What foods affect Nexplanon?

October 7, 2025 •

4 min read

While most foods do not affect the effectiveness of Nexplanon, consuming grapefruit or grapefruit juice can alter hormone levels in your body. It is important to know what foods affect Nexplanon and how to avoid potential side effects and complications.

Quick Summary

This guide explains the specific food and supplement interactions with the Nexplanon implant, focusing on grapefruit products and St. John's wort. It details how these substances can influence hormone levels and cause adverse effects, while clarifying that most other foods are safe.

Key Points

Grapefruit Interaction: Grapefruit and its juice can increase the level of the hormone from Nexplanon in your body by inhibiting a specific enzyme.
Higher Side Effect Risk: Elevated hormone levels from grapefruit consumption can lead to an increased risk of side effects such as headaches and nausea.
St. John's Wort Hazard: The herbal supplement St. John's wort can speed up hormone breakdown, potentially reducing Nexplanon's effectiveness and increasing pregnancy risk.
Most Foods Are Safe: Standard foods like fruits, vegetables, and grains do not affect Nexplanon's function due to the implant's consistent, slow-release mechanism.
Consistency Is Key: If you consume grapefruit, maintaining a consistent intake is better than fluctuating amounts; however, always inform your doctor.
Herbal supplements to avoid: Beyond St. John's wort, some other herbs like alfalfa may also impact effectiveness, so always consult a doctor before taking new supplements.
Consult a Doctor: Always inform your healthcare provider of all foods, supplements, and medications you consume to ensure the implant's safety and effectiveness.

Understanding How Nexplanon Works

Nexplanon is a long-acting reversible contraceptive (LARC) implant that is inserted under the skin of the upper arm. It continuously releases a synthetic progestin hormone called etonogestrel to prevent pregnancy for up to three years. Etonogestrel works primarily by preventing ovulation, thickening cervical mucus to block sperm, and thinning the uterine lining. For the implant to work effectively, the hormone must be released and processed by the body at a consistent rate. While this process is generally resistant to interference from daily dietary habits, some substances can disrupt this hormonal balance.

The Grapefruit Interaction

The most significant and well-documented food interaction with Nexplanon is with grapefruit and grapefruit juice. This interaction is not unique to hormonal contraceptives and affects numerous medications.

The mechanism behind the interaction

Grapefruit and grapefruit juice contain compounds known as furanocoumarins, which inhibit a crucial enzyme in the body called cytochrome P450 3A4 (CYP3A4). This enzyme, found primarily in the intestines and liver, is responsible for metabolizing (breaking down) many medications, including etonogestrel. By inhibiting CYP3A4, grapefruit products prevent the body from breaking down the hormone as quickly as it normally would. This leads to higher-than-intended levels of etonogestrel in the bloodstream.

What happens when etonogestrel levels are too high?

An elevated level of etonogestrel can increase the risk of experiencing certain side effects associated with Nexplanon. While it does not decrease the implant's effectiveness in preventing pregnancy, it can worsen bothersome symptoms such as:

Headaches
Nausea
Breast pain or tenderness
Fluid retention
Abdominal pain

How to manage grapefruit consumption with Nexplanon

Healthcare providers generally recommend avoiding grapefruit and its juice while using Nexplanon. However, if you regularly consume grapefruit products, it is important to maintain a consistent amount rather than fluctuating your intake. Sudden changes in consumption can alter hormone levels and lead to unwanted effects. Always discuss your diet with your doctor when you get your implant inserted or at any follow-up visits.

Herbal and Supplement Interactions

While technically not a food, it is crucial to address the herbal supplement St. John's wort, as it has a well-established and significant interaction with Nexplanon.

The mechanism behind St. John's wort interaction

Unlike grapefruit, St. John's wort has the opposite effect on drug metabolism. It induces (speeds up) the activity of the CYP3A4 enzyme. This causes the body to break down the etonogestrel hormone more quickly than intended, which can significantly lower the hormone levels in your system.

