Nexplanon Interactions: Alcohol, Medications, and Others

Certain health conditions or other factors could raise your risk of harm if you have a Nexplanon implant. In such cases, your doctor may not prescribe Nexplanon for you. These are known as contraindications. The list below includes contraindications of Nexplanon.

If you’re pregnant. Nexplanon is used to help prevent pregnancy. Healthcare professionals will not insert the Nexplanon implant if you’re pregnant.

If you become pregnant while you have a Nexplanon implant, tell your doctor right away. They’ll help you decide whether it’s safe to continue the pregnancy. If you choose to continue the pregnancy, your doctor will remove the Nexplanon implant.

If you have certain cancers or had them in the past. Healthcare professionals will not insert the Nexplanon implant if you have breast cancer or had it in the past. They also will not insert Nexplanon if you’ve had any other cancer that’s sensitive to a hormone called progestin.

This is because Nexplanon contains a type of progestin hormone called etonogestrel. This hormone may increase the risk of these cancers growing or coming back.

Before having Nexplanon inserted, be sure to tell your doctor about any cancers you have or had in the past. They can tell you whether Nexplanon is a safe treatment option. If needed, your doctor can recommend a different birth control option.

If you have liver disease or liver tumors. Healthcare professionals will not insert the Nexplanon implant if you have liver disease or liver tumors. This is because Nexplanon contains a hormone called etonogestrel. This hormone may worsen liver disease or liver tumors.

Before having Nexplanon inserted, tell your doctor if you have liver disease or liver tumors. They can recommend a different option for birth control.

If you have irregular genital bleeding with no known cause. Healthcare professionals will not insert the Nexplanon implant if you have irregular genital bleeding with no known cause.

Before having Nexplanon inserted, tell your doctor if you have irregular genital bleeding. They can recommend a different option for birth control. Your doctor can also help check for possible causes of genital bleeding.

If you have blood clots or have had them in the past. Healthcare professionals will not insert the Nexplanon implant if you have blood clots or have had them in the past.

This is because Nexplanon may raise your risk of blood clots. In severe cases, blood clots can lead to a stroke or heart attack. Your risk of blood clots may be higher if you already have a blood clot or have had one in the past.

Before having Nexplanon inserted, tell your doctor if you’ve had blood clots. They can recommend a different birth control option.

If you’ve had an allergic reaction. If you’ve had an allergic reaction to Nexplanon or any of its ingredients, your doctor likely won’t prescribe Nexplanon. This is because having the implant could cause another allergic reaction. You can ask your doctor about other treatments that may be better for you.

Before you start Nexplanon treatment, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Nexplanon is safe for you to use.

Nexplanon is not known to interact with alcohol. However, drinking alcohol while you have the Nexplanon implant could worsen certain side effects from the implant. Examples include headache and nausea. For more information about Nexplanon’s side effects, see this article.

If you drink alcohol, talk with your doctor about how much (if any) may be safe to drink with Nexplanon.

Before you start Nexplanon treatment, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. To learn whether Nexplanon interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Nexplanon?” section below.

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

The table below lists drugs that may interact with Nexplanon. Keep in mind that this table does not include all drugs that may interact with Nexplanon. For more information about some of these interactions, see the “Drug interactions explained” section below.

* To learn more about Nexplanon’s side effects, see this article.

Learn more about certain drug interactions that can occur with Nexplanon.

Interactions with certain seizure drugs

Nexplanon can interact with certain seizure drugs. These are drugs prescribed to treat conditions that cause seizures, such as epilepsy.

Examples of seizure medications include:

• topiramate (Topamax, Qudexy XR, Trokendi XR)
• lamotrigine (Lamictal, Lamictal XR, others)
• carbamazepine (Carbatrol, Tegretol, others)
• oxcarbazepine (Oxtellar XR, Trileptal)
• phenobarbital (Sezaby)

What could happen

Taking certain seizure drugs while you have the Nexplanon implant could make Nexplanon less effective. This is because certain seizure drugs can cause your body to break down etonogestrel too quickly. (Etonogestrel is the active drug in Nexplanon. An active drug is what makes a medication work.)

