EPILEPSY AND ORAL HORMONAL CONTRACEPTION-INDIAN PERSPECTIVE
DOI:
https://doi.org/10.22159/ijpps.2017v9i3.16540Keywords:
Oral contraception, Epilepsy, Anti-Epileptic Drugs (AED), Hepatic enzyme induction, OrmeloxifeneAbstract
There are about 50 million people with epilepsy in the world and a quarter of them are in the reproductive age group. India alone contributes to 10% of this fig. Because of the advances in therapeutic drugs, the women affected with epilepsy easily enter into reproductive life. These women like others are highly fertile and frequently need to adopt effective and safe contraceptive measures to avoid unplanned pregnancy. There are several concerns regarding the efficacy and safety of natural methods or barrier methods in women who are taking antiepileptic drugs (AED), failure of which poses a great risk to the affected person because pregnancy can result in exposure of fetus to the teratogenic effect of AEDs and also the hemodynamic changes in pregnancy can lower the plasma concentrations of AED and there can be poor seizure control. Oral hormonal pills are prescribed to epileptic women, not only for birth control but also in certain situations such as polycystic ovaries, irregular menstruation, acne and dysfunctional uterine bleeding. There are major bidirectional interactions between reproductive hormones and antiepileptic drugs which the physician should be aware of while dealing with these women. There are now enough evidence that oral contraceptive pills can reduce the efficacy of AEDs by affecting their metabolism and also AEDs by themselves may affect the contraceptive efficacy of oral pills by different pathways. Though estrogen free hormonal contraception is least likely to be effected by this nature of drug interaction, but still caution should be exercised in drug prescription as progesterone by itself has a lesser contraceptive effect and hence even slighted drug interaction too can lead to contraceptive failure. This extensive review focusses upon potential drug interactions between constituents of various oral pills and anti-epileptic drugs, the formulations available in India with different dosages for oestrogen and newer progestogens with their advantages with a special note on ormeloxifene which is exclusively marketed for birth control in Rural India. Special conditions such as contraception during lactation and emergency contraception for epileptic women are also discussed
Downloads
References
Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India. Epilepsia 1999;40:631-6.
Pennell PB. 2005 AES annual course: evidence used to treat women with epilepsy. Epilepsia 2006;47(Suppl 1):46–53.
Reddy DS. The role of neurosteroids in the pathophysiology and treatment of catamenial epilepsy. Epilepsy Res 2009;85:1-30.
Sabers A. Pharmacokinetic interactions between contra-ceptives and antiepileptic drugs. Seizure 2008;17:141-4.
Jean-Jacques A. Contraception for women: an evidence based overview. Br Med J 2009;339:563-8.
Long L, Montouris G. Knowledge of women’s issues and epilepsy (KNOWIE-II): a survey of healthcare professionals. Epilepsy Behav 2005;6:90-3.
Shorvon SD, Tallis RC, Wallace HK. Antiepileptic drugs: coprescription of pro convulsant drugs and oral contraceptives: a national study of antiepileptic drug prescribing practice. J Neurol Neurosurg Psychiatry 2002; 72:114-5.
Bhat M, Ramesha KN, Nirmala C, Sarma PS, Thomas SV. Knowledge and practice profile of obstetricians regarding epilepsy in women in Kerala state, India. Ann Indian Acad Neurol 2011;14:169-71.
Vijayasri S, Archana H, Agrawal A, Hopper W. Computational analysis of interactions between antiepileptic drugs and important placental proteins-a possible route for neural tube defects in humans. Int J Pharm Pharm Sci 2016;8:19-23.
Kadam P, Dherai A, Naik P, Lokhande R, Udani V, Gursahani R, et al. Retrospective study on therapeutic drug monitoring of lamotrigine in Indian epileptic patients. Int J Pharm Pharm Sci 2014;6:430-3.
Fairgrieve SD, Jackson M, Jonas P. Population-based, prospective study of the care of women with epilepsy in pregnancy. Br Med J 2000;321:674-5.
Harden CL, Leppik I. Optimizing therapy of seizures in women who use oral contraceptives. Neurology 2006;67(Suppl 4):S56–S58.
Coulam CB, Annegers JF. Do anticonvulsants reduce the efficacy of oral contraceptives? Epilepsia 1979;20:519–25.
Crawford P, Chadwick DJ, Martin C, Tjia J, Back DJ, Orme M. The interaction of phenytoin and carbamazepine with combined oral contraceptive steroids. Br J Clin Pharmacol 1990;30:892-6.
Wilbur K, Ensom MHH. Pharmacokinetic drug interactions between oral contraceptives and second-generation anticonvulsants. Clin Pharmacokinet 2000;38:355–65.
Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol 2006;61:246-55.
Miners JO, Mackenzie PI. Drug glucuronidation in humans. Pharmacol Ther 1991;51:347–69.
Sabers A, Ohman I, Christensen J, Tomson T. Oral contra-ceptives reduce lamotrigine plasma levels. Neurology 2003;61:570-1.
Hachad H, Ragueneau-Majlessi I, Levy RH. New antiepileptic drugs: a review on drug interactions. Ther Drug Monit 2002;24:91-103.
Sabers A, Buchholt JM, Uldall P, Hansen EL. Lamotrigine plasma levels reduced by oral contraceptives. Epilepsy Res 2001; 47:151-4.
Sidhu J, Job S, Singh S, Philipson R. The pharmacokinetic and pharmacodynamic consequences of the co-administration of lamotrigine and a combined oral contraceptive in healthy female subjects. Br J Clin Pharmacol 2006;61:191-9.
Schwenkhagen AM, Stodieck SR. Which contraception for women with epilepsy? Seizure 2008;17:145-50.
Reddy DS. Clinical pharmacokinetic interactions between antiepileptic drugs and hormonal contraceptives. Expert Rev Clin Pharmacol 2010;3:183-92.
O'brien MD, Guillebaud J. Contraception for women taking antiepileptic drugs. J Fam Plann Reprod Health Care 2010;36:239-42.
Rice C, Killick S, Dieben T, CoelinghBennink H. A comparison of the inhibition of ovulation achieved by desogestrel 75 mcg and levonorgestrel 30 mcg daily. Hum Reprod 1999;14:982-5.
O'brien MD, Guillebaud J. Contraception for women with epilepsy. Epilepsia 2006;47:1419-22.
Rajesh B, Neelam P, Laxman B, Nirajan B, Buddha BB, Bidur S. To determine the risk factors associated with ectopic pregnancy. Asian J Pharm Clin Res 2015;8:93-7.
O’Connor SE, Zupanc ML. Women and epilepsy. J Pediatr Pharmacol Ther 2009;14:212-20.
