Pharmacokinetic interactions between contraceptives and antiepileptic drugs

Seizure : the Journal of the British Epilepsy Association
Anne Sabers

Abstract

The occurrence of bi-directional drug interactions between antiepileptic drugs (AEDs) and combined oral contraceptives (OCs) pose potential risks of un-intended pregnancy and as well as seizure deterioration. It is well established that several of the older AEDs (carbamazepine, phenytoin and phenobarbital), are strong inducers of the hepatic cytochrome P450 (CYP) 3A4 enzyme system, and are associated with increased the risk of contraceptive failure. In addition, it is demonstrated that also some of the newer AEDs, oxcarbazepine and topiramate influence on the pharmacokinetics of OCs, which is thought to be due to a more selective induction of subgroups of the hepatic enzyme system. Estrogens containing OCs induce the glucuronosyltransferase and may reduce the plasma levels and the effect of AEDs cleared by glucuronidation. This has been most intensively studied for lamotrigine but also other AEDs, which undergoes glucuronidation processes, such as valproate and oxcarbazepine, may be affected by OCs. The magnitude of the drug-drug interactions show in general wide inter-individual variability and the change in the elimination rate is often unpredictable and can be influenced by a number of co-variants such as co-medication of ot...Continue Reading

References

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Citations

May 9, 2009·Radiation Protection Dosimetry·Brian C Foster
Apr 7, 2010·Expert Review of Clinical Pharmacology·Doodipala Samba Reddy
Dec 18, 2013·Expert Opinion on Drug Metabolism & Toxicology·Sophia Yui Kau FongZhong Zuo
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May 16, 2014·Drug Metabolism and Drug Interactions·Yu-Yuan ChiuAntony Loebel

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