Pre- and post-operative counseling for women on hormonal contraceptives receiving sugammadex at an academic hospital

Abstract

Sugammadex is a steroid binder and can potentially bind the estrogens and progestins contained within hormonal contraception. Therefore, the FDA label for sugammadex contains a drug drug interaction warning between this medication and hormonal contraception, advising that women taking hormonal contraception use a back-up contraceptive method or abstinence for seven days after exposure to sugammadex. However, given concerns that this warning may not be appropriately provided to at-risk patients, we conducted a retrospective chart review to identify women administered sugammadex while using hormonal contraception to identify documented counseling on this drug-drug interaction prior to implementation of a formalized counseling process. We reviewed 1000 randomly selected charts from the University of Colorado Hospital between January 2016 and December 2017. We identified 134 women using hormonal contraception at the time of sugammadex exposure; only one patient (0.7%, 95% CI 0.0, 4.1) had documented counseling. One patient had an unintended pregnancy within the same cycle as her exposure to sugammadex. Improved counseling processes are needed to avoid unnecessary risk for unintended pregnancies.

Ethnicity in Anaesthesia research: Time to search our own backyards!

“…An example is the recent advent of sugammadex to reverse neuromuscular blocking agents in India – systemic side effects like it making oral contraceptives ineffective from enzyme induction might have higher consequences in India, where oral contraceptive pills are the family planning method used by a significant percentage of those at pregnancy risk. [ 17 ] The advent and deployment of such agents in India thus requires directed testing, clinical trials as well as practitioner and patient education. All this can help improve clinical and patient safety.…”

Unanticipated Consequences of Switching to Sugammadex: Anesthesia Provider Survey on the Hormone Contraceptive Drug Interaction

“…Instead, most reports describe informing patients of sugammadex exposure and contraceptive counseling ex post facto. 5–8…”

“…1 This warning and recommendation have been promulgated by the Society for Obstetric Anesthesia and Perinatology 2 and embraced by numerous medical centers. [3][4][5][6][7][8] Some authors have recommended considering intentional avoidance of this interaction by using the alternative neuromuscular blockade (NMB) antagonist, neostigmine. 3,4 Ethical considerations of administering sugammadex to women using HC without prior discussion vis-à-vis paternalism have been reviewed, 3 but reports describing preoperative discussion with at-risk women of implications of the sugammadex/HC drug interaction are lacking.…”

“…Instead, most reports describe informing patients of sugammadex exposure and contraceptive counseling ex post facto. [5][6][7][8] Considering clinical and financial implications of complications from postoperative residual NMB, such as tracheal reintubation, our institution decided that enhanced safety of ensuring complete NMB reversal was worth the added cost of routine sugammadex use instead of neostigmine. Beginning February 2017, sugammadex was officially designated as the NMB antagonist of choice.…”

“…Sugammadex was readily available in operating room carts, while the number of neostigmine vials in carts was limited to 1. As reported by other institutions, [5][6][7][8] women using HC and exposed to sugammadex were to be counseled postoperatively in the postanesthesia care unit (PACU), including provision of an informational document that describes the sugammadex/HC interaction, potential risk of HC failure, and recommendations for alternative contraceptive measures (see Supplemental Digital Content 1, Appendix 1, http://links.lww.com/AA/ D413, for discharge instructions for patients exposed to sugammadex).…”