Nextstellis (drospirenone/estetrol) is a prescription drug that’s used to help prevent pregnancy. This drug can interact with other medications and some supplements. For example, Nextstellis can interact with cholestyramine (Locholest, Prevalite) and metformin (Fortamet, Glumetza).
Nextstellis is used to help prevent pregnancy in females* of any age who can become pregnant.
Nextstellis comes as an oral tablet. Its active ingredients are drospirenone and estetrol. These are what make the drug work.
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Nextstellis’s possible interactions. And for more information about Nextstellis, including details about its uses, see this article.
* In this article, we use the term “female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.
Before you start taking Nextstellis, 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 Nextstellis interacts with herbs or vitamins and supplements, see the “Are there other interactions with Nextstellis?” 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 Nextstellis. Keep in mind that this table does not include all drugs that may interact with Nextstellis. For more information about some of these interactions, see the “Drug interactions explained” section below.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| bile acid sequestrants | • cholestyramine (Locholest, Prevalite) • colesevelam (Welchol) • colestipol (Colestid) | can make Nextstellis less effective |
| corticosteroids | • prednisone (Rayos) • methylprednisolone (Medrol) • dexamethasone (Hemady) | can increase the risk of side effects from corticosteroids |
| diabetes drugs | • metformin (Fortamet, Glumetza) • glyburide (Diabeta, Glynase) • insulin | can make diabetes drugs less effective |
| thyroid hormone drugs | • levothyroxine (Synthroid, Unithroid, other) • liothyronine (Cytomel) • desiccated thyroid (Armour Thyroid, NP Thyroid) | can make thyroid hormone drugs less effective |
| potassium-sparing diuretics | • triamterene (Dyrenium) • spironolactone (Aldactone, Carospir) • eplerenone (Inspra) | can increase the risk of high blood potassium from Nextstellis and potassium-sparing diuretics |
| certain seizure drugs | • carbamazepine (Carbatrol, Epitol, others) • oxcarbazepine (Oxtellar XR, Trileptal) • phenytoin (Dilantin, Phenytek) • topiramate (Qudexy XR, Topamax) | can make Nextstellis less effective |
| certain antifungal drugs | • itraconazole • fluconazole (Diflucan) • voriconazole (Vfend) • ketoconazole • griseofulvin (Fulvicin, Gris-PEG) | can make Nextstellis less effective or increase the risk of side effects from Nextstellis |
| certain HIV drugs | • nelfinavir (Viracept) • ritonavir (Norvir) • nevirapine (Viramune, Viramune XR) • etravirine (Intelence) | can increase the risk of liver damage from Nextstellis and certain HIV drugs |
| rifampin (Rifadin, Rimactane) | — | can make Nextstellis less effective |
| lamotrigine (Lamictal, Lamictal XR, others) | — | can make lamotrigine less effective |
Certain health conditions or other factors could raise your risk of harm if you take Nextstellis. In such cases, your doctor may not prescribe Nextstellis for you. These are known as contraindications. The list below includes contraindications of Nextstellis.
If you have certain liver problems: Doctors typically will not prescribe Nextstellis if you have certain liver problems. These include:
- hepatic adenoma (a rare type of liver tumor)
- hepatocellular carcinoma (a type of liver cancer)
- acute (sudden) hepatitis (inflammation of the liver)
- decompensated cirrhosis (severe liver scarring)
Nextstellis contains a hormone that could worsen liver tumors or liver cancer. Nextstellis may also increase liver enzyme levels, which could worsen liver inflammation or scarring.
In addition, having a liver problem could increase the risk of high blood potassium as a side effect of Nextstellis.
If you have kidney problems: Doctors typically will not prescribe Nextstellis if you have a kidney problem, such as kidney failure. This is because having a kidney problem could increase the risk of high blood potassium as a side effect of Nextstellis.
If you have adrenal insufficiency: Doctors typically will not prescribe Nextstellis if you have adrenal insufficiency. With this condition, your adrenal glands do not make enough cortisol hormone. Having adrenal insufficiency could increase the risk of high blood potassium as a side effect of Nextstellis.
If you have a high risk of blood clots: Doctors typically will not prescribe Nextstellis if you have factors that increase your risk of blood clots. These factors include:
- smoking cigarettes and being age 35 years or above*
- current or past blood clots in a lung or blood clots in a deep vein or having a genetic (inherited) condition that increases this risk
- coronary artery disease (a type of heart disease)
- cerebrovascular disease (conditions that affect blood flow in your brain)
- migraine with aura
- type 1 diabetes with high blood pressure or having type 1 diabetes for more than 20 years
- type 2 diabetes with high blood pressure or having type 2 diabetes for more than 20 years
- high blood pressure that isn’t well managed or that occurs with circulation problems
- irregular heart rhythm, such as atrial fibrillation
Taking Nextstellis may raise your risk of blood clots. Your risk may be even higher if you have any of the factors above.
* Nextstellis has a boxed warning about the risk of serious cardiovascular events with cigarette smoking. For details, see the “Boxed warning” at the top of this article.
