clearance. Minor/Significance Unknown.calcium chlorideMinor (1)drospirenone decreases levels of calcium chloride by increasing renal clearance. Minor/Significance Unknown.calcium citrateMinor (1)drospirenone decreases levels of calcium citrate by increasing renal clearance. Minor/Significance Unknown.calcium gluconateMinor (1)drospirenone decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.canagliflozinMonitor Closely (1)drospirenone and canagliflozin both increase serum potassium. Use Caution/Monitor.candesartanMonitor Closely (1)candesartan and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.captoprilMonitor Closely (1)captopril, drospirenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.carbamazepineMonitor Closely (1)carbamazepine will decrease the level or effect of drospirenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Advise patients to use alternative contraceptive method during coadministration; continue alternative contraception for 28 days after discontinuing therapy to ensure contraception reliability carbenoxoloneMonitor Closely (1)drospirenone increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.carvedilolMonitor Closely (1)carvedilol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.celecoxibMonitor Closely (1)drospirenone and celecoxib both increase serum potassium. Modify Therapy/Monitor Closely.celiprololMonitor Closely (1)celiprolol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.chlorothiazideMonitor Closely (1)drospirenone increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.chlorthalidoneMonitor Closely (1)drospirenone increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.choline magnesium trisalicylateMonitor Closely (1)drospirenone and choline magnesium trisalicylate both increase serum potassium. Modify Therapy/Monitor Closely.clobazamMonitor Closely (1)clobazam will decrease the level or effect of drospirenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clobazam is a weak CYP3A4 inducer; effectiveness of hormonal contraceptives may be diminished when given concurrently with clobazam. Additional non-hormonal forms of contraception are recommended.cornsilkMinor (1)cornsilk increases effects of drospirenone by pharmacodynamic synergism. Minor/Significance Unknown.cyclopenthiazideMonitor Closely (1)drospirenone increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.cyclosporineMonitor Closely (1)drospirenone, cyclosporine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Monitor serum cyclosporine concentrations, and for signs and symptoms of renal and hepatic toxicity.darunavirMonitor Closely (1)darunavir will increase the level or effect of drospirenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Significant changes (increase or decrease) can occur in estrogen plasma levels. Efficacy of hormonal contraceptives may be reduced. Use of a nonhormonal contraceptive is recommended.diclofenacMonitor Closely (1)drospirenone and diclofenac both increase serum potassium. Modify Therapy/Monitor Closely.diflunisalMonitor Closely (1)drospirenone and diflunisal both increase serum potassium. Modify Therapy/Monitor Closely.digoxinMonitor Closely (1)drospirenone and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.disopyramideMonitor Closely (1)drospirenone increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiovascular depression.dobutamineMonitor Closely (1)drospirenone increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.dopexamineMonitor Closely (1)drospirenone increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.enalaprilMonitor Closely (1)enalapril, drospirenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.enasidenibMinor (1)enasidenib, drospirenone. unknown mechanism. Minor/Significance Unknown. Coadministration of enasidenib may increase or decrease the concentrations of combined hormonal contraceptives. Clinical significance of this interaction is unknown.ephedrineMonitor Closely (1)drospirenone increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.epinephrineMonitor Closely (1)drospirenone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.epinephrine racemicMonitor Closely (1)drospirenone increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.eplerenoneSerious - Use Alternative (1)drospirenone, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.epoprostenolMinor (1)epoprostenol increases effects of drospirenone by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.eprosartanMonitor Closely (1)eprosartan and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.esmololMonitor Closely (1)esmolol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.ethacrynic acidMonitor Closely (1)drospirenone increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.etodolacMonitor Closely (1)drospirenone and etodolac both increase serum potassium. Modify Therapy/Monitor Closely.exenatide injectable solutionMonitor Closely (1)drospirenone, exenatide injectable solution. Other (see comment). Use Caution/Monitor. Comment: Oral contraceptives may decrease hypoglycemic effects of antidiabetics by impairing glucose tolerance. The effect of exenatide to slow gastric emptying may reduce the extent and rate of oral medications that require rapid GI absorption. Advise patients to take oral contraceptives at least 1 hr before exenatide. .exenatide injectable suspensionMonitor Closely (1)drospirenone, exenatide injectable suspension. Other (see comment). Use Caution/Monitor. Comment: Oral contraceptives may decrease hypoglycemic effects of antidiabetics by impairing glucose tolerance. The effect of exenatide to slow gastric emptying may reduce the extent and rate of oral medications that require rapid GI absorption. Advise patients to take oral contraceptives at least 1 hr before exenatide.fedratinibSerious - Use Alternative (1)drospirenone will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.fenbufenMonitor Closely (1)drospirenone and fenbufen both increase serum potassium. Modify Therapy/Monitor Closely.fenoprofenMonitor Closely (1)drospirenone and fenoprofen both increase serum potassium. Modify Therapy/Monitor Closely.fezolinetantContraindicated (1)drospirenone will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitorsfinerenoneMonitor Closely (2)drospirenone will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed. drospirenone and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.flibanserinMonitor Closely (1)drospirenone will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.flurbiprofenMonitor Closely (1)drospirenone and flurbiprofen both increase serum potassium. Modify Therapy/Monitor Closely.formoterolMonitor Closely (1)drospirenone increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.forskolinMinor (1)forskolin increases effects of drospirenone by pharmacodynamic synergism. Minor/Significance Unknown.fosinoprilMonitor Closely (1)fosinopril, drospirenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.furosemideMonitor Closely (1)drospirenone increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.gentamicinMonitor Closely (1)drospirenone increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.goldenrodMinor (1)goldenrod increases effects of drospirenone by pharmacodynamic synergism. Minor/Significance Unknown.hydrochlorothiazideMonitor Closely (1)drospirenone increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.ibuprofenMonitor Closely (1)drospirenone and ibuprofen both increase serum potassium. Modify Therapy/Monitor Closely.ibuprofen IVMonitor Closely (1)drospirenone and ibuprofen IV both increase serum potassium. Modify Therapy/Monitor Closely.imidaprilMonitor Closely (1)imidapril, drospirenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.indapamideMonitor Closely (1)drospirenone increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.indomethacinMonitor Closely (1)drospirenone and indomethacin both increase serum potassium. Modify Therapy/Monitor Closely.iodinated glycerolMinor (1)iodinated glycerol, drospirenone. Mechanism: decreasing renal clearance. Minor/Significance Unknown. Hyperkalemia.iodineMinor (1)iodine, drospirenone. Mechanism: decreasing renal clearance. Minor/Significance Unknown. Hyperkalemia.irbesartanMonitor Closely (1)irbesartan and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.isavuconazonium sulfateSerious - Use Alternative (1)isavuconazonium sulfate will increase the level or effect of drospirenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.isoproterenolMonitor Closely (1)drospirenone increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.ivacaftorMonitor Closely (1)drospirenone increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .juniperMonitor Closely (1)juniper, drospirenone. Other (see comment). Use Caution/Monitor. Comment: Juniper may potentiate or interfere with diuretic therapy. Juniper has diuretic effects, but may cause kidney damage at large doses.ketoprofenMonitor Closely (1)drospirenone and ketoprofen both increase serum potassium. Modify Therapy/Monitor Closely.ketorolacMonitor Closely (1)drospirenone and ketorolac both increase serum potassium. Modify Therapy/Monitor Closely.ketorolac intranasalMonitor Closely (1)drospirenone and ketorolac intranasal both increase serum potassium. Modify Therapy/Monitor Closely.labetalolMonitor Closely (1)labetalol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.lamotrigineMonitor Closely (1)drospirenone will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.lemborexantMonitor Closely (1)drospirenone will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.levalbuterolMonitor Closely (1)drospirenone increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.liraglutideMonitor Closely (1)drospirenone decreases effects of liraglutide by passive renal tubular reabsorption due to increased pH. Use Caution/Monitor. Oral contraceptives may decrease hypoglycemic effects of antidiabetics by impairing glucose tolerance. Monitor for glycemic control in diabetic patients.lisinoprilMonitor Closely (1)lisinopril, drospirenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.lomitapideMonitor Closely (1)drospirenone increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.lonafarnibSerious - Use Alternative (1)drospirenone will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.lonapegsomatropinMonitor Closely (2)drospirenone will decrease the level or effect of lonapegsomatropin by Other (see comment). Use Caution/Monitor. Oral estrogens may reduce serum insulin-like growth factor-1 response to lonapegsomatropin. Patients receiving oral estrogen replacement may require higher lonapegsomatropin dosages. drospirenone will decrease the level or effect of lonapegsomatropin by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Oral estrogens may reduce serum insulin-like growth factor I (IGF-1) response to growth hormone (GH) analogs. Higher GH dose may be requiredlornoxicamMonitor Closely (1)drospirenone and lornoxicam both increase serum potassium. Modify Therapy/Monitor Closely.losartanMonitor Closely (1)losartan and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.magnesium chlorideMinor (1)drospirenone increases levels of magnesium chloride by decreasing renal clearance. Minor/Significance Unknown.magnesium citrateMinor (1)drospirenone increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown.magnesium hydroxideMinor (1)drospirenone increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown.magnesium oxideMinor (1)drospirenone increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.magnesium sulfateMinor (1)drospirenone increases levels of magnesium sulfate by decreasing renal clearance. Minor/Significance Unknown.maitakeMinor (1)maitake increases effects of drospirenone by pharmacodynamic synergism. Minor/Significance Unknown.maravirocMonitor Closely (1)drospirenone increases levels of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity.mavacamtenMonitor Closely (1)drospirenone will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose. Serious - Use Alternative (1)mavacamten will decrease the level or effect of drospirenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Progestin and ethinyl estradiol are CYP3A4 substrates. Mavacamten may decrease systemic exposures of ethinyl estradiol and progestin, which may lead to contraceptive failure or an increase in breakthrough bleeding. Advise patients to use a contraceptive method that is not affected by CYP450 enzyme induction (eg, intrauterine system) or add nonhormonal contraception (eg, condoms) during coadministration and for 4 months after last mavacamten dose.meclofenamateMonitor Closely (1)drospirenone and meclofenamate both increase serum potassium. Modify Therapy/Monitor Closely.mefenamic acidMonitor Closely (1)drospirenone and mefenamic acid both increase serum potassium. Modify Therapy/Monitor Closely.meloxicamMonitor Closely (1)drospirenone and meloxicam both increase serum potassium. Modify Therapy/Monitor Closely.metaproterenolMonitor Closely (1)drospirenone increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.metforminMonitor Closely (1)drospirenone decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor.methyclothiazideMonitor Closely (1)drospirenone increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely. .metolazoneMonitor Closely (1)drospirenone increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.metoprololMonitor Closely (1)metoprolol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.midazolam intranasalMonitor Closely (1)drospirenone will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.mifepristoneMonitor Closely (1)mifepristone decreases effects of drospirenone by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.minoxidilMinor (1)drospirenone increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.mobocertinibSerious - Use Alternative (1)mobocertinib will decrease the level or effect of drospirenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of mobocertinib with hormonal contraceptives may lead to contraceptive failure or increased