The risk of reduced contraceptive effectiveness

If the level of etonogestrel drops too low due to St. John's wort, Nexplanon's primary function of preventing pregnancy may be compromised. This can lead to breakthrough bleeding, irregular cycles, and, most importantly, an increased risk of unintended pregnancy. For this reason, healthcare professionals strongly advise against using St. John's wort while on Nexplanon and may recommend an alternative treatment or a backup birth control method.

Other Foods and Diet

For the vast majority of foods, there are no known interactions that affect Nexplanon's effectiveness or safety. The slow, continuous release of the hormone from the implant is not easily swayed by daily dietary intake, unlike oral contraceptives which must be absorbed through the digestive tract daily.

Foods that are generally safe with Nexplanon

Most fruits and vegetables
Dairy products (milk, yogurt, cheese)
Grains and breads
Meats and poultry
Fish and seafood
Soy products (tofu, soy milk), in moderation
Caffeinated beverages
Alcohol (no direct interaction, but heavy consumption can worsen side effects or lead to forgetfulness with other medication forms)

Summary of Interactions: Grapefruit vs. St. John's Wort


Feature	Grapefruit / Grapefruit Juice	St. John's Wort
Effect on Hormone	Increases etonogestrel levels.	Decreases etonogestrel levels.
Mechanism	Inhibits CYP3A4 enzyme, slowing breakdown.	Induces (speeds up) CYP3A4 enzyme, increasing breakdown.
Primary Risk	Increased risk of side effects (e.g., headaches, nausea).	Decreased contraceptive effectiveness and increased risk of pregnancy.
Recommendations	Limit or maintain consistent intake; inform doctor.	Avoid completely; use backup contraception if necessary.

The Role of a Healthy Diet

While specific foods do not interfere with Nexplanon's effectiveness, maintaining a healthy, balanced diet is always beneficial for overall health. A healthy diet can help manage some of the side effects, such as mood swings or weight fluctuations, that some individuals experience with hormonal contraception. Proper nutrition also supports liver function, which is critical for processing hormones and medications. If you experience side effects, discuss them with your healthcare provider to determine if they are related to the implant or other factors.

Conclusion

In summary, when asking what foods affect Nexplanon, the answer is primarily grapefruit and grapefruit juice, which can raise hormone levels and increase the risk of side effects. The herbal supplement St. John's wort is an even more significant concern, as it can reduce the implant's effectiveness and increase the risk of unintended pregnancy. Aside from these specific exceptions, the vast majority of common foods do not have an impact on Nexplanon. For any dietary or supplement-related questions, always consult with your healthcare provider for personalized advice.

For more detailed information on drug interactions with grapefruit, refer to the FDA's official consumer update.

Is it safe to eat grapefruit with Nexplanon?

Frequently Asked Questions

It is generally recommended to avoid consuming grapefruit and grapefruit juice while on Nexplanon, as it can increase the hormone level in your body and potentially worsen side effects like headaches and nausea.

Using St. John's wort with Nexplanon is risky because it can speed up the breakdown of the hormone, making the implant less effective and increasing your risk of an unintended pregnancy.

No, other citrus fruits like oranges are not expected to interact with Nexplanon. The specific compounds in grapefruit are responsible for inhibiting the enzyme that breaks down the hormone.

Alcohol does not directly affect Nexplanon's effectiveness in preventing pregnancy. However, heavy alcohol consumption could worsen some side effects like headaches or nausea, and can lead to impaired judgment that might affect birth control adherence.

Activated charcoal is known to interact with birth control pills, potentially reducing effectiveness by interfering with absorption. While the effect on an implant like Nexplanon is less direct, it is best to discuss any such supplement use with your doctor.

Some research suggests that soy products, which contain phytoestrogens, could potentially affect hormone levels, but there is no definitive conclusion on their interaction with birth control implants. Moderation is recommended, but a normal intake is generally considered safe.

Studies have shown no significant decrease in the effectiveness of Nexplanon in overweight or obese women compared to those of normal weight. The implant remains a highly reliable method of contraception regardless of body mass index.