Interaction of anticonvulsants and oral contraceptives in epileptic adolescents

Diamond, Michael P.; Greene, John W.; Thompson, Julliette M.; VanHooydonk, John E.; Wentz, Anne Colston

doi:10.1016/0010-7824(85)90062-9

Cited by 22 publications

(7 citation statements)

References 22 publications

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“…Comparative data on OC efficacy in women taking enzyme-inducers versus those not taking such medication are sparse, though numerous anecdotal reports suggest a higher risk in the former. [4][5][6][7] Surveys of healthcare professionals 8 and women suffering from epilepsy 9 have clearly demonstrated the need for better information, particularly with regard to the risk of drug interactions.…”

Section: Introductionmentioning

confidence: 99%

Observational series on women using the contraceptive Mirena<SUP>®</SUP> concurrently with anti-epileptic and other enzyme-inducing drugs

Bounds¹,

Guillebaud²

2002

j fam plann reprod health care

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IntroductionFinding an acceptable and effective method of contraception is problematic for many women, even more so for those taking concurrent enzyme-inducing medication. This group presents a particular challenge and can also be the cause of confusion among prescribers in this situation where a high degree of contraceptive protection is often a key requirement. Copper intrauterine contraceptive devices (IUDs) may be inappropriate if there is a history of menorrhagia, barrier methods may not be acceptable to either or both partners, and oral contraceptives (OCs) carry the risk of drug interactions and hence reduced efficacy, 1 though not all anticonvulsants are enzyme-inducers. 2,3 In the presence of enzyme-inducers, even increasing the oestrogen dose in combined OCs, tri-cycling, and/or decreasing the pill-free interval give no guarantee of protection, though such measures may reduce the risk of accidental pregnancies. Comparative data on OC efficacy in women taking enzyme-inducers versus those not taking such medication are sparse, though numerous anecdotal reports suggest a higher risk in the former. 4-7 Surveys of healthcare professionals 8 and women suffering from epilepsy 9 have clearly demonstrated the need for better information, particularly with regard to the risk of drug interactions.A possibly more suitable option for women on enzymeinducers might be the hormone-releasing intrauterine system (IUS) Mirena ® . This can be true even for nulliparous women, with appropriate counselling and skilled insertion. The IUS has various modes of action: thickening of the cervical mucus and local inflammatory effects in the uterine cavity impairs sperm migration through the uterus; ovulation is inhibited to various degrees during treatment time in 25-55% of women; and the endometrium is suppressed.In women not taking enzyme-inducers Mirena ® is a highly effective contraceptive with a failure rate of only two pregnancies per 1000 women per year. Whether this exceptionally high level of efficacy also applies to women on enzyme-inducers is at present unknown. In theory, drug interaction is not impossible since some of the progestogen released enters the general circulation. Conversely, there is direct local release leading to high levonorgestrel concentrations in the endometrium and the utero-tubocervical fluid, hence contraceptive protection from the local mechanisms is unlikely to be reduced by enzyme-inducers acting at the liver. _________________________________________________________________________________________________________________ ORIGINAL ARTICLE

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Section: Introductionmentioning

confidence: 99%

Observational series on women using the contraceptive Mirena<SUP>®</SUP> concurrently with anti-epileptic and other enzyme-inducing drugs

Bounds¹,

Guillebaud²

2002

j fam plann reprod health care

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“…As a result of case reports and clinical studies (Kenyon, 1972;Hempel et al, 1973;Janz & Schmidt, 1974;Gagnaire et al, 1975;Coulam & Annegers, 1979;Diamond et al, 1985;Mattson et al, 1986) the potential for a number of antiepileptic drugs to interact adversely with oral contraceptives (OCS) has been widely recognised. Most reports have concerned phenytoin, phenobarbitone, carbamazepine and primidone which are all recognised as inducers of hepatic microsomal drug metabolising enzymes in man (Park & Breckenridge, 1981).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Committee on Safety of Medicines yellow card reports on oral contraceptive‐drug interactions with anticonvulsants and antibiotics.

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Grimmer

Orme

et al. 1988

Brit J Clinical Pharma

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1. We have searched the adverse reactions register for the years 1968‐ 84 in an attempt to evaluate data relating to reported pregnancies in women on oral contraceptive steroids (OCS) who concurrently received either an antiepileptic drug or an antibiotic. 2. A total of 43 pregnancies were reported in women on OC therapy who concurrently received antiepileptic drugs and 63 pregnancies in women receiving antibiotics. In addition the number of prescriptions for both antiepileptics and antibiotics in England are reported for the years 1973‐84.

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“…Existen dos mecanismos que pueden explicar la falla de los ACO en las mujeres epilépticas: en primer lugar la inducción por parte de los anticonvulsivantes de las enzimas microsomales hepáticas, y en segundo lugar el incremento de la capacidad de las globulinas transportadoras de hormonas sexuales (SHBG) (3,15,16).…”

Section: Fisiología Y Mecanismos De Interacciónunclassified

Epilepsia y anticonceptivos

2004

Rev. chil. obstet. ginecol.

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Interaction of anticonvulsants and oral contraceptives in epileptic adolescents

Cited by 22 publications

References 22 publications

Observational series on women using the contraceptive Mirena<SUP>®</SUP> concurrently with anti-epileptic and other enzyme-inducing drugs

Observational series on women using the contraceptive Mirena<SUP>®</SUP> concurrently with anti-epileptic and other enzyme-inducing drugs

Evaluation of Committee on Safety of Medicines yellow card reports on oral contraceptive‐drug interactions with anticonvulsants and antibiotics.

Epilepsia y anticonceptivos

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