What to avoid when taking Yaz pills? Essential interactions and safety guide

October 10, 2025 •

4 min read

The FDA includes a boxed warning for Yaz, highlighting the increased risk of serious cardiovascular events in smokers over 35. Understanding what to avoid when taking Yaz pills is essential for minimizing health risks, including severe drug, herbal, and food interactions.

Quick Summary

Lifestyle factors like smoking, medications including certain antibiotics and seizure drugs, plus supplements such as St. John's wort can interact with Yaz, impacting efficacy and increasing side effect risks.

Key Points

Avoid smoking: Women over 35 who smoke are at a significantly higher risk for serious cardiovascular events like blood clots and stroke when taking Yaz.
Check for drug interactions: Certain medications, including specific antibiotics (rifampin), antiseizure drugs, and HIV/HCV treatments, can make Yaz less effective.
Monitor potassium levels: Yaz can increase potassium in your blood. Avoid potassium supplements, ACE inhibitors, and potassium-sparing diuretics unless directed by a doctor.
Be cautious with supplements: The herbal supplement St. John's wort and activated charcoal can reduce Yaz's effectiveness. Tell your doctor about all supplements you take.
Limit grapefruit intake: Grapefruit and its juice can raise Yaz blood levels, increasing the risk of side effects. Avoid or limit your consumption.
Inform providers of major surgery: Due to an increased risk of blood clots, Yaz should be stopped before and after major surgery or prolonged immobility.
Discuss health conditions: Certain conditions like liver, kidney, or adrenal disease, migraines with aura, or a history of blood clots are contraindications for Yaz use.

Lifestyle factors to avoid or manage

Smoking and serious cardiovascular risks

One of the most critical warnings for Yaz use concerns smoking. The Food and Drug Administration (FDA) has issued a boxed warning emphasizing that cigarette smoking significantly increases the risk of serious cardiovascular events, such as blood clots, heart attack, and stroke, especially for women over 35. If you are a smoker over 35, your doctor will likely not prescribe Yaz and will suggest an alternative contraceptive. The risk increases with age and the amount of smoking.

Impact of major surgery and prolonged immobilization

Major surgery and periods of prolonged immobility, such as long-term bed rest, can increase your risk of developing a venous thromboembolism (VTE) or blood clot. Healthcare providers often recommend discontinuing Yaz at least four weeks before a major surgery and not resuming it until two weeks after you are fully mobile again. Always inform your doctor or surgeon that you are taking Yaz before any procedure.

Medications and supplements with serious interactions

Drugs that reduce Yaz effectiveness

Several medications can interfere with the effectiveness of Yaz, potentially leading to breakthrough bleeding and unplanned pregnancy. This is often due to an acceleration of the body's metabolism of the oral contraceptive. These medications include:

Certain antiseizure drugs: Phenytoin, carbamazepine, oxcarbazepine, and topiramate.
Certain antibiotics: Rifampin and rifabutin.
Herbal supplements: St. John's wort, which is used for depression, significantly reduces Yaz's effectiveness.
HIV/HCV drugs: Certain treatments for HIV and Hepatitis C, such as ombitasvir/paritaprevir/ritonavir.

Medications increasing potassium levels (Hyperkalemia)

Yaz contains drospirenone, a progestin that can cause elevated blood potassium levels (hyperkalemia) in certain individuals. This risk is heightened when Yaz is combined with other drugs that also increase potassium. High potassium can lead to serious heart problems. Your doctor should monitor your potassium levels if you are taking Yaz with:

Potassium-sparing diuretics: Spironolactone, eplerenone, and triamterene.
ACE inhibitors: Such as lisinopril and captopril.
Angiotensin-II receptor blockers (ARBs): Such as losartan and valsartan.
NSAIDs: Long-term use of ibuprofen or naproxen.
Potassium supplements.

Supplements and food to use with caution

Grapefruit and Grapefruit Juice: Consuming grapefruit can inhibit the enzyme that breaks down Yaz in your body, increasing its blood levels and potentially heightening side effects. It is recommended to avoid significant and sudden changes in grapefruit intake or limit consumption entirely while on Yaz.
St. John's Wort: As mentioned previously, this herbal supplement is a potent enzyme inducer and should be avoided due to the high risk of reducing contraceptive effectiveness.
Activated Charcoal: This supplement can interfere with drug absorption, potentially making Yaz less effective.
Cannabis/CBD Products: Taking these with Yaz could cause it to break down faster, reducing effectiveness. Inform your doctor if you use these products.
Supplements with High Vitamin C or Potassium: Taking high-dose vitamin C or potassium supplements can also increase the risk of elevated Yaz levels or hyperkalemia. Check with your pharmacist before taking multivitamins or other supplements.

