Drug Interactions with Oral Contraceptives

1986 ◽  
Vol 20 (5) ◽  
pp. 353-362 ◽  
Author(s):  
P. F. D'Arcy
Keyword(s):  
Oral Contraceptive ◽  
Drug Interactions ◽  
Oral Contraceptives ◽  
Contraceptive Use ◽  
Enzyme Inhibitors ◽  
Enterohepatic Circulation ◽  
Oral Contraceptive Use ◽  
Contraceptive Steroids ◽  
Increased Risk ◽  
Contraceptive Activity

In the very rare cases where a pregnancy occurs during oral contraceptive use, the blame is usually laid against the patient for having forgotten to take the pill. Evidence has started to accumulate to suggest that neither the patient nor the pill is at fault in some contraceptive failures. It may be because the patient is taking other medicines and these may be preventing the pill from suppressing ovulation. Most drug interactions reducing or negating contraceptive activity are due to concomitant use of drugs having microsomal enzyme-inducing activity (e.g., some antibiotics, especially rifampicin, and anticonvulsants, including phenobarbital, Phenytoin, and primidone. Other antibiotics (e.g., tetracycline) may also interact by interruption of the enterohepatic circulation of contraceptive steroids. Less well appreciated, oral contraceptive steroids may themselves modify the metabolism and pharmacological activity of various other drugs (e.g., anticoagulants, benzodiazepines, β-blockers, caffeine, corticosteroids, and tricyclic antidepressants); in this respect the oral contraceptives are acting as enzyme inhibitors. Contraceptive steroids may also interact with drugs that cause enzyme inhibition and this delays the metabolism of the hormonal agents. Interactions of this type would be expected to potentiate the action of the contraceptive steroids. It is suggested that the effects of such interaction might be presented in terms of increased incidence of side effects, including water retention, diabetogenic effects, hypertension, and an increased risk of thromboembolic disorders. The spectrum of interactions with oral contraceptives is presented in three tables.

scholarly journals The risk of breast, cervical, endometrial and ovarian cancer in oral contraceptive users

2010 ◽  
Vol 63 (9-10) ◽  
pp. 657-661 ◽  
Author(s):  
Milena Veljkovic ◽  
Slavimir Veljkovic
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Cervical Cancer ◽  
Oral Contraceptive ◽  
Oral Contraceptives ◽  
Young Women ◽  
Contraceptive Use ◽  
Epidemiologic Studies ◽  
Oral Contraceptive Use ◽  
Increased Risk

Introduction. Oral contraceptives, mainly combined monophasic pills, are widely used by young women who expect their physicians to prescribe them safe drugs which will not harm their health and which will simplify their life. Numerous epidemiologic studies have been performed to determine the relation between oral contraceptive use and the development of neoplasms. Breast cancer. An increased incidence of breast cancer has occurred simultaneously with the growing use of oral contraceptives. The possibility of a link between the oral contraceptive use and breast cancer has led to intensive research, but studies have provided inconsistent results causing confusion among clinicians. It was noticed that the risk of breast cancer was slightly elevated in current and recent young oral contraceptives users. That finding could be influenced by a detection bias or could be due to the biologic effect of the pills. The absolute number of additional breast cancer cases will be very small because of low baseline incidence of the disease in young women. Oral contraceptives probably promote growth of the already existing cancer, they are probably promoters not initiators of breast cancer. The available data do not provide a conclusive answer that is need. Cervical cancer. Numerous factors may influence the development of cervical cancer. The evidence suggests that current and recent oral contraceptive users have an increased risk of cervical cancer which decline after discontinuation of the application of medication. Oral contraceptives might increase the biological vulnerability of the cervix. Cervical cancer develops slowly over a long time period and can be effectively prevented by periodic cervical screening. Fortunately, oral contraceptives do not mask abnormal cervical citology. Conclusions regarding invasive cervical cancer and oral contraceptive use are not definitive but if there is any increased risk, it is low. Endometrial cancer. In oral contraceptive users the endometrium is almost under the influence of progestin component which suppresses endometrial mitotic activity and its proliferation. Most epidemiologic studies show that oral contraceptives reduce the risk of endometrial cancer and that this protective effect exists many years after the discontinuation of medication. Ovarian cancer. It has been long known that the oral contraceptive use causes protective an ovulation and reduces the risk of ovarian cancer. This powerful reduction is the best demonstrated major benefit of oral contraception. This protection is especially observed in nulliparous and seems to persist for many years after the discontinuation of medication.

