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Drug Interactions between Hyprogesterone and Omeclamox-Pak

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

clarithromycin HYDROXYprogesterone

Applies to: Omeclamox-Pak (amoxicillin / clarithromycin / omeprazole) and Hyprogesterone (hydroxyprogesterone)

Consumer information for this interaction is not currently available.

MONITOR CLOSELY: Coadministration of clarithromycin, telithromycin, or troleandomycin may increase the plasma concentrations of drugs that are substrates of the CYP450 3A4 isoenzyme, by reducing their clearance, as these antibiotics are potent inhibitors of this isoenzyme. Many estrogen and progestin type medications are CYP450 3A4 substrates. These medications are used for a variety of purposes including, but not limited to, contraception, acne treatment, hormone replacement therapy, and appetite stimulation. When telithromycin was co-administered with oral contraceptives containing ethinyl estradiol and levonorgestrel, studies showed that the systemic concentration (AUC) of ethinyl estradiol did not change and the AUC of levonorgestrel increased by 50%. The study showed that telithromycin did not interfere with the anti-ovulatory effect of oral contraceptives containing ethinyl estradiol and levonorgestrel.

MANAGEMENT: Caution is advised if clarithromycin, telithromycin, or troleandomycin must be used concurrently with medications that undergo metabolism by CYP450 3A4. Patients should be monitored for increased adverse effects from the hormonal treatment if it must be co-administered with one of these antibiotics. Some serious side effects associated with hormonal treatment include, but are not limited to, cardiovascular disease (e.g., venous thromboembolism, myocardial infarction, and stroke); breast cancer; loss of bone mineral density; changes in mood; cholestatic jaundice; and dementia. Some of these side effects are affected by other factors such as medication dosage, concurrent medications, age, smoking status, and other disease states. If concurrent therapy with any of these antibiotics is necessary, please refer to the product labeling for more specific adverse effects to monitor for and counsel the patient and/or the patient's caregiver on the risks and benefits of concurrent therapy.

MONITOR CLOSELY: Estrogenic steroids, but not progestins, undergo enterohepatic cycling. It is possible that antimicrobials may interfere with the enterohepatic recirculation of estrogens by decreasing bacteria in the gastrointestinal tract that are responsible for regenerating parent estrogen molecules following first-pass metabolism. Most of the research regarding this possible interaction has been done with oral contraceptives; however, all estrogens appear to undergo enterohepatic recirculation so theoretically this interaction is a possibility with estrogen containing medications that are being used for alternative purposes. The risk appears to be small, and supportive data are primarily limited to anecdotal evidence from case reports and findings from uncontrolled or poorly controlled studies. Most antimicrobials, except for enzyme inducing medications like the rifamycins and possibly griseofulvin, have not been shown to significantly increase the clearance of estrogens present in combined hormonal contraceptives. It is possible that a small number of women may be more sensitive to the effects of antimicrobials on estrogen disposition in vivo, but risk factors or genetic predispositions have yet to be identified.

MANAGEMENT: If a person is using estrogen for a purpose other than contraception, it is important to note that there is a theoretical possibility of lower levels of systemic estrogen available during treatment with an antibiotic due to interference with enterohepatic cycling. These patients should be counseled to report any changes in efficacy of the hormonal product to their healthcare provider. In the case of contraception specifically, the Centers for Disease Control and Prevention do not consider most broad-spectrum antibiotics to significantly interfere with the effectiveness of combined hormonal contraception. However, the manufacturers of certain combined hormonal contraceptives and/or certain antibiotics do recommend using a back-up method of birth control for varying amounts of time; therefore, consulting the product labeling of each medication involved is advised. Some illnesses, as well as some antibiotics, may cause nausea, vomiting, and/or diarrhea. If the patient vomits within a few hours of taking an oral contraceptive pill, consult the product labeling for instructions on what to do in the event of a missed pill. Some authorities recommend a back-up method of birth control if an individual has persistent vomiting or diarrhea.

