Wednesday, 19 October 2016

Clinically Important Drug Interactions of Hormonal Contraceptives:


 




More presentations from Naina Mohamed Pakkir Maideen
 
©   The use of contraception has been increased from 54% (1990) to 57.4% (2014), globally.

©   In 2015, 64 per cent of married women or those in-relationship were using some form of contraception, worldwide.

©   Contraceptive Methods include

Ø Hormonal Contraceptive Methods

Ø Copper containing Intrauterine device (IUD)

Ø Male condoms

Ø Female condoms

Ø Vasectomy (Male sterilization)

Ø Tubal ligation (Female sterilization)

Ø Lactational Amenorrhea Method (LAM)

Ø Standard Days Method or SDM

Ø Basal Body Temperature (BBT) Method

Ø Two-day Method

Ø Sympto-thermal Method

Ø Calendar method or rhythm method

Ø Withdrawal (coitus interruptus)

©   Hormonal Contraceptive Methods include

Ø The Pill or Combined oral contraceptives (COCs)

Ø The Minipill or Progestogen-only pills (POPs)

Ø Implants

Ø Progestogen only injectables

Ø Monthly injectables or combined injectable contraceptives (CIC)

Ø Combined contraceptive patch

Ø Combined contraceptive vaginal ring (CVR)

Ø Emergency contraception

Ø Levonorgestrel containing Intrauterine device (IUD)

©    Hormonal contraceptives are the preparations containing Progesterone alone or the combination of an Estrogen and a Progesterone.

Ø Estrogens

ü Ethinyl estradiol (Most commonly used)

ü Mestranol

Ø Progestins

ü Norgestrel

ü Levonorgestrel (Most commonly used)

ü Desogestrel

ü Etonogestrel

ü Drospirenone (Most commonly used)

ü Ethynodiol diacetate

ü Norethindrone

ü Norgestimate

ü Medroxyprogesterone acetate

©   As the use of contraceptives increases, the probability of Contraceptive - Drug interaction also raises.

©   Concomitant use of Combination contraceptives (an Estrogen plus a Progestin) and Tranexamic acid is contraindicated especially in Obese or smoking women.

©   It is contraindicated to use contraceptives containing Ethinyl estradiol and Antiviral (Hepatitis C) Drugs such as Dasabuvir, Paritaprevir/Ritonavir and Ombitasvir, together.

©   Unintended pregnancy or breakthrough bleeding may result due to concurrent use of Hormonal Contraceptives and CYP3A4 Inducers (Carbamazepine, Rifampin, St.John’s Wort, Phenytoin, Griseofulvin, Phenobarbital, etc)

©   Concomitant use of Combination Contraceptives and Theophylline warrants the monitoring of signs of theophylline toxicity (Nausea, tremors, headache, or rapid, irregular heartbeat).

©   Hypotensive and sedative effects might be elevated by the combination of Hormonal contraceptives and Tizanidine.

©   Concurrent use of Combination Contraceptives and Isotretinoin may decrease the effectiveness of hormonal contraceptives.

©    Monitor patients for increased adverse effects related to Voriconazole (peripheral edema, visual disturbance) and Ethinyl estradiol/Norethindrone (abnormal menstruation, breast tenderness, edema), when Combination Contraceptives and Voriconazole used together.

©   Before supplying Hormonal contraceptives, the Doctor or Pharmacist should

Ø Ask women about current and previous drug use, including prescription, OTC, herbal, recreational drugs and dietary supplements.

Ø Provide information about possible interactions between hormonal contraception and other drugs.

Ø Encourage women to consider a contraceptive method that is unaffected by the interacting drug.

Ø Educate the women about the drugs reducing the efficacy of hormonal contraception and advise them about additional contraceptive protection, such as condoms.

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