This can lead to high levels of etonogestrel in your system. Having high levels of the drug may raise your risk of side effects from the implant.

What you can do

Before having the Nexplanon implant, tell your doctor about any seizure drugs you take. They may avoid prescribing Nexplanon with certain seizure drugs. Your doctor can determine whether it’s safe to take the specific seizure drug you’re prescribed while you have the Nexplanon implant.

In some cases, your doctor may still prescribe a seizure drug that interacts with Nexplanon. For example, they may do so if the seizure drug is the best option for treating your specific condition.

If you take certain seizure drugs with Nexplanon, your doctor may have you watch for symptoms of the implant not working as well as it should. These include changes in your menstrual cycle, such as spotting or irregular bleeding. Your doctor can advise you on whether you’ll need to use a backup method of birth control if you take certain seizure drugs with Nexplanon.

Interactions with certain antibiotics

Nexplanon interacts with certain antibiotics, which are drugs used to treat bacterial infections.

Examples of antibiotics include:

• ciprofloxacin (Cipro)
• clarithromycin
• erythromycin (Eryc, Ery-Tab, others)
• griseofulvin (Fulvicin, Gris-Peg)
• rifampin (Rifadin, Rimactane)

What could happen

The effects of taking certain antibiotics while you have the Nexplanon implant can vary, depending on the specific antibiotic. Certain antibiotics can make Nexplanon less effective, while others may increase the risk of side effects from Nexplanon.

For example, taking rifampin or griseofulvin while you have Nexplanon could make Nexplanon less effective. These antibiotics may cause your body to break down etonogestrel* too quickly.

As a result, you may have lower levels of etonogestrel in your system. This could make Nexplanon less effective.

However, taking clarithromycin, ciprofloxacin, or erythromycin while you have Nexplanon can raise your risk of side effects from Nexplanon. These antibiotics may keep the body from breaking down etonogestrel as well as it should. This can lead to higher levels of etonogestrel in your system, raising your risk of side effects from the implant.

* Etonogestrel is the active drug in Nexplanon.

What you can do

If you develop a bacterial infection while you have a Nexplanon implant, be sure the doctor treating the infection knows you have this implant. They may avoid prescribing certain antibiotics with Nexplanon. Your doctor can prescribe an antibiotic that won’t interact with Nexplanon.

In some cases, your doctor may need to prescribe an antibiotic that interacts with Nexplanon. They may do this if a certain antibiotic is the best option for treating your infection.

If you take an antibiotic that interacts with Nexplanon, your doctor can tell you about symptoms to watch for that may mean Nexplanon isn’t working effectively. These may include changes in your menstrual cycle, such as spotting or irregular bleeding. Your doctor can also advise you on whether you’ll need to use a backup method of birth control while you’re taking certain antibiotics with Nexplanon.

Due to interactions that could affect your hormone levels, your doctor may advise you to watch for side effects of the implant. These may include acne, breast pain, or headache. To learn more about Nexplanon’s side effects and what to do if you have them, see this article.

Interactions with certain antifungals

Nexplanon interacts with certain antifungals, which are drugs used to treat fungal infections.

Examples of antifungals include:

• fluconazole (Diflucan)
• itraconazole (Sporanox)
• ketoconazole
• voriconazole (Vfend)

What could happen

Taking certain antifungals while you have the Nexplanon implant could increase your risk of side effects from Nexplanon.

Certain antifungals may keep your body from breaking down etonogestrel properly. (Etonogestrel is the active drug in Nexplanon.) This can lead to high levels of etonogestrel in your system, which can raise your risk of side effects from the implant.

What you can do

If you develop a fungal infection while you have Nexplanon, be sure the doctor treating the infection knows you have the Nexplanon implant. They may avoid prescribing certain antifungals with Nexplanon. Your doctor can recommend an antifungal that won’t affect Nexplanon.

In some cases, your doctor may still prescribe an antifungal that interacts with Nexplanon. For example, they may do so if the antifungal is the best option for treating your specific infection.

If you take an antifungal that interacts with Nexplanon, watch for side effects of Nexplanon. Examples include acne, breast pain, and headache. To learn more about Nexplanon’s side effects and what to do if you have them, see this article.

