Antiepileptic medication and oral contraceptive interactions: A national survey of neurologists and obstetricians

被引:85
作者
Krauss, GL
Brandt, J
Campbell, M
Plate, C
Summerfield, M
机构
[1] JOHNS HOPKINS UNIV,DEPT NEUROL,BALTIMORE,MD 21218
[2] JOHNS HOPKINS UNIV,DEPT PSYCHIAT,BALTIMORE,MD 21218
关键词
D O I
10.1212/WNL.46.6.1534
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Hepatic enzyme-inducing. antiepileptic drugs (AEDs) lower oral contraceptive (OC) sex hormone levels approximately 40% and increase the risk of unplanned pregnancies in women with epilepsy, AEDs also increase the risk of birth defects in offspring of women with epilepsy. We performed a national survey to determine obstetricians' and neurologists' knowledge of OC and AED interactions and the risk of birth defects for women with epilepsy taking AEDs. We received responses to a mailed questionnaire from 160 of 1,000 neurologists (16%) and 147 of 1,000 obstetricians (15%) from 41 states. Practice demographics and ages of responder were typical for U.S. neurologists and obstetricians. Ninety-one percent of neurologists and 75% of obstetricians said they treat women with epilepsy of child-bearing age, Only 4% of the neurologists and none of the obstetricians, however, knew the effects of the six most common AEDs on OCs, even though 27% of neurologists and 21% of obstetricians reported OC failures in their patients taking AEDs. Although increasing OC doses can compensate for insufficient OC sex hormone levels due to AEDs, most physicians do not increase the doses. Even though the risk of birth defects for the offspring of women with epilepsy is 4 to 6%, up from the background level of 2%, 44% of neurologists thought the risk was lower (0 to 3%), and some of the respondents guessed that it was as high as 50%. Many neurologists and obstetricians do not have accurate informatian to counsel women with epilepsy properly about their contraceptive and pregnancy choices.
引用
收藏
页码:1534 / 1539
页数:6
相关论文
共 33 条
[1]   THE INTERACTION OF PHENOBARBITAL AND OTHER ANTICONVULSANTS WITH ORAL-CONTRACEPTIVE STEROID-THERAPY [J].
BACK, DJ ;
BATES, M ;
BOWDEN, A ;
BRECKENRIDGE, AM ;
HALL, MJ ;
JONES, H ;
MACIVER, M ;
ORME, M ;
PERUCCA, E ;
RICHENS, A ;
ROWE, PH ;
SMITH, E .
CONTRACEPTION, 1980, 22 (05) :495-503
[2]   EVALUATION OF COMMITTEE ON SAFETY OF MEDICINES YELLOW CARD REPORTS ON ORAL CONTRACEPTIVE DRUG INTERACTIONS WITH ANTI-CONVULSANTS AND ANTIBIOTICS [J].
BACK, DJ ;
GRIMMER, SFM ;
ORME, MLE ;
PROUDLOVE, C ;
MANN, RD ;
BRECKENRIDGE, AM .
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 1988, 25 (05) :527-532
[3]   PHARMACOKINETIC DRUG-INTERACTIONS WITH ORAL-CONTRACEPTIVES [J].
BACK, DJ ;
ORME, MLE .
CLINICAL PHARMACOKINETICS, 1990, 18 (06) :472-484
[4]   PHENOBARBITONE INTERACTION WITH ORAL-CONTRACEPTIVE STEROIDS IN THE RABBIT AND RAT [J].
BACK, DJ ;
BRECKENRIDGE, AM ;
CRAWFORD, FE ;
ORME, ML ;
ROWE, PH .
BRITISH JOURNAL OF PHARMACOLOGY, 1980, 69 (03) :441-452
[5]  
BERESFORD HR, 1994, NEUROLOGICAL COMPLIC
[6]   DO ANTICONVULSANTS REDUCE THE EFFICACY OF ORAL-CONTRACEPTIVES [J].
COULAM, CB ;
ANNEGERS, JF .
EPILEPSIA, 1979, 20 (05) :519-525
[7]  
Cramer Joyce A., 1993, P686
[8]   THE INTERACTION OF PHENYTOIN AND CARBAMAZEPINE WITH COMBINED ORAL-CONTRACEPTIVE STEROIDS [J].
CRAWFORD, P ;
CHADWICK, DJ ;
MARTIN, C ;
TJIA, J ;
BACK, DJ ;
ORME, M .
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 1990, 30 (06) :892-896
[9]  
CRAWFORD P, 1985, CONTRACEPTION, V33, P23
[10]   INTERACTION OF ANTICONVULSANTS AND ORAL-CONTRACEPTIVES IN EPILEPTIC ADOLESCENTS [J].
DIAMOND, MP ;
GREENE, JW ;
THOMPSON, JM ;
VANHOOYDONK, JE ;
WENTZ, AC .
CONTRACEPTION, 1985, 31 (06) :623-632