The use of oral contraceptives in women over age 35 years

1995 ◽  
Vol 4 (2) ◽  
pp. 115-120
Author(s):  
Robert F Casper ◽  
Selim Senoz ◽  
Avraham Ben-Chetrit
Keyword(s):  
Cardiovascular Disease ◽  
Oral Contraceptive ◽  
Oral Contraceptives ◽  
Contraceptive Use ◽  
Older Woman ◽  
Oral Contraceptive Use ◽  
Increased Risk ◽  
Potential Risks ◽  
Europe Today ◽  
The Impact

Oral contraceptives remain the most widely used form of contraception in North America and Europe today. In spite of the concerns of many women relating to the potential risks of these preparations, recent data have demonstrated that currently available oral contraceptives are safe, with no increased risk of cardiovascular disease or cancer in nonsmoking women. The present review will focus on the impact of oral contraceptive use in the older woman, including a discussion of the noncontraceptive health benefits of oral contraceptives.

Oral contraceptive use and risk of suicidal behavior among young women

2020 ◽  
pp. 1-8
Author(s):  
Alexis C. Edwards ◽  
Sara Larsson Lönn ◽  
Casey Crump ◽  
Eve K. Mościcki ◽  
Jan Sundquist ◽  
...  
Keyword(s):  
Oral Contraceptive ◽  
Oral Contraceptives ◽  
Young Women ◽  
Suicidal Behavior ◽  
Contraceptive Use ◽  
Cox Proportional Hazards ◽  
Causal Mechanism ◽  
Parental History ◽  
Oral Contraceptive Use ◽  
Increased Risk

Abstract Background Oral contraceptive use has been previously associated with an increased risk of suicidal behavior in some, but not all, samples. The use of large, representative, longitudinally-assessed samples may clarify the nature of this potential association. Methods We used Swedish national registries to identify women born between 1991 and 1995 (N = 216 702) and determine whether they retrieved prescriptions for oral contraceptives. We used Cox proportional hazards models to test the association between contraceptive use and first observed suicidal event (suicide attempt or death) from age 15 until the end of follow-up in 2014 (maximum age 22.4). We adjusted for covariates, including mental illness and parental history of suicide. Results In a crude model, use of combination or progestin-only oral contraceptives was positively associated with suicidal behavior, with hazard ratios (HRs) of 1.73–2.78 after 1 month of use, and 1.25–1.82 after 1 year of use. Accounting for sociodemographic, parental, and psychiatric variables attenuated these associations, and risks declined with increasing duration of use: adjusted HRs ranged from 1.56 to 2.13 1 month beyond the initiation of use, and from 1.19 to 1.48 1 year after initiation of use. HRs were higher among women who ceased use during the observation period. Conclusions Young women using oral contraceptives may be at increased risk of suicidal behavior, but risk declines with increased duration of use. Analysis of former users suggests that women susceptible to depression/anxiety are more likely to cease hormonal contraceptive use. Additional studies are necessary to determine whether the observed association is attributable to a causal mechanism.

Polymorphisms in the protein C gene as risk factor for venous thrombosis

2009 ◽  
Vol 101 (01) ◽  
pp. 62-67 ◽  
Author(s):  
Carine Doggen ◽  
Hans Vos ◽  
Pieter Reitsma ◽  
Frits Rosendaal ◽  
Elisabeth Pomp
Keyword(s):  
Oral Contraceptive ◽  
Venous Thrombosis ◽  
Protein C ◽  
Contraceptive Use ◽  
Factor V Leiden ◽  
Factor V ◽  
Thrombotic Risk ◽  
Control Subjects ◽  
Oral Contraceptive Use ◽  
Increased Risk

SummaryProtein C is an important inhibitor of blood coagulation. We investigated the effect of two polymorphisms within the promoter region of the protein C gene (C/T at position 2405 and A/G at position 2418) on risk of venous thrombosis and on plasma protein C levels. In addition the combined effect of the two polymorphisms with factor V Leiden and oral contraceptive use was investigated. Previous studies on these polymorphisms were small and were not able to investigate synergistic effects. In the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis (MEGA study), protein C levels were determined in 2,043 patients with venous thrombosis and 2,857 control subjects, and the two polymorphisms in 4,285 patients and 4,863 control subjects. The CC/GG genotype was associated with the lowest protein C levels. Compared to carriers of the TT/AA genotype – a genotype associated with higher protein C levels – the risk of venous thrombosis in CC/GG carriers was 1.3-fold increased (95% confidence interval 1.09–1.48). The combination of factor V Leiden with the CC/GG genotype led to a 4.7-fold increased risk, compared to non-carriers with the TT/AA genotype. Oral contraceptive use together with the CC/ GG genotype resulted in a 5.2-fold increased risk. In conclusion, the CC/GG genotype is associated with lower levels of protein C and an elevated risk of venous thrombosis compared to the TT/AA genotype. There is no clear synergistic effect of the CC/ GG genotype with factor V Leiden or oral contraceptive use on thrombotic risk.