Nexplanon may have other interactions. They could occur with supplements, foods, vaccines, or lab tests. See below for details. Note that the information below does not include all other possible interactions with Nexplanon.

Does Nexplanon interact with supplements?

Before you start Nexplanon treatment, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Nexplanon interactions with herbs

Having a Nexplanon implant while taking St. John’s wort could make Nexplanon less effective. (St. John’s wort is an herbal supplement for treating conditions such as depression.)

Before treatment with Nexplanon, tell your doctor if you take St. John’s wort. They can discuss whether it’s safe to take while you have the Nexplanon implant.

If you take St. John’s wort during Nexplanon treatment, watch for symptoms that could happen if Nexplanon is not working properly. For example, you may notice changes in your menstrual cycle that include spotting or irregular bleeding.

Nexplanon and vitamins

There are currently no reports of Nexplanon interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products during Nexplanon treatment.

Does Nexplanon interact with food?

Nexplanon may interact with grapefruit or grapefruit juice.

Consuming grapefruit products while you have the Nexplanon implant could keep your body from breaking downetonogestrel properly. (Etonogestrel is the active drug in Nexplanon.) This may increase the amount of Nexplanon in your body, which could raise your risk of side effects from the implant.

Before starting treatment with Nexplanon, tell your doctor if you eat grapefruit or drink grapefruit juice. They can recommend whether it’s safe to continue doing so while you have the Nexplanon implant.

If you do eat grapefruit or drink grapefruit juice during Nexplanon treatment, watch for side effects of Nexplanon. Examples include acne, breast pain, and headache. For more information about Nexplanon’s side effects and what to do if you have them, see this article.

Does Nexplanon interact with vaccines?

There are currently no reports of Nexplanon interacting with vaccines. If you have questions about getting specific vaccines while you have the Nexplanon implant, talk with your doctor.

Does Nexplanon interact with lab tests?

There are currently no reports of Nexplanon interacting with lab tests. If you have questions about getting certain lab tests while you have the Nexplanon implant, talk with your doctor.

Does Nexplanon interact with cannabis or CBD?

There are currently no reports of Nexplanon interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before taking cannabis with Nexplanon.

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

Certain medical conditions or other health factors may raise the risk of interactions with Nexplanon. Before having a Nexplanon implant, talk with your doctor about your health history. They’ll determine whether Nexplanon is right for you.

Health conditions or other factors that might interact with Nexplanon include:

Blood clots. Healthcare professionals will not insert the Nexplanon implant if you have blood clots or have had them in the past. For details, see the “When should I avoid Nexplanon?” section above.

Cancer. Healthcare professionals will not insert the Nexplanon implant if you have certain cancers or have had them in the past. For details, see the “When should I avoid Nexplanon?” section above.

Depression. Before having a Nexplanon implant, be sure to tell your doctor if you have depression. Nexplanon can cause depression and other mood changes. If you already have depression, Nexplanon may make it worse. Talk with your doctor about whether Nexplanon is right for you.

Diabetes or prediabetes. Before starting treatment with Nexplanon, tell your doctor if you have diabetes or prediabetes. Nexplanon can increase your blood sugar level, which could worsen diabetes or prediabetes. Your doctor can recommend whether the Nexplanon implant is a safe option for you.

Genital bleeding. Healthcare professionals will not insert the Nexplanon implant if you have irregular genital bleeding with no known cause. For details, see the “When should I avoid Nexplanon?” section above.

High blood pressure. Before starting Nexplanon treatment, tell your doctor if you have high blood pressure. Nexplanon can increase your blood pressure. If you already have high blood pressure, Nexplanon could worsen your condition. Your doctor can determine 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 use Nexplanon or any other form of hormonal birth control. Talk with your doctor about the right birth control option for you.

Liver problems. Healthcare professionals will not insert the Nexplanon implant if you have certain liver problems. These include liver disease or liver tumors. For details, see the “When should I avoid Nexplanon?” section above.

