Dr. Staci Tanouye is a wellness contributor to In The Know. Follow her on Instagram and Tik Tok for more.
This seems to be an unfortunate trend on TikTok: Users posting videos claiming that certain supplements or foods somehow “cancel” birth control pills, also known as oral contraceptive pills (OCP). By “cancel,” they refer to interacting negatively with birth control pills, rendering them ineffective.
And that Really interacts with birth control pills and what doesn’t?
This can be a really confusing question with potentially confusing answers. I’m sure at one point your Aunt Karen told you that she once lived next door to a healthcare provider who told her that the sun overrides birth control pills, which means that you would definitely get pregnant walking outside without sunscreen.
Well probably not exactly well, but you see where I’m going with this.
To be fair, the myth that certain things, from sunlight to antibiotics, can interact with birth control pills has been around for decades. Some of these myths are still perpetuated by healthcare providers and pharmacists to this day. I can see how navigating the truths and myths surrounding the “cancellation” of birth control pills can get very confusing.
But what I’m starting to see online now is people making wild and dangerous claims that everything from alcohol to melatonin to cinnamon can inhibit the effectiveness of OCs. Yeah I’m not even kidding cinnamon.
There are so many mixed messages (and crazy rumors) about what and excuse me things could potentially interact with birth control pills.
I’m here to break it down for you. These are the important things to remember:
The failure rates of OCs with average use can be as high as 9%, regardless of other medications taken at the same time.
That’s not a small number when it comes to unintended pregnancies, so it’s important to realize that while we often want to blame external forces, accidents and mistakes when taking OCs happen much more often than you think. . Also, anything that affects the absorption of any medicine could make it less effective. Therefore, things like a stomach virus, various illnesses, or bariatric surgery can affect the absorption of OCPs and increase failure rates.
Some medications can lower the levels of ethinyl estradiol (synthetic estrogen) and / or the progestin component in OACs.
This is because certain medications do not regulate the activity of liver enzymes, which increases the metabolism of OCP, causing a decrease in the concentration of OCP. Basically these drugs can make birth control less effective. But the list of drugs that do this is much shorter than you think:
Phenobarbital and other barbiturates; anticonvulsants, such as phenytoin, carbamazepine, primidone, topiramate, felbamate, and oxcarbazepine; the antibiotics rifampicin and rifabutin (yes, just both, that’s all folks); the antifungal griseofulvin; anti-HIV medication; and St. John’s wort.
At one time, tetracyclines and penicillins were thought to decrease the effectiveness of OACs. But this finding (based on small studies) has since been refuted by larger studies, as well as pharmacokinetic studies. But we know in science and medicine that nothing is impossible, and sometimes data evolves. If you’re still concerned, it’s always a good idea to add a condom, especially since condoms are recommended to prevent sexually transmitted infections anyway.
Even these drugs do not automatically reduce the effectiveness of an OCP.
But lowering the concentration of an estrogen component of OCP May make them less effective in preventing ovulation. Therefore, the failure rate will not be 100% every time you take these other medications together with the OCPs. But it can be higher than the initial failure rate of 9%. This also means that if a person is taking one of these medications, OCs could still be an option for them with appropriate informed consent, especially if they cannot take or do not have access to other options. If possible, adding a barrier method, such as a condom, is a good idea. Basically, in some patients, something may be better than nothing.
Interactions between drugs and OACs can also mean interactions other than decreased effectiveness of OACs.
For example, OCPs can decrease the effectiveness of lamotrigine, an anticonvulsant medicine. Also, some medications can increase OCP concentrations or vice versa. Melatonin is an example. If taken with an OCP, the concentration of both the OCP and melatonin could potentially increase. There is limited data here, but it is possible.
Grapefruit is another example that can increase concentration of the OCP. Increasing the circulating concentrations of something might increase the side effects, but should not alter the efficacy.
Wow, that was a mouthful. Are you still following me?
Let’s sum things up:
The only antibiotics that have been shown to decrease the strength of oral contraceptives and thus decrease efficacy are rifampicin and rifabutin.
Remember, OCs have a typical baseline use failure of up to 9% for multiple different reasons that do not include the use of antibiotics. Misplaced guilt is not helpful in solving the underlying problems here.
OCs can also affect the levels of other medications both positively and negatively.
Things that do not “cancel” birth control pills: melatonin, grapefruit, caffeine, nicotine, alcohol, cinnamon, and most antibiotics.
Check out this link for a reliable and up-to-date review of OCP interactions. And as always, when in doubt, add another backup method, if possible.
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