Jasmiel 28 Day Drug Interactions: What to Avoid and What to Tell Your Doctor

Jasmiel 28 Day (drospirenone 3 mg / ethinyl estradiol 0.02 mg) can interact with a number of medications, supplements, and herbal products. Some interactions reduce the effectiveness of Jasmiel (increasing pregnancy risk), while others increase the risk of serious side effects like high potassium levels or liver damage.

Always tell your healthcare provider and pharmacist about every medication, supplement, and herbal product you take before starting Jasmiel. This guide covers the most important interactions to know.

CONTRAINDICATED: Do Not Take With Jasmiel

The following drug combination is absolutely contraindicated — do not take Jasmiel if you are prescribed:

• Ombitasvir/paritaprevir/ritonavir ± dasabuvir (HCV combination therapy — e.g., Viekira Pak): Coadministration causes ALT elevations >5x the upper limit of normal (including some >20x ULN). Stop Jasmiel before starting this HCV therapy and restart approximately 2 weeks after completing the HCV regimen.
• Tranexamic acid oral: Combined use increases thrombotic risk through pharmacodynamic synergism. Both drugs are contraindicated together.

Interactions That Reduce Jasmiel's Effectiveness (Pregnancy Risk)

The following drugs can reduce the effectiveness of Jasmiel by increasing the metabolism of its hormones through CYP3A4 induction or other mechanisms. If you take any of these, use backup contraception (condoms) and talk to your provider about alternative contraceptive methods:

• Rifampin, rifabutin, rifapentine (antibiotics for tuberculosis/infections) — strong CYP3A4 inducers; significantly reduce hormone levels
• Carbamazepine (Tegretol) — anticonvulsant; CYP3A4 inducer
• Oxcarbazepine (Trileptal) — anticonvulsant; CYP3A4 inducer
• Phenobarbital, phenytoin — anticonvulsants; reduce hormone levels
• St. John's Wort (Hypericum perforatum) — herbal supplement; reduces hormone levels through CYP3A4 induction
• Griseofulvin, ketoconazole, itraconazole — antifungals; may alter hormone levels unpredictably
• HIV/HCV protease inhibitors and non-nucleoside reverse transcriptase inhibitors — may alter hormone levels; some increase, some decrease
• Mavacamten (Camzyos) — cardiomyopathy medication; CYP3A4 inducer; may cause contraceptive failure. Use non-hormonal contraception during treatment and for 4 months after stopping.

Interactions That Increase Potassium (Hyperkalemia Risk)

Drospirenone has anti-mineralocorticoid (potassium-sparing) activity. Combining it with other drugs that raise potassium levels can cause hyperkalemia (dangerously elevated potassium). The FDA prescribing information recommends monitoring serum potassium in the first treatment cycle for patients taking any of these medications:

• Potassium-sparing diuretics: Amiloride, spironolactone, triamterene
• ACE inhibitors: Lisinopril, ramipril, benazepril, enalapril, and others
• Angiotensin II receptor blockers (ARBs): Losartan, valsartan, irbesartan, olmesartan, and others
• Eplerenone (Inspra): Aldosterone antagonist; additive potassium-raising effect
• NSAIDs: Ibuprofen, naproxen, and other non-steroidal anti-inflammatory drugs, especially with regular/daily use
• Heparin, low-molecular-weight heparins: May increase serum potassium

Interactions Where Jasmiel Affects Other Drugs

Jasmiel can also affect the levels of other medications in your body:

• Lamotrigine (Lamictal): COCs containing EE significantly decrease plasma lamotrigine levels (through induction of glucuronidation). This may reduce seizure control in epilepsy patients. Lamotrigine dose adjustments may be necessary — consult your neurologist or provider.
• Theophylline, tizanidine: EE-containing COCs may inhibit their metabolism; levels may increase

Antibiotics: What the Evidence Says

You may have heard that antibiotics can reduce birth control effectiveness. The evidence is nuanced. Clinical pharmacokinetic studies have NOT consistently shown that non-rifamycin antibiotics (like amoxicillin, doxycycline, or azithromycin) reduce hormone levels in women taking COCs. The FDA prescribing information notes that while there have been reports of pregnancies while taking hormonal contraceptives and antibiotics, clinical studies have not confirmed a significant interaction for most antibiotics.

The exception is rifampin and its derivatives — these ARE confirmed to reduce contraceptive effectiveness and require backup contraception. For other antibiotics, continuing your pill as normal is generally recommended, but discuss any concerns with your provider.

Lab Test Interference

Jasmiel may affect the results of certain laboratory tests, including coagulation factors, lipids, glucose tolerance, and binding proteins. Drospirenone also increases plasma renin activity and plasma aldosterone due to its anti-mineralocorticoid activity. Make sure any lab ordering physician knows you are taking Jasmiel.

What to Tell Your Doctor and Pharmacist

Before starting Jasmiel, give your provider and pharmacist a complete list of:

• All prescription medications
• All over-the-counter medications (including NSAIDs like ibuprofen)
• All vitamins and supplements (especially potassium or St. John's Wort)
• Any herbal products

For more on Jasmiel side effects, see our complete guide: Jasmiel 28 Day Side Effects. If you need help finding Jasmiel at a pharmacy near you, medfinder can call pharmacies and text you the results.