Adrafinil + Segesterone Acetate, Ethinyl Estradiol
Segesterone Acetate, Ethinyl Estradiol brand name: Annovera.
Segesterone Acetate, Ethinyl Estradiol falls into 3 drug categories that Adrafinil can interact with; the most serious is rated moderate. Theoretically, adrafinil might reduce the levels and clinical effects of CYP1A2 substrates.
Read the full interaction reportAdrafinil and Segesterone Acetate, Ethinyl Estradiol
These two interact in 3 distinct ways. Each one is explained separately below.
Why Are There 3 Interactions?
Adrafinil interacts with whole categories of medication. Segesterone Acetate, Ethinyl Estradiol falls into 3 of those categories, so it can interact with Adrafinil in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES
1 of 3Why this applies to Segesterone Acetate, Ethinyl Estradiol
Segesterone Acetate, Ethinyl Estradiol falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Adrafinil interacts with.
Adrafinil is a precursor to the stimulant prescription drug modafinil. Modafinil has been shown to weakly induce CYP1A2 activity in vitro.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Annovera is a vaginal ring that releases a steady dose of two hormones (segesterone and ethinyl estradiol) to prevent pregnancy. The concern here is that adrafinil turns into modafinil in your body, and modafinil may slightly speed up a liver enzyme (CYP1A2) that helps process estrogen. In theory, that could nudge your hormone levels down a bit and weaken the birth control's reliability.
I want to be honest: this is a theoretical concern based on lab data, not real-world failures, and the effect on estrogen is expected to be weak. Still, since reduced effectiveness could mean an unplanned pregnancy or spotting, it's worth a quick chat with your pharmacist or doctor before combining them. Please don't stop your ring on your own.
- Urban AE, Cubala WJ. The role of eugeroics in the treatment of affective disorders. Psychiatr Pol. 2020;54(1):21-33. PubMed
- Kumar R. Approved and investigational uses of modafinil: an evidence-based review. Drugs. 2008;68(13):1803-39. PubMed
- Provigil (modafinil) [package insert]. North Wales, PA: Teva Pharmaceuticals USA, Inc. Published: January 2015. Accessed on: Nov 11, 2022.
CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS
2 of 3Segesterone Acetate, Ethinyl Estradiol also falls under CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS.
Adrafinil is a precursor to the stimulant prescription drug modafinil. Modafinil is metabolized by CYP3A4.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Here's how this one works. Your Annovera ring contains hormones (segesterone and ethinyl estradiol) that gently block the CYP3A4 enzyme in your liver. Adrafinil has to be processed by that same enzyme into modafinil, the part that actually wakes you up. So if Annovera slows that enzyme a bit, more adrafinil could pile up and turn into modafinil, which might mean stronger stimulant effects like jitteriness, a racing heart, trouble sleeping, headache, or anxiety.
I want to be honest that this is theoretical, based on how these chemicals behave, not on real patient studies, so it may be mild or barely noticeable. Still, since adrafinil is unregulated and hard on the liver, please run it by your pharmacist or doctor before combining them.
- Urban AE, Cubala WJ. The role of eugeroics in the treatment of affective disorders. Psychiatr Pol. 2020;54(1):21-33. PubMed
- Provigil (modafinil) [package insert]. North Wales, PA: Teva Pharmaceuticals USA, Inc. Published: January 2015. Accessed on: Nov 11, 2022.
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
3 of 3Segesterone Acetate, Ethinyl Estradiol also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
Adrafinil is a precursor to the stimulant prescription drug modafinil. Modafinil has been shown to weakly induce CYP3A4 activity.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Annovera is a vaginal ring that releases two hormones, segesterone and ethinyl estradiol, to prevent pregnancy. Both hormones are cleared by a liver enzyme called CYP3A4. Here's the concern: once adrafinil is converted into modafinil in your body, modafinil can mildly speed up that same enzyme. In theory, that could lower your hormone levels a bit and make the birth control less reliable.
To be clear, this is a theoretical interaction based on how these drugs work, not hard proof from studies. Still, since the stakes are an unintended pregnancy, I'd take it seriously. You might also notice breakthrough spotting if levels drop. Please talk with your doctor or pharmacist before combining these, and ask whether a backup method makes sense.
- Urban AE, Cubala WJ. The role of eugeroics in the treatment of affective disorders. Psychiatr Pol. 2020;54(1):21-33. PubMed
- Provigil (modafinil) [package insert]. North Wales, PA: Teva Pharmaceuticals USA, Inc. Published: January 2015. Accessed on: Nov 11, 2022.
What These Ratings Mean
Every interaction above is graded three ways — here’s the key to each label.
Clinically significant. Avoid the combination, or use only under close professional supervision.
Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.
Generally not serious. Be aware of it and mention it to your pharmacist.
- LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
- ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
- PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
- UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
- AHigh-quality meta-analysis (quantitative systematic review).
- BCase-control study.
- CConsensus.
- DAnecdotal evidence.
These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.
Adrafinil Also Interacts With Other Medications
Adrafinil has 1 major, 1,055 moderate known drug interactions in our database — the Segesterone Acetate, Ethinyl Estradiol one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Adrafinil
We haven’t checked that one against Adrafinil yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Adrafinil. Pick one to open its full report.
See Every Supplement That Interacts With Segesterone Acetate, Ethinyl Estradiol
This page covers Adrafinil only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Segesterone Acetate, Ethinyl Estradiol page lists 229 supplements it has a documented interaction with, worst first, each one explained.
The most serious there right now: Beer (major), Grapefruit (major), Siberian Cocklebur (major), St. John's Wort (major) and Wine (major).
By severity: 5 major · 193 moderate · 31 minor.