Comparison of Key Yaz Interactions


Interaction Type	Examples	Potential Outcome	Action Required
Reduced Efficacy	Rifampin, St. John's Wort, certain seizure drugs	Increased risk of pregnancy, breakthrough bleeding	Use backup contraception, consult doctor
Increased Potassium	Spironolactone, ACE inhibitors, potassium supplements, NSAIDs	Hyperkalemia, which can cause heart problems	Monitor potassium levels, consult doctor
Increased Side Effects	Grapefruit, Vitamin C supplements	Elevated Yaz levels, possibly heightened side effects like nausea or breast tenderness	Avoid or limit intake, discuss with doctor
Contraindication	Hepatitis C medications (ombitasvir/paritaprevir/ritonavir)	Increased liver enzyme levels and potential liver problems	Do not take Yaz with these medications, consult doctor [1.1, 1.2.5]

Health conditions that contraindicate Yaz use

Certain pre-existing health conditions make taking Yaz unsafe due to the risk of serious complications. Your doctor will assess your medical history before prescribing Yaz. You should not take Yaz if you have:

History of blood clots, heart attack, or stroke: This includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
Inherited or acquired blood clotting disorders.
Certain migraines: Particularly migraines with aura, especially if you are over 35.
Uncontrolled high blood pressure.
Diabetes with vascular complications.
Severe kidney, liver, or adrenal disease: These can increase the risk of dangerous hyperkalemia.
Liver tumors or jaundice related to pregnancy or past birth control use.
Hormone-sensitive cancers: Such as breast or uterine cancer.
Undiagnosed abnormal uterine bleeding.

Conclusion

For anyone on Yaz, proactive management of potential interactions and risks is crucial for both safety and efficacy. Serious health risks are associated with smoking, especially for women over 35, and with major surgeries. Numerous medications, including common antiseizure drugs, antibiotics, and blood pressure regulators, can alter Yaz's performance or increase dangerous side effects like hyperkalemia. Furthermore, herbal supplements such as St. John's wort, certain dietary choices like grapefruit juice, and other supplements can also pose risks. Always have an open and comprehensive conversation with your healthcare provider about all medications, supplements, and lifestyle habits before starting or continuing Yaz. A good practice is to carry a list of all your medications to share with any healthcare professional, including dentists and specialists.

For more in-depth prescribing information, consult the FDA's DailyMed database, a key authoritative resource.

Frequently Asked Questions

The search results indicate there are no known interactions between Yaz and alcohol. However, it is always best to consume alcohol in moderation and to discuss your drinking habits with your doctor, as alcohol can affect your overall health.

No, grapefruit juice does not typically make Yaz less effective at preventing pregnancy. Instead, it can raise the levels of Yaz in your bloodstream, potentially increasing your risk of experiencing side effects such as nausea or breast tenderness. It is best not to significantly change your grapefruit intake while on Yaz.

If you miss one active pill, take it as soon as you remember, and take the next pill at your regular time. This might mean taking two pills in one day. Specific instructions for two or more missed pills, or depending on where you are in the pack, are detailed in the patient information leaflet, and you should always refer to that or contact your doctor for guidance.

Symptoms of high potassium, or hyperkalemia, can include muscle cramps, pain, weakness, or unusual fatigue. If you experience these symptoms, especially while taking other medications that can increase potassium, contact your doctor immediately. They may order a blood test to check your potassium level.

Yes, taking St. John's wort is not recommended with Yaz. The herbal supplement can speed up the breakdown of Yaz in your body, lowering its effectiveness and increasing the risk of an unplanned pregnancy. You should use a backup contraceptive method for at least one month after stopping St. John's wort if you take it while on Yaz.

Yes, Yaz can interfere with the results of certain lab tests, including those for cholesterol, blood clotting, and glucose tolerance. It is important to inform any healthcare professional performing lab work that you are taking Yaz.

Spotting or breakthrough bleeding is common during the first few months of Yaz use. However, if the bleeding persists, becomes heavy, or occurs after your cycles have been regular, you should contact your doctor to rule out other causes, such as pregnancy.