Learn which medications and supplements can interact with Afterpill, reduce its effectiveness, and what to discuss with your doctor.
When you take Afterpill (Levonorgestrel 1.5 mg), you want it to work as effectively as possible. But certain medications and supplements can reduce Afterpill's effectiveness by changing how your body processes the drug — potentially leaving you at risk of pregnancy when you thought you were protected.
This guide covers every major drug interaction you should know about, what to tell your doctor or pharmacist, and what alternatives exist if you're taking an interacting medication.
Afterpill is metabolized (broken down) by the liver, primarily through enzymes in the cytochrome P450 system, especially the CYP3A4 enzyme. Medications that speed up this enzyme — called enzyme inducers — can cause your body to break down Levonorgestrel faster than normal, lowering the amount of active drug in your bloodstream.
The result: Afterpill may not reach high enough levels to suppress ovulation effectively, reducing its ability to prevent pregnancy.
The following medications are known to significantly reduce Afterpill's effectiveness. If you take any of these, talk to a healthcare provider before relying on Afterpill:
These are among the most significant enzyme-inducing medications. They can substantially lower Levonorgestrel levels in the blood.
Note: Common antibiotics like Amoxicillin, Azithromycin, and Doxycycline are not known to interact with Afterpill. The myth that "all antibiotics reduce birth control effectiveness" is largely unfounded — Rifampin is the notable exception.
Some HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors (NNRTIs) may interact with Levonorgestrel. The interaction varies by specific medication. If you're on HIV treatment, consult your healthcare provider about emergency contraception options.
This is perhaps the most important moderate interaction to know about: Do not take Afterpill and Ella together. They work through different hormonal pathways and may interfere with each other's effectiveness. If you've already taken one, do not take the other as a backup.
Choose one or the other based on your situation — for help deciding, see our guide on alternatives to Afterpill.
Food: There are no significant food interactions with Afterpill. It can be taken with or without food. Taking it with a light meal may help reduce nausea.
Alcohol: There is no direct interaction between alcohol and Levonorgestrel. However, heavy alcohol consumption could increase nausea or vomiting after taking Afterpill. If you vomit within 2 hours, the medication may not be fully absorbed.
When seeking emergency contraception, make sure to mention:
Even though Afterpill is available over the counter, a pharmacist can help you evaluate whether it's the best option given your current medications.
If you take a medication that interacts with Afterpill, you have several options:
The copper IUD (Paragard) is the most effective form of emergency contraception regardless of what medications you take. It doesn't rely on hormones, so enzyme inducers don't affect it. It must be inserted by a healthcare provider within 5 days of unprotected intercourse.
Ella (Ulipristal Acetate) is also affected by enzyme-inducing drugs, but your provider can help determine if it's a better option for your specific situation. It requires a prescription.
Some healthcare providers may consider a double dose of Levonorgestrel (3.0 mg) for patients on enzyme-inducing drugs, though this is not a standard FDA-approved approach. This should only be done under medical guidance.
For help finding a provider to discuss your options, see our guide on finding a doctor who can prescribe Afterpill.
To put your mind at ease, here are categories of medications that are generally safe to use alongside Afterpill:
If you recently stopped taking an enzyme-inducing medication, be aware that the enzyme-inducing effect may persist for several weeks after stopping. For example:
If you stopped one of these medications within the past month, mention this to your healthcare provider.
| Medication | Interaction Level | Effect on Afterpill | Recommendation |
|---|---|---|---|
| Rifampin | Major | Can reduce levels by 50%+ | Use copper IUD instead |
| Carbamazepine | Major | Significantly reduces effectiveness | Consult provider; consider IUD |
| Phenytoin | Major | Significantly reduces effectiveness | Consult provider; consider IUD |
| Phenobarbital | Major | Significantly reduces effectiveness | Consult provider; consider IUD |
| St. John's Wort | Major | Reduces effectiveness | Stop supplement; consult provider |
| Ella (Ulipristal) | Moderate | May interfere with each other | Do not combine |
| Most antibiotics | None | No interaction | Safe to use together |
Most people can take Afterpill without worrying about drug interactions. However, if you take anti-seizure medications, Rifampin, St. John's Wort, or certain HIV drugs, Afterpill may not be your best option. The copper IUD is the most reliable alternative when drug interactions are a concern.
When in doubt, talk to a pharmacist or healthcare provider — they can help you choose the most effective emergency contraception for your situation.
For more Afterpill information, explore our guides on what Afterpill is, how it works, side effects, and saving money on Afterpill. If you're having trouble finding it, use MedFinder to check stock near you.
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