What the FDA labels say about taking them together
Ethinyl estradiol/levonorgestrel and ritonavir
Ethinyl estradiol/levonorgestrel's FDA label of August 27, 2026 names ritonavir in its contraindications section; the ritonavir label PlainMeds reads does not name ethinyl estradiol/levonorgestrel. The ethinyl estradiol/levonorgestrel label: “Significant changes (increase or decrease) in the plasma concentrations of estrogen and/or progestin have been noted in some cases of co-administration with HIV/HCV protease inhibitors and non-nucleoside reverse …”
Check it at the source: the ethinyl estradiol/levonorgestrel FDA label on DailyMed (effective August 27, 2026, Exeltis USA, Inc.); the ritonavir FDA label on DailyMed (effective July 23, 2026, AbbVie Inc.).
What does the ethinyl estradiol/levonorgestrel label say about ritonavir?
Ethinyl estradiol/levonorgestrel label, contraindications… hepatitis, or severe (decompensated) cirrhosis [see Warnings and Precautions (5.2) ] Undiagnosed abnormal uterine bleeding [see Warnings and Precautions (5.8) ] Use of hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, due to the potential for ALT elevations [see Warnings and Precautions (5.14) ] High risk of arterial or venous thrombotic diseases. ( 4 ) Breast cancer or other estrogen- or progestin-sensitive cancer. ( 4 ) Liver tumors, acute viral hepatitis or decompensated cirrhosis. ( 4 ) Undiagnosed abnormal uterine bleeding. …
Ethinyl estradiol/levonorgestrel label, drug interactionsSignificant decreases in systemic exposure of the estrogen and/or progestin have been noted when CHCs are co-administered with some HIV protease inhibitors (e.g., nelfinavir, ritonavir, darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/ritonavir, and tipranavir/ritonavir), some HCV protease inhibitors (e.g., boceprevir and telaprevir), and some non-nucleoside reverse transcriptase inhibitors (e.g., nevirapine).
Ethinyl estradiol/levonorgestrel label, warnings and precautionsElevations with Concomitant Hepatitis C Treatment During clinical trials with the Hepatitis C combination drug regimen that contains ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, ALT elevations greater than 5 times the upper limit of normal (ULN), including some cases greater than 20 times the ULN, were significantly more frequent in women using ethinyl estradiol-containing medications, such as COCs.
Balcoltra label (Avion Pharmaceuticals, December 5, 2025), contraindicationsUse of Hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, due to the potential for ALT elevations [see Warnings and Precautions ( 5.3 )] •A high risk of arterial or venous thrombotic diseases ( 4 ) •Liver tumors or liver disease ( 4 ) •Undiagnosed abnormal uterine bleeding ( 4 ) •Pregnancy ( 4 ) •Breast cancer ( 4 ) •Hypersensitivity of any of the components ( 4 ) •Co-administration with Hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir
Balcoltra label (Avion Pharmaceuticals, December 5, 2025), drug interactionsSignificant changes (increase or decrease) in the plasma concentrations of estrogen and/or progestin have been noted in some cases of co-administration with HIV/HCV protease inhibitors and non-nucleoside reverse transcriptase inhibitors (decrease [e.g., nelfinavir, ritonavir, darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/ritonavir, tipranavir/ritonavir, boceprevir, telaprevir, nevirapine and efavirenz] or increase [e.g., indinavir, atazanavir/ritonavir and etravirine]).
Twirla label (Agile Therapeutics, Inc., June 30, 2026), contraindicationsObserved reactions include itching and irritation at the TDS application site [see Adverse Reactions ( 6.1 )] Use of Hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, due to the potential for alanine aminotransferase (ALT) elevations [see Warnings and Precautions ( 5.3 )] High risk of arterial or venous thrombotic diseases ( 4 ) Breast cancer ( 4 ) BMI ≥ 30 kg/m 2 ( 4 ) Liver tumors, acute viral hepatitis or decompensated cirrhosis ( 4 ) Undiagnosed abnormal uterine bleeding ( 4 ) Pregnancy ( 4 , 8.1 ) Hypersensitivity reactions to components of TWIRLA ( 4 ) Use of Hepatitis C drug combinations containing …
Source: FDA drug label (Balcoltra, NDA208612), Avion Pharmaceuticals, effective December 5, 2025 (SPL set 752ab698-4b48-4614-8016-d1d33ee7c007), via openFDA
Source: FDA drug label (Tyblume), Exeltis USA, Inc., effective August 27, 2026 (SPL set b2482d51-d606-4aaa-8af4-19e4fe2f8872), via openFDA; the full label on DailyMed
What does the ritonavir label say about ethinyl estradiol/levonorgestrel?
Ritonavir's label (effective July 23, 2026) does not name ethinyl estradiol/levonorgestrel in these sections. A label lists what its studies and reports found; it is not a complete list.
Source: FDA drug label (Norvir), AbbVie Inc., effective July 23, 2026 (SPL set 2849298e-de6e-47bb-8194-56e075b33fc3), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Ethinyl estradiol/levonorgestrel | Ritonavir | |
|---|---|---|
| Labeled for | Birth control | HIV |
| Boxed warning | Yes | Yes |
| Pharmacy cost (NADAC) | $0.154 per tablet 28 tablet | $0.607 per tablet 100 mg tablet |
| Shortage now | No current entry | A presentation being discontinued |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
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