Visanne Drug Interactions

Effects of Other Medicaments on Visanne: Individual Enzyme-Inducers or Inhibitors (CYP3A4): Progestogens including dienogest are metabolized mainly by the cytochrome P450 3A4 system (CYP3A4) located both in the intestinal mucosa and in the liver. Therefore, inducers or inhibitors of CYP3A4 may affect the progestogen drug metabolism.
An increased clearance of sex hormones due to enzyme induction may reduce the therapeutic effect of Visanne and may result in undesirable effects eg, changes in the uterine bleeding profile.
A reduced clearance of sex hormones due to enzyme inhibition may increase the exposure to dienogest and may result in undesirable effects.
Substances with Enzyme-Inducing Properties: Interactions can occur with drugs (eg, phenytoin, barbiturates, primidone, carbamazepine, rifampicin and possibly also oxcarbazepine, topiramate, felbamate, griseofulvin, nevirapine and products containing St. John's wort) that induce microsomal enzymes (eg, cytochrome P450 enzymes) which can result in increased clearance of sex hormones.
Maximum enzyme induction is generally not seen for 2-3 weeks but may then be sustained for at least 4 weeks after the cessation of therapy.
Substances with Enzyme-Inhibiting Properties: Known CYP3A4 inhibitors like azole antifungals (eg, ketoconazole, itraconazole, fluconazole), cimetidine, verapamil, macrolides (eg, erythromycin, clarithromycin and roxithromycin), diltiazem, protease inhibitors (eg, ritonavir, saquinavir, indinavir, nelfinavir), antidepressants (eg, nefazodone, fluvoxamine, fluoxetine) may increase plasma levels of progestogens and result in adverse reactions.
Effects of Dienogest on Other Medicaments: Based on in vitro inhibition studies, a clinically relevant interaction of Visanne with the cytochrome P450 enzyme mediated metabolism of other medicaments is unlikely.
Drug-Food Interactions: A standardized high fat meal did not affect the bioavailability of Visanne.
Other Forms of Interactions: The use of progestogens may influence the results of certain laboratory tests.
Incompatibilities: None known.