The Combined Oral Contraceptive (COC) pill may interact with other medicines. Some of the more commonly known interactions are listed below. However, this is not a complete list. If you want to check that your medicines are safe to take with the COC pill, you can ask your doctor or pharmacist (chemist) or read the Patient Information Leaflets that come with your medicines.

The COC pill may interact with broad spectrum antibiotics. These include the following:

• amoxicillin,
• ampicillin,
• azithromycin,
• cefadroxil,
• cefixime,
• cefradine,
• cefalexin,
• cefpodoxime,
• clarithromycin,
• co-amoxiclav,
• co-fluampicil,
• doxycycline,
• erythromycin,
• metronidazole,
• minocycline,
• oxytetracycline,
• tetracycline,and
• tinidazole.

Broad spectrum antibiotics may reduce the effectiveness of the COC pill.

If you are prescribed one of these antibiotics, use additional contraception (e.g. condoms) while you are taking the antibiotic and for 7 days after finishing the course. If the 7 days runs beyond the end of a pill pack, skip the pill free break and start a new pack straight away. In the case of the Every Day (ED) pill – if the 7 days runs into the inactive pills, skip the inactive pills and start a new pack straight away.

If you are prescribed a long course of one of these antibiotics, after you have taken it for 3 weeks or more you don’t need additional contraception. But, if you are then also prescribed a short course of a different antibiotic later, you will need to use additional contraception again as above.

The COC pill may also interact with medicines that speed up how quickly the liver breaks down oestrogen and progestogen. These include:

• aprepitant,
• bosentan,
• carbamazepine,
• griseofulvin,
• modafinil,
• nelfinavir,
• nevirapine,
• oxcarbazepine,
• phenytoin,
• phenobarbital,
• primidone,
• rifabutin,
• rifampicin,
• ritonavir,
• rufinamide,
• St John’s Wort (Hypericum), and
• topiramate.

As these medicines speed up the process of the liver breaking down the oestrogen and progestogen in the COC pill, they reduce the effectiveness of the COC pill.

If you are prescribed a short course of one of these medicines, use additional contraception while you are taking the medicine, and for four weeks after you stop taking it.

If you are prescribed a long course of one of the above medicines, remind your prescriber that you are taking a COC pill. You will need to think about switching to another method of contraception while you are taking it, and for 4-8 weeks after you stop taking it.

Talk to your doctor, or prescriber, about other methods of contraception. An alternative (except when taking rifampicin, or rifabutin) is to take two COC pills a day. However, this is an unlicensed use of the COC pill and it should only be taken in this way on the advice of your doctor.

Lamotrigine

The combined oral contraceptive (COC) pill can speed up how quickly the liver breaks down lamotrigine. This reduces the amount of lamotrigine in the blood, making it less effective at controlling fits. Tell your doctor if you decide to start (or stop) taking the COC pill because your dose of lamotrigine may need to be adjusted.

Missed or extra doses

If you forget to take a COC pill or are more than 24hours late taking it, the advice depends on:

• What type of COC pill you are taking (see section on “Names” for the type of COC pill),
• How many pills you have forgotten to take,
• If you have had sex without using another form of contraception during the last 7 days.

Low strength oestrogen – 21 day COC pill

If you are taking Loestrin 20, Mercilon, Femodette or Sunya 20/75 and you have missed one pill, you do not need to worry.

Take the missed pill as soon as you remember and the remaining pills as normal. This may mean taking two pills on the same day or even at the same time (one at the time of remembering and one at the usual time).

• You do not need to use any additional contraception.
• If you have had sex without using another form of contraception – you do not need emergency contraception.

However, if you are taking Loestrin 20, Mercilon, Femodette or Sunya 20/75 and you have missed two or more pills (48 hours or more without taking a pill), then:

1. Take the last pill you missed now and the remaining pills as normal. This may mean taking two pills on the same day or even at the same time (one at the time of remembering and one at the usual time).
2. If you have less than seven pills left in your pack, finish the pack but skip the pill free break and start a new pack the next day. This may mean you don’t get a bleed until the end of the second pack. If you do not get a bleed by then, speak to your doctor straight away.
3. Use additional contraception (such as condoms) for the next seven days.
4. If you have had sex without using another form of contraception within the last 7 days – you may need emergency contraception. You should get advice straight away from your doctor, family planning clinic or pharmacist.

Standard strength oestrogen – 28 day or Every Day (ED) COC pill

If you are taking Femodene ED, Logynon ED or Microgynon 30 ED, and have missed one or two active pills or any number of the inactive pills (last 7 pills in the pack), you do not need to worry.

Take the last pill you missed now, and the remaining pills as normal. This may mean taking two pills on the same day or even at the same time (one at the time of remembering and one at the usual time).

• You do not need to use any additional contraception.
• If you have had sex without using another form of contraception – you do not need emergency contraception.

However, if you are taking Femodene ED, Logynon ED or Microgynon 30 ED, and have missed three or more active pills then:

• Take the last pill you missed now and the remaining pills as normal. This may mean taking two pills on the same day or even at the same time (one at the time of remembering and one at the usual time).
• If you have less than seven active pills left in your pack, finish the active pills but skip the inactive pills (last 7 pills in the pack) and start a new pack the next day. This may mean you don’t get a bleed until the reaching the inactive pills at the end of the second pack. If you don get a bleed by then, speak to your doctor straight away.
• Use additional contraception (such as condoms) for the next seven days.
• If you have had sex without using another form of contraception within the last 7 days – you may need emergency contraception. You should get advice straight away from your doctor, family planning clinic or pharmacist.

Standard dose – 21 day COC pill

If you are taking any other type of COC pill and have missed one or two active pills, you do not need to worry.

• Take the last pill you missed now and the remaining pills as normal. This may mean taking two pills on the same day or even at the same time (one at the time of remembering and one at the usual time).
• You do not need to use any additional contraception.
• If you have had sex without using another form of contraception – you do not need emergency contraception.
• However, if you have missed three or more pills then:
• Take the last pill you missed now and the remaining pills as normal. This may mean taking two pills on the same day or even at the same time (one at the time of remembering and one at the usual time).
• If you have less than seven pills left in your pack, finish the pack but skip the pill free break and start a new pack the next day. This may mean you don’t get a bleed until the end of the second pack. If you do not get a bleed by then, speak to your doctor straight away.
• Use additional contraception (such as condoms) for the next seven days.
• If you have had sex without using another form of contraception within the last 7 days – you may need emergency contraception.

If you accidentally take one extra COC pill – you do not need to seek medical advice and you will have no symptoms.

If you accidentally take more than one COC pill – you may feel slightly nauseous (sick) or even vomit (be sick). This will pass and you do not need to seek medical advice. However, if you are concerned, speak to your doctor, family planning clinic or pharmacist.

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