Nexplanon interactions: Alcohol, medications, and other factors

Before you start treatment with Nexplanon, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Nexplanon interacts with supplements, herbs, or vitamins, see the “Nexplanon and other interactions” section later in the article.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Nexplanon. Keep in mind that this table doesn’t include all drugs that may interact with Nexplanon. Some of these interactions are described in detail later in the article in “Drug interactions in depth.”

Some factors or conditions could prevent your doctor from prescribing Nexplanon due to the risk of harm. These are known as contraindications. The contraindications of Nexplanon include:

Having certain cancers

Healthcare professionals typically won’t insert Nexplanon if you’ve ever had breast cancer. They’ll also avoid prescribing Nexplanon if you’ve had another progestin-sensitive cancer in the past.

This is because Nexplanon contains a type of progestin hormone called etonogestrel. This hormone may encourage certain cancers to grow or come back.

If you’ve ever had cancer, talk with your doctor before having Nexplanon inserted. They can help decide whether Nexplanon or a different type of birth control may be the right treatment option.

Having liver disease or liver cancer

Healthcare professionals typically won’t insert Nexplanon if you have liver disease or liver cancer. This is because Nexplanon contains a hormone that may worsen these liver conditions.

If you have liver disease or liver cancer, talk with your doctor before having Nexplanon inserted. They’ll likely recommend a different birth control option.

Healthcare professionals typically won’t insert Nexplanon if you’ve ever had a blood clot. This is because having Nexplanon may increase your risk of a blood clot. In severe cases, a blood clot may lead to heart attack or stroke.

If you’ve ever had a blood clot, talk with your doctor before having Nexplanon inserted. They’ll likely recommend a different birth control option.

Healthcare professionals typically won’t insert Nexplanon if you have irregular periods without a known cause. This is because irregular periods are a possible side effect of Nexplanon. If you already experience irregular periods, it may be difficult to tell whether Nexplanon or another factor is causing them.

If you have irregular periods, talk with your doctor before having Nexplanon inserted. They can help decide whether Nexplanon or a different type of birth control may be the right treatment option.

Being pregnant or possibly pregnant

Nexplanon is a birth control implant that’s used to help prevent pregnancy. Healthcare professionals won’t insert Nexplanon during a pregnancy or possible pregnancy.

If you become pregnant while you have the Nexplanon implant, tell your doctor right away. They can advise you on whether it’s safe to continue the pregnancy. If you continue the pregnancy, your doctor will remove the Nexplanon implant.

Having had an allergic reaction to Nexplanon or any of its ingredients

If you have had an allergic reaction to Nexplanon or any of its ingredients, your doctor will likely not prescribe Nexplanon. Having the implant could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Nexplanon, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Nexplanon.

There are no known interactions between Nexplanon and alcohol. However, drinking alcohol while you have the implant may worsen some of Nexplanon’s side effects. For example, you may experience worsened headache or nausea.

In addition, consuming large amounts of alcohol can cause liver damage. Nexplanon may also cause liver problems as a side effect. This means that drinking alcohol while you have the implant may increase the risk of liver problems.

If you have questions about drinking alcohol while you have the Nexplanon implant, talk with your doctor.

Here’s a closer look at certain drug interactions of Nexplanon.

Certain antibiotics

Doctors prescribe antibiotics to treat bacterial infections.

Interaction result: Taking certain antibiotics while you have the Nexplanon implant could increase the risk of Nexplanon’s side effects. Other antibiotics could make Nexplanon less effective.

Interaction explained:Certain antibiotics may slow down the activity of an enzyme (protein) that helps break down the hormone in Nexplanon. Taking these antibiotics while you have Nexplanon could cause the hormone to leave your body more slowly than it should. This can raise the level of the hormone, increasing your risk of side effects from Nexplanon.

Other antibiotics may slow down the activity of an enzyme that helps break down the hormone in Nexplanon. If you take these antibiotics while you have Nexplanon, the hormone may leave your body faster than it should. This can lower the level of the hormone in your system, making Nexplanon less effective.

Examples of antibiotic drugs: Here are some antibiotics that may interact with Nexplanon:

• ciprofloxacin (Cipro)
• clarithromycin
• erythromycin (Eryc, Ery-Tab, others)

Steps you or your doctor may take:If you’re prescribed an antibiotic while you have Nexplanon, your doctor can tell you whether it may interact with Nexplanon.