Pregnancy. Nexplanon is prescribed to help prevent pregnancy. Healthcare professionals will not insert the Nexplanon implant if you’re pregnant or may be pregnant. For details, see the “When should I avoid Nexplanon?” section above.

Breastfeeding. Etonogestrel may pass into breast milk. (Etonogestrel is the active drug in Nexplanon. An active drug is what makes a medication work.)

Side effects from etonogestrel haven’t been reported in children who are breastfed. So Nexplanon is likely safe to have implanted while breastfeeding. But it’s important to note that etonogestrel may decrease milk production. This could make it more difficult to breastfeed while you have a Nexplanon implant.

To learn more about having Nexplanon while breastfeeding, talk with your doctor.

Allergic reaction. If you’ve had an allergic reaction to Nexplanon or any of its ingredients, your doctor will likely not prescribe Nexplanon. This is because having the Nexplanon implant could cause another allergic reaction. You can ask your doctor about other treatments that may be better for you.

Find answers to some frequently asked questions about Nexplanon and possible interactions.

Are there any drug interactions that could make Nexplanon stop working early?

Yes, it’s possible. Taking certain medications or supplements while you have Nexplanon implanted could make Nexplanon less effective. This means the implant may stop working sooner than the usual 3 years.

Examples include:

• certain seizure drugs
• bosentan (Tracleer)
• aprepitant (Aponvie, Cinvanti, Emend)
• St. John’s wort, an herbal supplement

Keep in mind that this article does not include all drugs that may interact with Nexplanon. For this reason, it’s important to tell your doctor about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions with Nexplanon.

Your doctor can advise you on symptoms to watch for that may mean Nexplanon is not working effectively. For example, you may notice changes in your menstrual cycle that include spotting or irregular bleeding.

If you’re concerned that Nexplanon may not be working properly, talk with your doctor. They can advise you on whether you’ll need to use a backup method of birth control. You may also ask them whether Nexplanon should be removed or replaced.

How do Nexplanon’s interactions compare with those of other forms of birth control?

Currently, Nexplanon is the only hormonal birth control implant available in the United States. But other types of hormonal birth control are available.

Because these other medications also contain hormones, their interactions may be similar to those of Nexplanon. Your doctor or pharmacist can tell you more.

Other kinds of hormonal birth control include:

• birth control pills, such as:
  • drospirenone/ethinyl estradiol (Loryna, Yaz, others)
  • ethinyl estradiol/norethindrone (Finzala, Gildess, others)
  • norethindrone (Camila, Errin, others)
• vaginal ring, such as ethinyl estradiol/etonogestrel (NuvaRing)
• injection, such as medroxyprogesterone (Depo-Provera)
• skin patch, such as:
  • ethinyl estradiol/norelgestromin (Xulane)
  • ethinyl estradiol/levonorgestrel (Twirla)
• intrauterine device (IUD), such as levonorgestrel (Kyleena, Mirena, others)

Nonhormonal birth control options are also available. Examples include:

• the copper IUD (Paragard)
• the vaginal gel lactic acid/citric acid/potassium bitartrate (Phexxi)
• condoms or diaphragms

Because these birth control options do not contain hormones, their interactions are likely to be different from Nexplanon’s interactions. For details about this, you can talk with your doctor or pharmacist.

Taking certain steps can help you avoid interactions with Nexplanon. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or take cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you start taking a new drug during your Nexplanon treatment.

It’s also important to understand Nexplanon’s label and other paperwork that may come with the implant. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. If you did not get paperwork with Nexplanon, ask your pharmacist to print a copy for you.

If you have trouble reading or understanding this information, your doctor or pharmacist can help.

If you still have questions about Nexplanon and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• If I have the Nexplanon implant and have certain health conditions, will I be monitored more closely during treatment?
• Do I need to tell you if I start taking another drug or supplement while I have the Nexplanon implant?
• Does the length of time I have the Nexplanon implant affect my risk of interactions?

To learn more about Nexplanon, see these articles:

• All About Nexplanon
• Side Effects of Nexplanon: What You Need to Know
• Dosage Details for Nexplanon
• Nexplanon and Cost: What You Need to Know

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Disclaimer: Healthline 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.