Contraceptive failure and sugammadex administration: a single centre survey and audit of professional knowledge and practice

Passi, Neha Natasha; Mutebi, Marvin; Tan, Melanie; Oliver, Charles M.

doi:10.1016/j.bja.2022.11.017

Cited by 2 publications

(2 citation statements)

References 3 publications

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“…Unintended pregnancy can be personally, socially, and economically burdensome; therefore, patients should be informed and educated even if there is a slight possibility. However, several studies show that 78–94% of anesthesia providers are aware of the risk of oral contraceptive failure with sugammadex, whereas only 20 to 33% of anesthesia providers discuss this with their patients [ 44 , 45 ]. Appropriate education and policies are required to overcome discrepancies between knowledge and practice.…”

Section: Clinical Evidencementioning

confidence: 99%

What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives

Cho

2023

Anesth Pain Med

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Sugammadex is a chemically modified γ-cyclodextrin that is used as a selective reversal agent for steroidal neuromuscular blockade. The use of sugammadex has greatly increased globally; however, little is known about its potential adverse effects in pregnant and lactating women or those using hormonal contraceptives. There are three important theoretical assumptions. Firstly, pregnancy-related physiological changes involve most organs and affect the pharmacokinetic profiles of medications. Considering the physiological changes in pregnant women and the pharmacokinetic properties of sugammadex, alterations in the dosage and safety profiles of sugammadex may occur during pregnancy. Secondly, very large and polarized sugammadex molecules are expected to have limited placental transfer to the fetus and excretion into breast milk. Finally, sugammadex can bind to steroidal neuromuscular blocking agents as well as other substances with similar structures, such as progesterone. As a result of using sugammadex, progesterone levels can be reduced, causing adverse effects such as early pregnancy cessation and failure of hormonal contraceptives. This narrative review aims to demonstrate the correlations between sugammadex and pregnancy, lactation, and reproductive potential based on previously published preclinical and clinical studies. This will bridge the gap between theoretical assumptions and currently unknown clinical facts. Moreover, this review highlights what anesthesia providers should be aware of and what actions to take while administering sugammadex to such patients.

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Section: Clinical Evidencementioning

confidence: 99%

What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives

Cho

2023

Anesth Pain Med

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“…Early pharmacokinetic-pharmacodynamic studies postulated a potential interaction between sugammadex and progestogen-based hormonal contraceptives which the drug manufacturing company, Merck Sharp and Dohme (MSD), suggested was equivalent to a missed dose of hormonal contraceptive (oral and nonoral) [2]. The concept of a potential reduction in contraceptive efficacy has been adopted internationally with widespread calls for greater awareness about the perceived need for anesthetists to counsel patients [4][5][6][7][8]. This review will consider the evidence behind this position.…”

Section: Introductionmentioning

confidence: 99%

Sugammadex and oral contraceptives

Devoy,

Smith

2024

Current Opinion in Anaesthesiology

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Purpose of review This review article explores the evidence regarding sugammadex (MSD Australia) and its potential interaction with hormonal contraceptives. The impact of recent clinical trials and review articles is examined. Recent findings Recent clinical data suggest that the interaction between sugammadex and estrogen and progesterone concentrations may not be clinically significant and may confer some protection against ovulation. There are no clinical trials reporting interactions between sugammadex and the exogenous hormonal compounds found in oral contraceptive pills. The method of contraception is an important consideration, as sugammadex theoretically affects oral and nonoral, and combined versus single agent methods differently. Two large retrospective database studies have reported two cases of pregnancy postoperatively in patients on hormonal contraceptives whose anesthetic included sugammadex. Summary Strong clinical evidence to support or refute claims of a significant impact of sugammadex on contraceptive efficacy in women on contraception is lacking. The existing evidence does not suggest a basis for concern regarding the impact of sugammadex on contraception in the perioperative setting.

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Contraceptive failure and sugammadex administration: a single centre survey and audit of professional knowledge and practice

Cited by 2 publications

References 3 publications

What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives

What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives

Sugammadex and oral contraceptives

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