With certain antibiotics, your doctor may advise you to watch for side effects from Nexplanon. Examples include nausea, headache, and mood changes. Your doctor can recommend what to do if you have side effects while taking an antibiotic with Nexplanon.

With other antibiotics, your doctor may recommend using a backup method of birth control. Examples of backup methods include a diaphragm or condom. Your doctor may advise you to continue using the backup method for at least 4 weeks after stopping the antibiotic.

If you have other questions about Nexplanon and antibiotics, talk with your doctor or pharmacist.

Certain stimulants

Doctors prescribe stimulants for many uses, including excessive daytime sleepiness.

Interaction result: Taking certain stimulants while you have Nexplanon could make Nexplanon less effective.

Interaction explained: Certain stimulants may speed up the activity of an enzyme (protein) that helps break down the hormone in Nexplanon. Taking these stimulants while you have Nexplanon could cause the hormone to leave your body faster than it should. This can lower the level of the hormone in your system, making Nexplanon less effective.

Examples of stimulant drugs: Armodafinil (Nuvigil) and modafinil (Provigil) are some stimulants that may interact with Nexplanon.

Steps you or your doctor may take: If you take a stimulant that interacts with Nexplanon, your doctor may recommend using a backup method of birth control. Examples of backup methods include a diaphragm or condom.

If your doctor stops treatment with the stimulant, they may advise you to keep using the backup method for at least 4 weeks after stopping the stimulant.

If you have other questions about Nexplanon and certain stimulants, talk with your doctor or pharmacist.

Metformin

Metformin (Fortamet, Glumetza) is prescribed to treat type 2 diabetes.

Interaction result: Taking metformin while you have Nexplanon could make metformin less effective.

Interaction explained: Metformin is used to manage blood sugar levels. Nexplanon may increase your blood sugar level, which could make metformin less effective for this use.

Steps you or your doctor may take: If you take metformin while you have Nexplanon, your doctor may have you check your blood sugar levels more often than usual. They’ll use these test results to decide whether they should adjust your metformin dosage.

If you have other questions about Nexplanon and metformin, talk with your doctor or pharmacist.

Nexplanon may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Nexplanon.

Nexplanon interactions with supplements

Before you start treatment with Nexplanon, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Nexplanon interactions with herbs

Doctors will typically recommend that you avoid taking St. John’s wort with Nexplanon. St. John’s wort is an herbal supplement that that some people take to treat depression and other conditions.

St. John’s wort may speed up the activity of an enzyme in your body that helps break down the hormone in Nexplanon. By speeding up this enzyme, St. John’s wort can cause the hormone to break down more quickly. And this may lead to a low level of the hormone in your system. If the level of this hormone in your system is too low, Nexplanon may not work to prevent pregnancy.

If your doctor prescribes Nexplanon with St. John’s wort, be sure to tell them if you have breakthrough bleeding. This could be a sign that Nexplanon isn’t working as well as it should. Your doctor may advise you to stop taking St. John’s wort. They may also recommend using a backup method of birth control for at least 4 weeks after stopping the herb. (Examples of backup methods include a diaphragm or condom.)

Your doctor may be able to suggest a treatment option other than St. John’s wort.

Nexplanon and vitamins

There are no specific reports of vitamins interacting with Nexplanon. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product while you have the Nexplanon implant.

Nexplanon interactions with food

Nexplanon may interact with grapefruit and grapefruit juice. Grapefruit products can stop your body from breaking down the hormone found in Nexplanon. This may raise the level of the hormone in your body, which increases your risk of side effects from Nexplanon.

Before starting Nexplanon treatment, tell your doctor if you consume grapefruit products. They may recommend having a consistent amount of grapefruit or grapefruit juice while you have the Nexplanon implant.

If you have additional questions or want more information about consuming grapefruit while you have Nexplanon, talk with your doctor.

Nexplanon and vaccines

There are no known interactions between Nexplanon and vaccines. Talk to your doctor or pharmacist to see whether you’re due for any vaccines.

Nexplanon interactions with lab tests

Nexplanon may interact with certain lab tests. Specifically, it may interact with certain tests used to monitor for endocrine disorders. These include lab tests for sex hormone-binding globulin and a thyroid hormone called thyroxine.

If you need to have one of these tests done, make sure the healthcare professional giving the test knows you have the Nexplanon implant.