Postscript: starting oral contraceptives (25 May, page 41)

1992 ◽  
Vol 30 (14) ◽  
pp. 56.1-56
Keyword(s):  
Breast Cancer ◽  
Oral Contraceptives ◽  
Contraceptive Use ◽  
Causal Relation ◽  
Case Control ◽  
Term Pregnancy ◽  
Oral Contraceptive Use ◽  
Increased Risk ◽  
The Uk

In our article on oral contraceptives (OCs) we state that ‘oral contraceptives increase the risk of breast cancer with long-term use but reduce the risk of endometrial and ovarian cancer’. Some commentators have questioned the breast cancer risk. The UK National Case-Control (UKNCC) study, which looked at oral contraceptive use in women with breast cancer diagnosed before age 36, found a trend for increased risk associated with duration of use.1 ‘The simplest and most plausible explanation’, say the authors of the study, ‘must be that there is a substantial causal relation between prolonged use and breast cancer in young women.’ The increased risk seems to be associated particularly with OC use before the first full-term pregnancy.2 Several studies found no excess risk in OC users aged 45 or over, few of whom had taken the pill before their first pregnancy.3–5 In the UKNCC study the relative risk of breast cancer was 1.43 after 4–8 years’ use and 1.74 after more than 8 years’ use. In broad terms this means that three women in 1000 who use oral contraceptives for 4 or more years might be expected to be under treatment for breast cancer by age 36, compared with two per 1000 non-users.

Associations of oral contraceptive use and dietary restraint with bone speed of sound and bone turnover in university-aged women

2008 ◽  
Vol 33 (4) ◽  
pp. 696-705 ◽  
Author(s):  
Gioia Di Giovanni ◽  
Brian D. Roy ◽  
Kimberley L. Gammage ◽  
Diane Mack ◽  
Panagiota Klentrou
Keyword(s):  
Physical Activity ◽  
Oral Contraceptive ◽  
Bone Turnover ◽  
Oral Contraceptives ◽  
Type I Collagen ◽  
Contraceptive Use ◽  
Dietary Restraint ◽  
Type I ◽  
Oral Contraceptive Use ◽  
Bone Speed Of Sound

The associations of oral contraceptive use and cognitive dietary restraint with bone speed of sound (SOS) and bone turnover were investigated in 100 Canadian university-aged women (18–25 years old). Dietary restraint was assessed using the Dutch Eating Behavior Questionnaire (DEBQ) and daily calcium intake (Ca++) was assessed by the rapid assessment method. Quantitative ultrasound was used to measure SOS at the tibia and radius. Bone formation was estimated from plasma osteocalcin (OC), 25-OH vitamin D, and serum bone-specific alkaline phosphatase (BAP). Bone resorption was determined from serum cross-linked N-teleopeptide of type I collagen (NTx) and plasma C-terminal telopeptide of type I collagen (CTx). Weekly physical activity energy expenditure (WAeq) was assessed using a standardized questionnaire, and height, body mass, relative body fat (%BF), and chest, waist, and hip circumferences were also measured. Participants were divided into low and moderate to high dietary restrainers (LDRs and MDRs, respectively). These groups were further sub-divided into users and non-users of oral contraceptives. All groups had similar age at menarche, body composition, WAeq, and equally low levels of Ca++and vitamin D. Within the non-users of oral contraceptives, MDR exhibited a lower tibial SOS (p ≤ 0.024) and OC (p ≤ 0.009) than LDR. Moreover, amongst the LDR, the oral contraceptive users had a lower tibial SOS (p ≤ 0.015) and BAP (p ≤ 0.002) than non-users. These results show that bone SOS and bone turnover were influenced by oral contraceptives and cognitive dietary restraint among this population of young women independent of body composition and physical activity.

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