If you have abnormal uterine bleeding without a known cause: Doctors typically will not prescribe Nextstellis if you have abnormal uterine bleeding without a known cause. This is because Nextstellis may cause bleeding or spotting between periods. This side effect can make it challenging to find out what’s causing the abnormal bleeding.
If you ever had breast cancer: Doctors typically will not prescribe Nextstellis if you have current or past breast cancer. This is because Nextstellis contains a hormone that could encourage breast cancer to grow or come back.
Before you start taking Nextstellis, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Nextstellis is safe for you to take.
Nextstellis is not known to interact with alcohol. But Nextstellis may cause high liver enzyme levels, which could be a sign of liver damage.
Consuming five or more alcoholic drinks daily greatly increases the risk of liver damage. So, drinking large amounts of alcohol during Nextstellis treatment could further increase this risk.
If you have questions about consuming alcohol during Nextstellis treatment, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with Nextstellis.
Interaction with bile acid sequestrants
Nextstellis can interact with bile acid sequestrants. These are drugs that lower cholesterol. Examples of bile acid sequestrants include:
- cholestyramine (Locholest, Prevalite)
- colesevelam (Welchol)
- colestipol (Colestid)
What could happen
Bile acid sequestrants may affect your body’s ability to absorb Nextstellis. So taking these drugs together could result in a lower level of Nextstellis in your system. This lower level could mean the drug is less effective at helping prevent pregnancy.
What you can do
If you take a bile acid sequestrant, talk with your doctor before starting Nextstellis treatment. They can help you determine whether it’s safe to take these medications together.
If your doctor prescribes Nextstellis with a bile acid sequestrant, they may have you separate your doses of each drug by several hours. This can help reduce the risk of an interaction between the drugs.
Your doctor can tell you about symptoms that could suggest Nextstellis is not working as it should. For example, you may notice more bleeding or spotting between periods. If you have these symptoms, your doctor can advise you on what to do.
Talk with your doctor or pharmacist if you have questions about taking Nextstellis with a bile acid sequestrant.
Interaction with diabetes drugs
Nextstellis can interact with diabetes drugs, which are used to help manage blood sugar levels. Examples of diabetes drugs include:
What could happen
Nextstellis may increase your blood sugar levels, while diabetes drugs are used to lower blood sugar levels. So taking these drugs together can make it difficult for the diabetes drug to work properly.
What you can do
Before starting Nextstellis treatment, tell your doctor if you take a diabetes drug. They can advise whether it’s safe to take these medications together.
If your doctor prescribes Nextstellis with a diabetes drug, they may increase your diabetes drug dosage. This may help you manage your blood sugar levels.
Talk with your doctor or pharmacist if you have questions about taking Nextstellis with a diabetes drug.
Interaction with thyroid hormone drugs
Nextstellis can interact with thyroid hormone drugs, which are used for certain thyroid conditions. Examples of thyroid hormone medications include:
- levothyroxine (Synthroid, Unithroid, other)
- liothyronine (Cytomel)
- desiccated thyroid (Armour Thyroid, NP Thyroid)
What could happen
Nextstellis may increase the level of a protein in your blood that’s related to thyroid conditions. So taking Nextstellis with a thyroid hormone drug could interfere with the thyroid hormone drug’s ability to work properly.
What you can do
Before taking Nextstellis, tell your doctor if you’re taking a thyroid hormone drug. They can advise you on whether it’s safe to take these medications together.
If you’re prescribed Nextstellis with a thyroid hormone drug, your doctor may adjust the dosage of your thyroid hormone drug. They can also monitor levels of the protein that Nextstellis may affect. Doing so can help them determine how well your thyroid hormone drug is working.
If you have questions about taking Nextstellis with a thyroid hormone drug, talk with your doctor or pharmacist.
Nextstellis may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Nextstellis.
Does Nextstellis interact with supplements?
Nextstellis may interact with potassium supplements. Both Nextstellis and these supplements may cause high blood potassium. So taking them together can increase the risk of this side effect.
Before you start taking Nextstellis, talk with your doctor and pharmacist about any herbs or vitamins and supplements 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.
Nextstellis interactions with herbs
Nextstellis can interact with St. John’s wort, which is an herb some people use to ease symptoms of depression and other conditions.
Taking Nextstellis with St. John’s wort could cause your body to break down Nextstellis too quickly. This can lower the level of Nextstellis in your system and make the drug less effective.
Due to this risk, your doctor may advise you to avoid St. John’s wort while you’re taking Nextstellis. They can recommend alternative treatments for you.
If you take Nextstellis with St. John’s wort, your doctor may advise you to use a backup method of birth control. They may suggest using a backup method while you take them together and for at least 4 weeks after you stop taking St. John’s wort. Examples of backup birth control methods include a diaphragm or condom.
Talk with your doctor or pharmacist before taking any herbal supplements with Nextstellis.
Nextstellis and vitamins
Nextstellis currently has no reports of 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 vitamins while taking Nextstellis.
Does Nextstellis interact with food?
Nextstellis may interact with grapefruit or grapefruit juice.