NEXPLANON AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Nexplanon. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Nexplanon. The impact of cannabis may affect how well you stick to your Nexplanon treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Nexplanon. Before you start Nexplanon treatment, be sure to talk with your doctor about your health history. Nexplanon may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Nexplanon include:

• Breast cancer: Healthcare professionals typically won’t insert Nexplanon if you’ve ever had breast cancer. For details, see the “When to avoid Nexplanon” section above.
• Liver disease or liver cancer: Healthcare professionals typically won’t insert Nexplanon if you have liver disease or liver cancer. For details, see the “When to avoid Nexplanon” section above.
• Blood clots: Healthcare professionals typically won’t insert Nexplanon if you’ve ever had a blood clot. For details, see the “When to avoid Nexplanon” section above.
• Irregular periods: Healthcare professionals typically won’t insert Nexplanon if you have irregular periods without a known cause. For details, see the “When to avoid Nexplanon” section above.
• Diabetes: If you have diabetes, talk with your doctor before starting Nexplanon treatment. The implant may increase your blood sugar level, which could worsen diabetes. Your doctor can tell you whether the Nexplanon implant is a safe birth control option.
• Depression: If you have depression, talk with your doctor before having Nexplanon inserted. Nexplanon may cause mood changes that worsen your condition. Talk with your doctor about whether Nexplanon is a safe birth control option for you.
• High blood pressure: If you have high blood pressure that isn’t well-managed, it may not be safe to have Nexplanon. This is because having the implant can raise your blood pressure even further. Your doctor can recommend whether Nexplanon is a safe birth control option for you.
• Kidney problems: If you have a kidney problem, such as kidney failure, it may not be safe to have Nexplanon. Kidney problems may increase your risk of high blood pressure as a side effect of the implant. Your doctor can recommend whether Nexplanon is the right birth control option for you.
• Allergic reaction: If you’ve had an allergic reaction to Nexplanon or any of its ingredients, your doctor will likely not prescribe Nexplanon. Having the implant could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: It’s likely safe to have the Nexplanon implant while breastfeeding. The hormone in Nexplanon may pass into breast milk. However, side effects of Nexplanon have not been reported in children who have been breastfed. If you’re breastfeeding or planning to, talk with your doctor before using Nexplanon. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: Nexplanon is a birth control implant that helps prevent pregnancy. Healthcare professionals won’t insert Nexplanon during a pregnancy or possible pregnancy. For details, see the “When to avoid Nexplanon” section above.

Here are some frequently asked questions about Nexplanon and possible interactions.

Are there any interactions that can cause Nexplanon to fail?

Yes, some interactions could make Nexplanon less effective. Certain medications or supplements could make the implant stop working before its recommended expiration time of 3 years.

Examples include:

• certain antibiotics, such as rifampin (Rifadin, Rimactane)
• certain antiseizure drugs, such as carbamazepine (Carbatrol, Tegretol, others)
• certain stimulants, such as armodafinil (Nuvigil)
• certain HIV drugs, such as efavirenz
• griseofulvin (Fulvicin, Gris-PEG)
• St. John’s wort

Your doctor can tell you about symptoms that could mean Nexplanon is not working as well as it should. For example, you may notice breakthrough bleeding.

Before you start treatment with Nexplanon, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. Doing so may help prevent possible interactions.

If you notice signs that suggest Nexplanon is wearing off, talk with your doctor. They can determine whether you need a backup birth control method or if Nexplanon should be removed.

Could any interactions increase the risk of Nexplanon’s side effects?

Yes, it’s possible. Certain medications or foods could increase the risk of side effects from Nexplanon.

Examples of these substances include:

• certain antibiotics, such as ciprofloxacin (Cipro)
• certain antifungals, such as ketoconazole
• certain calcium channel blockers, such as verapamil (Verelan, Verelan PM)
• certain HIV drugs, such as ritonavir (Norvir)
• grapefruit and grapefruit juice

Examples of Nexplanon’s side effects include nausea, headache, and mood changes. For details about the implant’s side effects, see this article.

Before you have Nexplanon inserted, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. Talking with them may help prevent possible interactions.

If you have other questions about interactions and Nexplanon’s side effects, talk with your doctor.

You can take certain steps to help prevent interactions with Nexplanon. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Nexplanon label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Nexplanon doesn’t come with paperwork, you can ask your doctor to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.