| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Atazanavir EE/NGM 799 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of hormonal contraception | Ethinyl estradiol AUC decreased 19%, Cmax decreased 16%, Cmin decreased 37% 17-deacetyl norgestimate AUC increased 85%, Cmax increased 68%, Cmin increased 102% |
With ritonavir boosted atazanavir, use an oral contraceptive containing at least 35 mcg of ethinyl estradiol. Oral contraceptives containing progestins other than norethindrone or norgestimate have not been studied. |
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| Tenofovir disoproxil fumarate EE/NGM 737 | Green: Administer standard doses | Administer standard doses | No significant change |
1 tab daily | No significant change |
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| Tenofovir alafenamide EE/NGM 710 | Green: Administer standard doses | Administer standard doses | Not studied |
NGM 0.180 / 0.215 / 0.250mg once daily with EE 0.025mg once daily | Norgestromin: Cmax increased 17%, AUC increased 12%, Cmin increased 16%; norgestrel: Cmax increased 10%, AUC increased 9%, Cmin increased 11%; EE: Cmax increased 22%, AUC increased 11%, Cmin increased 2% |
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| Efavirenz EE/NGM 457 | Red: Avoid combination | Do not coadminister: Reduced levels of progestin | Decreased effects of ethinyl estradiol and norgestimate |
0.035 mg ethinyl estradiol / 0.25 mg norgestimate x 14 days | Ethinyl estradiol: no significant change; Norgestromin AUC decreased 64%; Cmax decreased 46%; Cmin decreased 82% |
Use alternative contraceptive method |
|
| Efavirenz EE/NGM 456 | Red: Avoid combination | Do not coadminister: Reduced levels of progestin | Decreased effects of ethinyl estradiol and norgestimate |
0.035 mg ethinyl estradiol / 0.25 mg norgestimate x 14 days | Ethinyl estradiol: no significant change; Norgestromin AUC decreased 64%; Cmax decreased 46%; Cmin decrased 82% |
Use alternative contraceptive method |
|
| Efavirenz EE/NGM 455 | Red: Avoid combination | Do not coadminister: Reduced levels of progestin | Decreased effects of ethinyl estradiol and norgestimate |
0.025 mg ethinyl estradiol / 0.25 mg norgestimate | Ethinyl estradiol: no significant change; Norgestromin AUC decreased 64%; Cmax decreased 46%; Cmin decrased 82% |
Use alternative contraceptive method |
|
| Cabotegravir EE/NGM 329 | Green: Administer standard doses | Administer standard doses | Not studied |
0.03mg once daily | Cmax decreased 8%, AUC increased 2% |
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| Elvitegravir EE/NGM 137 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Potential for increased norgestimate effects (e.g. insulin resistance, dyslipidemia, acne, venous thrombosis); Potential decreased ethinyl estradiol effects |
Not reported |
0.18 / 0.215 / 0.250 mg NGM once daily, 0.025 mg EE once daily | Ethinyl estradiol Cmax decrease 6%, AUC decrease 25%, Cmin decrease 44%; Norgestimate Cmax increased 108%, AUC increased 126%, Cmin increased 167% |
Additional or alternative contraception should be considered. |
| Dolutegravir EE/NGM 100 | Green: Administer standard doses | Administer standard doses | No significant change |
0.035 mg ethinyl estradiol + norelgestromin 0.25 mg | No significant change |
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| Bictegravir EE/NGM 68 | Green: Administer standard doses | Administer standard doses | Not reported |
EE 0.025mg once daily with NGM 0.180 / 0.215 / 0.250mg once daily | Ethinyl estradiol Cmax inccreased 15%, AUC increased 4%, Cmin increased 5%. Norelgestromin Cmax increased 23%, AUC increased 8%, Cmin increased 10%. Norgestrel Cmax increase 15%, AUC increase 13%, Cmin increase 14% |