From our pharmacist’s overview on the Segesterone Acetate, Ethinyl Estradiol page
“St. John's wort is the interaction I would explain first to anyone using Annovera (segesterone acetate with ethinyl estradiol, a vaginal ring for birth control).”
Reviewed by 2 · Jul 18, 2026
Open the Segesterone Acetate, Ethinyl Estradiol interaction page
Taking Adrafinil as Part of a Dietary Supplement Product? Check It for Interactions
We hold 7 real supplement products containing Adrafinil, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Adrafinil. Your product may carry other ingredients that interact with Segesterone Acetate, Ethinyl Estradiol too, on top of Adrafinil — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Adrafinil and Segesterone Acetate, Ethinyl Estradiol Sit Against Everything Else
Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.
#539 of 1,452 supplements looked up here in the last 7 days
#505 of 2,830 medications looked up here in the last 7 days
Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.
About Adrafinil
What is Adrafinil?
- Wakefulness and alertness
- Fatigue
- Focus and concentration
- Cognitive enhancement (nootropic)
- Daytime sleepiness
Adrafinil is a synthetic compound that the body converts into modafinil, a prescription wakefulness-promoting drug. It is sometimes sold as a nootropic supplement, but it is unregulated, carries real risks (especially to the liver), and is banned in some sports and countries. Talk with a doctor or pharmacist before using it.
Other Drugs & Adrafinil
Browse every other medication we’ve checked against Adrafinil — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
1 interaction
1,055 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Theophylline ›
- Nifedipine ›
- Ibuprofen ›
- Metronidazole ›
- Phentermine ›
- Hydrocortisone ›
- Methylphenidate ›
- Naproxen ›
- Erythromycin ›
- Estradiol ›
- Propranolol ›
- Lidocaine ›
- Hydrochlorothiazide ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Phenylpropanolamine ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Glyburide ›
- Triazolam ›
- Zopiclone ›
- Bupropion ›
- Ciprofloxacin ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Nicotine ›
- Orphenadrine ›
- Oxybutynin ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Hydralazine ›
- Indomethacin ›
- Miconazole ›
- Phenylephrine ›
- Pseudoephedrine ›
- Trimipramine ›
- Acetaminophen ›
- Amphetamine ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Diethylpropion ›
- Everolimus ›
Showing 60 of 1,055 moderate interactions — see all 1,055 on the Adrafinil page.
No interaction 1,773 drugs checked — show the list
We also checked Adrafinil against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Ivermectin ›
- Aspirin ›
- Rosuvastatin ›
- Escitalopram ›
- Isotretinoin ›
- Tirzepatide ›
- Docusate ›
- Sumatriptan ›
- Valacyclovir ›
- Hydroxyurea ›
- Metformin ›
- Semaglutide ›
- Methotrexate ›
- Amoxicillin ›
- Levothyroxine, Liothyronine ›
- Doxycycline ›
- Azithromycin ›
- Pregabalin ›
- Lamotrigine ›
- Gabapentin ›
- Acyclovir ›
- Duloxetine ›
- Methylene Blue ›
- Amoxicillin, Clavulanate Potassium ›
- Acetylsalicylic Acid ›
- Ezetimibe ›
- Cyclopentolate ›
- Cephalexin ›
- Insulin Degludec, Liraglutide ›
- Calcium Oxybate, Magnesium Oxybate, Potassium Oxybate, Sodium Oxybate ›
- Thyroid Hormone ›
- Levetiracetam ›
- Levodopa ›
- Carbidopa, Levodopa ›
- Alginic Acid, Aluminum Hydroxide ›
- Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide ›
- Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide ›
- Acetaminophen, Dextromethorphan, Doxylamine ›
- Magnesium Hydroxide (otc Drug) ›
- Aluminum Hydroxide, Aspirin, Magnesium Hydroxide ›
- Canagliflozin, Metformin ›
- Mitomycin ›
- Avatrombopag Maleate ›
- Venlafaxine ›
- Levothyroxine Sodium ›
- Atropine Methyl Nitrate, Digestive Enzymes ›
- Acarbose ›
- Flutemetamol F-18 ›
- Ceftolozane Sulfate, Tazobactam Sodium ›
- Aspirin, Butalbital ›
- Articaine, Epinephrine ›
- Cefaclor ›
- Charcoal (otc Drug) ›
- Daptomycin ›
- Peginterferon Alfa-2a, Ribavirin ›
- Acenocoumarol ›
- Hydrocortisone, Clioquinol, Pramoxine ›
- Insulin Human, Sodium Chloride ›
- Digoxin ›
Showing the 60 most looked-up of 1,773 medications checked with no known interaction — see the full Adrafinil list.
Sources & How We Checked
Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for vitamins, herbs and supplements — the basis for our interaction data.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for the medication overviews.
- NIH Dietary Supplement Label Database (DSLD) — Official supplement product labels.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC
Segesterone Acetate, Ethinyl Estradiol Is Linked to Lower Levels of 7 Nutrients
Natural Medicines records Segesterone Acetate, Ethinyl Estradiol as a medicine that can lower these. This is not an interaction with Adrafinil — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
Read the full Segesterone Acetate, Ethinyl Estradiol nutrient depletion report ›
Depletion records come from the licensed Natural Medicines database. Do not start a supplement on the strength of this page — ask your pharmacist or doctor whether it applies to you.
Taking Adrafinil and Segesterone Acetate, Ethinyl Estradiol Together: Common Questions
Can you take Adrafinil with Segesterone Acetate, Ethinyl Estradiol?
Why are there 3 interactions listed for Adrafinil and Segesterone Acetate, Ethinyl Estradiol?
How serious is the Adrafinil and Segesterone Acetate, Ethinyl Estradiol interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
Still Have a Question About Segesterone Acetate, Ethinyl Estradiol and Adrafinil?
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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.