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Drug interactions between ethinyl estradiol / segesterone and sarilumab

Results for the following 2 drugs:
ethinyl estradiol/segesterone
sarilumab

Interactions between your drugs

Moderate

ethinyl estradiol sarilumab

Applies to: ethinyl estradiol / segesterone and sarilumab

Sarilumab may decrease the blood levels and effects of ethinyl estradiol. You may need a dose adjustment if you have been receiving ethinyl estradiol and are starting treatment with sarilumab. Likewise, if you have been receiving both medications, the dose of ethinyl estradiol may need to be adjusted when sarilumab is discontinued. Contact your doctor if your condition changes or you experience increased side effects. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

sarilumab segesterone

Applies to: sarilumab and ethinyl estradiol / segesterone

Consumer information for this interaction is not currently available.

MONITOR: Plasma concentrations of drugs that are CYP450 substrates may decrease following the initiation of interleukin (IL) inhibitors, tumor necrosis factor (TNF) blockers, or interferon (IFN) inhibitors in patients with chronic inflammatory diseases. Because the formation of hepatic CYP450 enzymes is down-regulated during infection and chronic inflammation by increased levels of certain cytokines (e.g., interleukins-1, -6, and -10; tumor necrosis factor alpha; interferons), treatment targeting these cytokines may restore or normalize CYP450 enzyme levels resulting in increased metabolism of these drugs. In vitro studies showed that tocilizumab, an IL-6 inhibitor, has the potential to impact expression of various hepatic microsomal enzymes including CYP450 1A2, 2B6, 2C9, 2C19, 2D6, and 3A4. Its effects on CYP450 2C8 or transporters is unknown. In vivo studies with omeprazole (a substrate of CYP450 2C19 and 3A4) and simvastatin (a substrate of CYP450 3A4 and OATP 1B1) showed decreases of up to 28% and 57% in systemic exposure, respectively, one week following a single dose of tocilizumab. Likewise, simvastatin and simvastatin acid exposures decreased by 45% and 36%, respectively, in 17 patients with rheumatoid arthritis one week following a single 200 mg subcutaneous dose of sarilumab, another IL-6 inhibitor. A role for other interleukins such as IL-12, IL-17A, or IL-23 in the regulation of CYP450 enzymes has not been established, and it is not known whether antagonists of these interleukins (e.g., guselkumab, ixekizumab, secukinumab, tildrakizumab, ustekinumab) would similarly affect CYP450 metabolism.

MANAGEMENT: Caution is advised when treatments targeting cytokines such as interleukins, tumor necrosis factors, or interferons are prescribed to patients receiving concomitant drugs that are CYP450 substrates, particularly those with narrow therapeutic ranges (e.g., antiarrhythmics, anticonvulsants, immunosuppressants, theophylline) or sensitive substrates where decreases in plasma levels may be significant or undesirable (e.g., oral contraceptives, statins, benzodiazepines, opioids). Clinical and/or laboratory monitoring should be considered following the initiation or withdrawal of such treatments, and the dosage(s) of the CYP450 substrate(s) adjusted accordingly. Clinicians should note that the effects of IL inhibitors, TNF blockers, and IFN inhibitors on CYP450 activities may persist for several weeks after stopping therapy.

References

  1. "Product Information. Ilaris (canakinumab)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. "Product Information. Gamifant (emapalumab)." Sobi Inc, Ardmore, PA.
  3. "Product Information. Cosentyx (secukinumab)." Novartis Pharmaceuticals, East Hanover, NJ.
  4. "Product Information. Kevzara (sarilumab)." sanofi-aventis, Bridgewater, NJ.
  5. "Product Information. Simponi (golimumab)." Centocor Inc, Malvern, PA.
  6. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  7. "Product Information. Actemra (tocilizumab)." Genentech, South San Francisco, CA.
  8. "Product Information. Sylvant (siltuximab)." Janssen Biotech, Inc., Horsham, PA, PA.
  9. "Product Information. Amevive (alefacept)." Biogen, Cambridge, MA.
  10. "Product Information. Remicade (infliximab)." Centocor Inc, Malvern, PA.
  11. "Product Information. Taltz Autoinjector (ixekizumab)." Eli Lilly and Company, Indianapolis, IN.
  12. "Product Information. Stelara (ustekinumab)." Centocor Inc, Malvern, PA.
  13. "Product Information. Arcalyst (rilonacept)." Regeneron Pharmaceuticals Inc, Tarrytown, NY.
View all 13 references

Drug and food interactions

Moderate

segesterone food

Applies to: ethinyl estradiol / segesterone

Consumer information for this interaction is not currently available.

MONITOR: Grapefruit juice may increase the plasma concentrations of orally administered drugs that are substrates of the CYP450 3A4 isoenzyme. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because grapefruit juice inhibits primarily intestinal rather than hepatic CYP450 3A4, the magnitude of interaction is greatest for those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability). In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Patients who regularly consume grapefruit or grapefruit juice should be monitored for adverse effects and altered plasma concentrations of drugs that undergo significant presystemic metabolism by CYP450 3A4. Grapefruit and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact with these drugs.

Minor

ethinyl estradiol food

Applies to: ethinyl estradiol / segesterone

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

For clinical details see professional interaction data.

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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