No Contraindication Between Abilify/Prozac and Progestin-Only Pills
Neither aripiprazole (Abilify) nor fluoxetine (Prozac) is contraindicated with progestin-only oral contraceptives, and these medications can be safely used together.
Evidence for Safety
Fluoxetine (Prozac) and Progestin-Only Pills
Fluoxetine has been specifically studied with oral contraceptives and shows no clinically significant drug interactions. A large retrospective analysis of 1,698 women found no evidence that concomitant use of fluoxetine and oral contraceptives affects the safety or efficacy of either agent 1.
The study demonstrated no statistically significant interaction in the incidence of unintended pregnancies (P = 0.111) or changes in depression scores, confirming that fluoxetine does not compromise contraceptive efficacy 1.
Progestin-only pills have very few contraindications overall, with only 1.6% of reproductive-aged women having any contraindication to their use 2.
Aripiprazole (Abilify) and Progestin-Only Pills
Aripiprazole has no documented pharmacokinetic or pharmacodynamic interactions that would contraindicate use with progestin-only contraceptives. While some drug interactions exist between aripiprazole and certain antidepressants (particularly fluoxetine and paroxetine affecting aripiprazole metabolism), these do not involve contraceptive hormones 3.
The interaction between aripiprazole and SSRIs relates to CYP2D6 inhibition affecting aripiprazole levels, not contraceptive efficacy 3.
Clinical Context for Progestin-Only Pills
When Progestin-Only Pills Are Specifically Recommended
Progestin-only pills are actually preferred contraceptive options in several clinical scenarios where combined estrogen-progestin contraceptives are contraindicated 4:
Women with antiphospholipid antibodies (aPL): Strongly recommended over combined contraceptives due to thrombosis risk 4.
Systemic lupus erythematosus (SLE) patients with moderate or severe disease activity: Progestin-only methods are strongly recommended 4.
Breastfeeding women: Progestin-only pills are safe during lactation 5.
Women with cardiovascular risk factors or hypertension: Progestin-only methods avoid estrogen-related thrombotic risks 5.
Important Contraceptive Counseling Points
Traditional progestin-only pills (norethindrone) require strict timing: Must be taken at the same time daily, with backup contraception needed if taken more than 3 hours late 5.
Newer drospirenone-containing progestin-only pills have a longer window for missed pills compared to traditional formulations 5.
Progestin-only pills do not protect against sexually transmitted infections: Condoms should be recommended for STI protection 5.
Pharmacokinetic Considerations
Neither psychiatric medication affects the cytochrome P450 enzymes involved in progestin metabolism in a way that would reduce contraceptive efficacy. The primary enzyme-inducing drugs that compromise hormonal contraception are anticonvulsants (phenobarbital, phenytoin, carbamazepine) and rifampicin 6.
Fluoxetine and paroxetine are CYP2D6 inhibitors, which can increase levels of certain antipsychotics but do not affect progestin metabolism 3.
Bottom Line for Clinical Practice
Prescribe progestin-only pills confidently to patients taking aripiprazole or fluoxetine. The only counseling needed relates to proper pill timing (especially with traditional norethindrone formulations) and the lack of STI protection—not drug interactions with psychiatric medications 5, 1.