References

  1. Curtis KM, Tepper NK, Jatlaoui TC, et al. "U.S. medical eligibility criteria (US MEC) for contraceptive use. https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/index.html" (2023):
  2. Faculty of Sexual & Reproductive Healthcare "FSRH CEU response to study: analysis of reports of unintended pregnancies associated with the combined use of non-enzyme inducing antibiotics and hormonal contraceptives - february 2021 https://www.fsrh.org/standards-and-guidance/documents/fsrh-ceu-respo" (2023):
  3. Faculty of Sexual & Reproductive Healthcare "FSRH CEU guidance: drug interactions with hormonal contraception (may 2022) https://www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-drug-interactions-with-hormonal/" (2023):
  4. Simmons KB, Haddad LB, Nanda K, Curtis KM "Drug interactions between non-rifamycin antibiotics and hormonal contraception: a systemic review." Am J Obstet Gynecol 218 (2018): 88-97.e14
  5. Zhanel GG, Siemens S, Slayter K, Mandell L "Antibiotic and oral contraceptive drug interactions: is there a need for concern?" Can J Infect Dis 10 (1999): 429-33
  6. Black A, Francoeur D, Rowe T, et al. "SOGC clinical practice guidelines canadian contraception consensus https://www.jogc.com/article/S1701-2163(16)30260-2/pdf" (2023):
  7. Allen K "Contraception - common issues and practical suggestions." Aust Fam Physician 41 (2012): 770-2
  8. "Product Information. Ketek (telithromycin)." Physicians Total Care (2010):
  9. "Product Information. Ketek (telithromycin)." Aventis Pharmaceuticals (2009):
  10. "Product Information. Ketek (telithromycine)." SANOFI BELGIUM (2011):
  11. "Product Information. Clarithromycin (clarithromycin)." Alembic Pharmaceuticals (2023):
  12. "Product Information. Clarithromycin ER (clarithromycin)." Actavis U.S. (Purepac Pharmaceutical Company) (2020):
  13. "Product Information. Act Clarithromycin XL (clarithromycin)." Actavis Pharma Company (2020):
  14. "Product Information. Biaxin BID (clarithromycin)." BGP Pharma Inc (2021):
  15. "Product Information. CLARITHROMYcin (Noumed) (cLARITHROMYcin)." Blooming Health Pty Ltd (2021):
  16. "Product Information. Klacid (cLARITHROMYcin)." Mylan Health Pty Ltd (2022):
  17. "Product Information. Klaricid IV (clarithromycin)." Viatris UK Healthcare Ltd (2022):
  18. "Product Information. Clarithromycin (clarithromycin)." Ranbaxy (UK) Ltd (2023):
  19. "Product Information. Clarithromycin (clarithromycin)." Milpharm Ltd (2023):
  20. "Product Information. Mycifor XL (clarithromycin)." Forum Products Ltd (2015):
  21. FDA. United States Food and Drug Administration "Drug development and drug interactions: table of substrates, inhibitors and inducers. https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers" (2023):
View all 21 references
Minor

amoxicillin clarithromycin

Applies to: Omeclamox-Pak (amoxicillin / clarithromycin / omeprazole) and Omeclamox-Pak (amoxicillin / clarithromycin / omeprazole)

Information for this minor interaction is available on the professional version.

Minor

clarithromycin omeprazole

Applies to: Omeclamox-Pak (amoxicillin / clarithromycin / omeprazole) and Omeclamox-Pak (amoxicillin / clarithromycin / omeprazole)

Information for this minor interaction is available on the professional version.

Drug and food interactions

Moderate

HYDROXYprogesterone food

Applies to: Hyprogesterone (hydroxyprogesterone)

Grapefruit juice may increase the blood levels of certain medications such as HYDROXYprogesterone. You may want to limit your consumption of grapefruit and grapefruit juice during treatment with HYDROXYprogesterone. However, if you have been regularly consuming grapefruit or grapefruit juice with the medication, then it is advisable for you to talk with your doctor before changing the amounts of these products in your diet, as this may alter the effects of your medication. Contact your doctor if your condition changes or you experience increased side effects. Orange juice is not expected to interact.

Switch to professional interaction data

Moderate

HYDROXYprogesterone food

Applies to: Hyprogesterone (hydroxyprogesterone)

HYDROXYprogesterone may reduce the blood levels and effects of caffeine. Contact your doctor if your symptoms worsen or your condition changes during treatment with these medications. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. 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

Minor

clarithromycin food

Applies to: Omeclamox-Pak (amoxicillin / clarithromycin / omeprazole)

Information for this minor interaction is available on the professional version.

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.


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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

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