Acitretin with Levonorgestrel Interaction Details

Brand Names Associated with Acitretin

Brand Names Associated with Levonorgestrel

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Feb 26, 2024

Interaction Effect

Loss of contraceptive effectiveness

Interaction Summary

Acitretin interferes with the contraceptive effect of preparations containing microdose progestins; use of progestin "minipill" is not recommended with acitretin. Women on acitretin therapy should not rely on progestin-only contraceptives as one of their two forms of reliable birth control. It is not known whether acitretin also interferes with injectable or implantable progestational contraceptives, but caution should be utilized if these products are used[1].

Severity

Moderate

Onset

Delayed

Evidence

Probable

How To Manage Interaction

Female patients on acitretin therapy should not rely on progestin-only contraceptives. Two other reliable forms of birth control should be utilized simultaneously unless abstinence is chosen[1].

Mechanism Of Interaction

Unknown

Literature Reports

A) Concomitant use of acitretin and combination contraceptives (levonorgestrel 0.15 to 0.5 mg plus ethinyl estradiol 0.03 to 0.05 mg) was reported to result in no interference of the antiovulatory activity of the contraceptive, even after prolonged use. However, failure of contraception was suspected in a patient receiving acitretin and a low-dose progestin contraceptive (levonorgestrel 0.03 mg) [2]. It is recommended that acitretin patients avoid very low dose progestin contraceptive agents [1].

References

1 ) Product Information: SORIATANE(R) oral capsules, acitretin oral capsules. Stiefel Laboratories, Coral Gables, FL, 2007.

2 ) Berbis PH, Bun H, Geiger JM, et al: Acitretin (RO 10-1670) and oral contraceptives: interaction study. Arch Dermatol Res 1988a; 280:388-389.

Acitretin Overview

• Acitretin is used to treat severe psoriasis (abnormal growth of skin cells that causes red, thickened, or scaly skin). Acitretin is in a class of medications called retinoids. The way acitretin works is not known.

Levonorgestrel Overview

• Levonorgestrel is used to prevent pregnancy after unprotected sexual intercourse (sex without any method of birth control or with a birth control method that failed or was not used properly [e.g., a condom that slipped or broke or birth control pills that were not taken as scheduled]). Levonorgestrel should not be used to prevent pregnancy on a regular basis. This medication is to be used as an emergency contraceptive or backup in case regular birth control fails or is used incorrectly. Levonorgestrel is in a class of medications called progestins. It works by preventing the release of an egg from the ovary or preventing fertilization of the egg by sperm (male reproductive cells). It also may work by changing the lining of the uterus (womb) to prevent development of a pregnancy. Levonorgestrel may prevent pregnancy, but it will not prevent the spread of human immunodeficiency virus (HIV, the virus that causes acquired immunodeficiency syndrome [AIDS]) and other sexually transmitted diseases.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.