التداخل بين ليفونورجيستريل وإيثينيل إستراديول وميتابيفات

Sensitive CYP3A substrates including hormonal contraceptives: Avoid concomitant use with substrates that have narrow therapeutic index.

Avoid concomitant use with hormonal contraceptives except for intrauterine systems containing levonorgestrel.

Co-administration of AQVESME will decrease systemic concentrations of drugs that are sensitive CYP3A substrates, including hormonal contraceptives (e.g., ethinyl estradiol) [see Clinical Pharmacology (12.3) ] .

If contraception is desired or needed, use an alternative contraceptive that is not affected by enzyme inducers.

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) ] .

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

Prevention or management Counsel females to use an alternative method of contraception or a backup method when enzyme inducers are used with CHCs.

Continue backup contraception for 28 days after discontinuing the enzyme inducer to maintain contraceptive reliability.