Levonorgestrel and ethinyl estradiol and Mitapivat interaction
Levonorgestrel and ethinyl estradiol and Mitapivat: both prescribing labels flag this combination with the strongest language, such as a contraindication, a boxed warning, or an instruction to avoid it.
Do not combine without a prescriber's guidance. The label language below is the strongest FDA uses.
What the FDA labels say
From the Mitapivat (AQVESME) label · effective 2026-08-27
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.
From the Levonorgestrel and ethinyl estradiol (Tyblume) label · effective 2026-08-27
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.
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Open in the checkerNot medical advice. Interaction Checker quotes FDA label text and NIH fact sheets. Whether an interaction matters for you depends on doses, timing, kidney and liver function, and other conditions. Confirm with a pharmacist or prescriber.