Segesterone and Isotretinoin: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Isotretinoin
Segesterone
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Isotretinoin (the acne medicine also known as Accutane) may make hormonal birth control like segesterone work less reliably. The changes are small but unpredictable, and pregnancies have happened in people using only one form of birth control while on isotretinoin. This matters a lot because isotretinoin can cause serious birth defects.
Please don't stop either medicine on your own. The good news is this is very manageable: your care team will have you use two forms of birth control at the same time during treatment. Talk with your pharmacist or doctor about the best plan for you.
Effect: Potential decreased contraceptive efficacy of hormonal contraceptives (segesterone) during isotretinoin therapy.
- Mechanism: Unknown. PK/PD changes to estrogens/progestins are small but highly variable and unpredictable. Neither agent is functionally a prodrug here.
- Direction/magnitude: Reduced/unreliable contraceptive effect; magnitude not quantified.
- Evidence: Theoretical, supported by post-marketing pregnancy reports, most in single-method users.
- Management: Per iPLEDGE, require 2 simultaneous forms of contraception (unless abstinence/hysterectomy). Progestin-only micro-dosed formulations may be inadequate. Reinforce contraceptive counseling and pregnancy-risk behaviors.
What happens
Decreased effectiveness of hormonal contraceptives
Interaction Deep Dive
The pharmacokinetic and pharmacodynamic effects on estrogens and progestins when given together with isotretinoin are minor, yet markedly variable and difficult to predict. Cases of pregnancy have been documented among women using combined oral contraceptives, along with topical, injectable, implantable, or insertable hormonal contraceptive products. These reports have been more common among individuals relying on a single contraceptive method. Micro-dosed progestin-only pills raise the likelihood of contraceptive failure when taken alongside isotretinoin. Throughout isotretinoin treatment, female patients capable of becoming pregnant are required to use 2 contraceptive methods at the same time, with one of them being: tubal ligation, a partner's vasectomy, intrauterine devices, birth control pills, or topical, injectable, implantable, or insertable hormonal birth control products123.
Why it happens (mechanism)
Unknown
How to manage this interaction
Keep taking both exactly as prescribed, and work with your care team on a reliable pregnancy-prevention plan.
- During isotretinoin, use two forms of contraception at the same time, unless you have agreed to complete abstinence or have had a hysterectomy.
- One form should be a primary method such as tubal ligation, a partner's vasectomy, an IUD, birth control pills, or a topical, injectable, implantable, or insertable hormonal product.
- Ask whether your segesterone method counts as a reliable primary form for you; progestin-only mini-pills may not be enough on their own.
- Talk with your pharmacist or prescriber about contraception and any behaviors that raise pregnancy risk.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In one study, isotretinoin showed no interaction with oral contraceptives. Nine women receiving isotretinoin 0.5 mg/kg for severe pustular acne had been taking oral contraceptives (brand unknown) for at least three months before beginning isotretinoin therapy. As measured by radioimmunoassay, plasma concentrations of ethinyl estradiol and levonorgestrel during the control cycle and during two cycles after starting isotretinoin were comparable 4.
b) When isotretinoin was administered with a combination ethinyl estradiol/norethindrone product, pharmacokinetic and pharmacodynamic alterations were inconsistent and relatively minor. In a single-center, open-label drug interaction study, 26 healthy women completed a protocol in which they received ethinyl estradiol/norethindrone oral contraceptive (OC) triphasic tablets (35 micrograms and 0.5/0.75/1 milligrams, respectively) each day. Beginning at the start of the third month, and once the possibility of pregnancy had been excluded, participants additionally received isotretinoin 1 milligrams/kilogram/day in two divided doses to complete 16 to 20 weeks of isotretinoin treatment for severe, recalcitrant nodular acne. Plasma concentrations of ethinyl estradiol and norethindrone were slightly lower (9% and 11%, respectively) during the OC plus isotretinoin phase than during the OC alone phase, although patient variability was high. Follicle stimulating hormone concentration fell 44% (p=0.03) with the addition of isotretinoin to the regimen, again with a high degree of variability; serum progesterone and luteinizing hormone levels were unchanged. No pregnancies were reported 5.
Common questions
Can I take Segesterone and Isotretinoin together?
Isotretinoin can make hormonal birth control like segesterone less reliable, so use two forms of contraception at the same time and confirm your plan with your pharmacist or prescriber. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Segesterone and Isotretinoin interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Segesterone and Isotretinoin interaction managed?
Keep taking both exactly as prescribed, and work with your care team on a reliable pregnancy-prevention plan. During isotretinoin, use two forms of contraception at the same time, unless you have agreed to complete abstinence or have had a hysterectomy. One form should be a primary method such as tubal ligation, a partner's vasectomy, an IUD, birth control pills, or a topical, injectable, implanta… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Segesterone or Isotretinoin need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (5)
- Product Information: Amnesteem(R) oral capsules, isotretinoin oral capsules. Mylan Pharmaceuticals Inc, Morgantown, WV, 2010. DailyMed
- Product Information: Claravis(TM) oral capsules, isotretinoin oral capsules. Barr Laboratories, Inc, Pomona, NY, 2010. DailyMed
- Product Information: Sotret(R) oral capsules, isotretinoin oral capsules. Ranbaxy Laboratories Inc. Jacksonville, FL, 2010. DailyMed
- Orme M, Back DJ, & Shaw MA: Isotretinoin and contraception. Lancet 1984; 2:752-753. PubMed
- Hendrix CW, Jackson KA, Whitmore E, et al: The effect of isotretinoin on the pharmacokinetics and pharmacodynamics of ethinyl estradiol and norethindrone. Clin Pharmacol Ther 2004; 75:464-75. PubMed
Keep reading about Isotretinoin
Keep reading about Segesterone
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist