have been postmarketing reports of contraceptive failure with etonogestrel in EFV-exposed patients.