Consuming grapefruit products while you’re taking Nextstellis could keep your body from breaking down the drug properly. This may increase the amount of Nextstellis in your system. In turn, that could raise your risk of side effects from the drug.
Before taking Nextstellis, tell your doctor if you eat grapefruit or drink grapefruit juice. They can advise whether it’s safe to continue doing so during Nextstellis treatment.
Does Nextstellis interact with vaccines?
Nextstellis currently has no reports of interacting with vaccines. If you have questions about getting certain vaccines during your Nextstellis treatment, talk with your doctor.
Does Nextstellis interact with lab tests?
Nextstellis currently has no reports of interacting with lab tests.
But it’s important to be aware that Nextstellis could increase the levels of certain proteins in your blood. These proteins are related to conditions pertaining to thyroid, cortisol, and sex hormones. This means that Nextstellis could affect the results of lab tests that monitor these conditions.
Be sure to inform your healthcare professional if you’re taking Nextstellis. This will help them understand the effect the drug may have on your lab test results.
Does Nextstellis interact with cannabis or CBD?Nextstellis currently has no reports of 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 using cannabis with Nextstellis.
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 Nextstellis. Before taking Nextstellis, talk with your doctor about your health history. They’ll determine whether Nextstellis is right for you.
Health conditions or other factors that might interact with Nextstellis include:
Kidney problems: Doctors typically will not prescribe Nextstellis if you have a kidney problem, such as kidney failure. For details, see the “When should I avoid Nextstellis?” section above.
Adrenal insufficiency: Doctors typically will not prescribe Nextstellis if you have adrenal insufficiency. For details, see the “When should I avoid Nextstellis?” section above.
Blood clots: Doctors typically will not prescribe Nextstellis if you have factors that increase your risk of blood clots. Examples include having:
- current or past blood clots in a lung or blood clots in a deep vein
- irregular heart rhythm
- migraine with aura
For details, see the “When should I avoid Nextstellis?” section above.
Abnormal uterine bleeding without a known cause: Doctors typically will not prescribe Nextstellis if you have abnormal uterine bleeding without a known cause. For details, see the “When should I avoid Nextstellis?” section above.
Liver problems: Doctors typically will not prescribe Nextstellis if you have certain liver problems. These include:
For details, see the “When should I avoid Nextstellis?” section above.
In addition, having a liver problem could raise your risk of side effects from the drug.
It’s not known whether Nextstellis is safe for people who have severe liver problems. In this case, your doctor may prescribe a birth control option other than Nextstellis.
Cancer: Doctors typically will not prescribe Nextstellis if you have certain cancers or had them before. These include cervical cancer and breast cancer. This is because Nextstellis contains a hormone that could encourage these cancers to grow or come back.
If you’ve ever had these cancers, your doctor may prescribe a birth control option besides Nextstellis.
High cholesterol or triglyceride levels: Before taking Nextstellis, be sure to tell your doctor if you have high cholesterol or high triglyceride levels. Taking Nextstellis may increase these levels more. Talk with your doctor about whether Nextstellis is right for you.
It’s important to note that having high cholesterol or high triglyceride levels could increase your risk of serious cardiovascular (heart and blood vessel) events. Nextstellis has a boxed warning about these events with cigarette smoking. For details, see the “Boxed warning” at the top of this article.
Gallbladder disease: Before taking Nextstellis, tell your doctor if you have gallbladder disease. Taking Nextstellis may worsen this condition. Your doctor can recommend whether Nextstellis is right for you.
Melasma during pregnancy: Before you take Nextstellis, tell your doctor if you ever had melasma during pregnancy. Having this condition in the past could increase your risk of melasma as a side effect of the drug. Talk with your doctor about whether Nextstellis is right for you.
Obesity: If you have obesity, Nextstellis may not work as well for preventing pregnancy. Your doctor can recommend whether Nextstellis or a different birth control option is right for you.
Pregnancy: Nextstellis is prescribed to help prevent pregnancy. Doctors will not prescribe the drug during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Nextstellis.
Breastfeeding: It’s not known whether it’s safe to take Nextstellis while breastfeeding. The drug may pass into breast milk, but it’s not known whether the drug may cause side effects in a child who’s breastfed.
It’s important to note that Nextstellis may decrease milk production. This could make it difficult to breastfeed while you’re taking the drug.
If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to Nextstellis or any of its ingredients, your doctor likely won’t prescribe Nextstellis. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Taking certain steps can help you avoid interactions with Nextstellis. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- Whether you drink alcohol or use 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 Nextstellis treatment.
It’s also important to understand Nextstellis’s
If you have difficulty reading or understanding this information, your doctor or pharmacist can help.
Taking Nextstellis exactly as prescribed can also help prevent interactions.
If you still have questions about Nextstellis and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- Does the length of time I take Nextstellis affect my risk of interactions?
- How do the interactions of Nextstellis compare with those of other birth control options?
- Knowing my health history, is Nextstellis the right birth control option for me?
To learn more about Nextstellis, see the article “Nextstellis (drospirenone/estetrol).”
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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.