Increased clearance of sex hormones & which may lead to breakthrough bleeding &/or contraceptive failure w/ drugs that induce microsomal enzymes eg, phenytoin, barbiturates, primidone, carbamazepine, rifampicin, & possibly also oxcarbazepine, topiramate, felbamate, griseofulvin & products containing St. John's wort. Increased or decreased plasma conc w/ many HIV/HCV PIs & NNRTIs. Decreased clearance & increased plasma conc w/ strong & moderate CYP3A4 inhibitors eg, azole antifungals (eg, itraconazole, voriconazole, fluconazole), verapamil, macrolides (eg, clarithromycin, erythromycin), diltiazem & grapefruit juice; etoricoxib. May either increase (eg, cyclosporin) or decrease (eg, lamotrigine) plasma & tissue conc of certain drugs. Weak increase in plasma conc of CYP3A4 substrates (eg, midazolam) while plasma conc of CYP1A2 substrates can increase weakly (eg, theophylline) or moderately (eg, melatonin & tizanidine). Increased ALT levels w/ direct-acting antiviral medicinal products containing ombitasvir, paritaprevir, or dasabuvir, & combinations of these.