From the Guidelines
Taking nelfinavir while on oral contraceptives is not recommended without additional contraceptive methods because nelfinavir can significantly reduce the effectiveness of hormonal birth control. According to the most recent guidelines, specifically the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1, nelfinavir, an HIV protease inhibitor, induces liver enzymes that metabolize contraceptive hormones more quickly, potentially leading to lower hormone levels and reduced contraceptive efficacy.
Key Points to Consider
- The interaction between nelfinavir and oral contraceptives can lead to decreased efficacy of the contraceptive, potentially resulting in unplanned pregnancies.
- Nelfinavir affects the cytochrome P450 enzyme system in the liver, which is responsible for metabolizing many drugs, including the estrogen and progestin components of oral contraceptives.
- This interaction can begin shortly after starting nelfinavir and may continue for some time after discontinuing it.
- If you must take both medications, you should use a backup contraceptive method such as condoms or an intrauterine device (IUD).
- It is essential to discuss this interaction with your healthcare provider, who may recommend alternative contraceptive options or possibly adjusting your contraceptive dose.
- Never stop either medication without medical guidance, as both serve important purposes for your health.
Recommendations
- Use a backup contraceptive method such as condoms or an IUD when taking nelfinavir and oral contraceptives.
- Discuss alternative contraceptive options with your healthcare provider.
- Do not stop either medication without medical guidance. The guidance from the 2010 U.S. Medical Eligibility Criteria for Contraceptive Use 1 and the 2009 Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus 1 also support the concern about drug interactions between antiretrovirals and hormonal contraceptives, but the most recent and highest quality study 1 provides the most up-to-date recommendations.
From the FDA Drug Label
Alternative or additional contraceptive measures should be used when oral contraceptives and VIRACEPT are coadministered. ethinyl estradiol↓ ethinyl estradiol When taking nelfinavir while taking oral contraceptives, alternative or additional contraceptive measures should be used due to the potential decrease in ethinyl estradiol levels 2.
From the Research
Interaction between Nelfinavir and Oral Contraceptives
- There is no direct evidence in the provided studies that discusses the interaction between nelfinavir and oral contraceptives 3, 4, 5, 6, 7.
- Nelfinavir is an antiretroviral drug used to treat HIV infection, and its use in pregnancy is mentioned, but there is no specific information about its interaction with oral contraceptives 3.
- Oral contraceptives are a common method of contraception, and their effectiveness and risks are discussed in several studies, but there is no mention of their interaction with nelfinavir 4, 5, 6, 7.
- One study discusses the risk of HIV acquisition among women using hormonal contraception, but it does not mention the interaction between nelfinavir and oral contraceptives 6.
Contraceptive Options for Women taking Nelfinavir
- Women taking nelfinavir may consider using alternative methods of contraception, such as intrauterine devices (IUDs), which are safe and effective 7.
- IUDs are available in different types, including the copper IUD and the levonorgestrel-releasing intrauterine system (LNG-IUS), and may be suitable for women with HIV infection 7.
- The use of IUDs in women with HIV infection is discussed in one study, which suggests that they may be a good option for women who are immunocompromised 7.