Is it safe to use fluconazole with desogestrel (a progestin), a component of certain oral contraceptives?

From the Guidelines

Fluconazole can be used with desogestrel, but caution is advised as fluconazole may increase desogestrel levels in your body. Fluconazole is an antifungal medication while desogestrel is a progestin used in birth control. When taken together, fluconazole can inhibit the liver enzymes that metabolize desogestrel, potentially leading to higher hormone levels in your bloodstream. This interaction is generally not severe enough to contraindicate their combined use, but it could theoretically increase the risk of side effects from desogestrel such as headaches, breast tenderness, or nausea. No specific dosage adjustments are typically recommended, but if you experience unusual side effects while taking both medications, contact your healthcare provider. This interaction is particularly relevant if you're taking fluconazole for longer periods (multiple doses) rather than a single dose for conditions like vaginal yeast infections. If you're concerned about contraceptive effectiveness, continue using your hormonal contraceptive as prescribed, as fluconazole is not known to reduce contraceptive efficacy 1. In fact, a study from 1 suggests that antifungal agents, including fluconazole, have no clinically significant pharmacokinetic interactions with combined oral contraceptives. However, it's essential to consider the potential for increased side effects and monitor your body's response to the combination of fluconazole and desogestrel. Given the most recent evidence from 2, which discusses the interactions between various medications and contraceptives, it's clear that the interaction between fluconazole and desogestrel is not a significant concern for contraceptive efficacy, but rather for potential side effects. Therefore, it is recommended to use fluconazole with desogestrel while being aware of the potential for increased side effects and monitoring your body's response.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Interaction between Fluconazole and Desogestrel

• The interaction between fluconazole and desogestrel is not directly addressed in most studies, but some research provides insight into the potential effects of fluconazole on hormonal contraceptives and the metabolism of desogestrel 3, 4.
• A study on the interaction between fluconazole and an oral contraceptive containing ethinyl estradiol and norethindrone found that fluconazole increased the concentrations of both ethinyl estradiol and norethindrone, but the increases were small and not considered to be a threat to contraceptive failure 3.
• Another study investigated the metabolic effects of low-dose fluconazole in healthy female users and non-users of oral contraceptives, and found that fluconazole had minor effects on the metabolic profile, including increases in serum thyroxine and testosterone concentrations, but these changes were small and of no clinical significance 5.
• A study on the role of CYP2C and CYP3A in the disposition of 3-keto-desogestrel after administration of desogestrel found that fluconazole, a selective inhibitor of CYP2C, had no significant effect on the plasma concentrations of 3-keto-desogestrel, whereas itraconazole, a selective inhibitor of CYP3A4, significantly increased the area under the plasma concentration-time curve of 3-keto-desogestrel 4.
• There is no direct evidence on the interaction between fluconazole and desogestrel, but based on the available studies, it appears that fluconazole may not have a significant effect on the metabolism of desogestrel 4.

Potential Effects on Contraceptive Efficacy

• The available studies suggest that fluconazole may not have a significant effect on the efficacy of hormonal contraceptives, including those containing desogestrel 3, 4.
• However, it is essential to note that the studies were conducted on oral contraceptives containing ethinyl estradiol and norethindrone, and the results may not be directly applicable to desogestrel-containing contraceptives.
• Further research is needed to fully understand the potential effects of fluconazole on the efficacy of desogestrel-containing contraceptives.

Safety and Efficacy of Fluconazole

• Fluconazole is a well-tolerated and effective antifungal agent, with a low risk of serious adverse effects or laboratory test abnormalities 6.
• The drug has been shown to be effective in the treatment of various fungal infections, including vaginal candidiasis, and is often used as a first-line treatment 6.
• However, recent studies have raised concerns about the potential risks of fluconazole use during pregnancy, including an increased risk of spontaneous abortion and cardiac septal closure anomalies 7.