Drug interactions between non-rifamycin antibiotics and hormonal contraception: a systematic review

Abstract

Evidence from clinical and pharmacokinetic outcomes studies does not support the existence of drug interactions between hormonal contraception and non-rifamycin antibiotics. Data are limited by low quantity and quality for some drug classes. Most women can expect no reduction in hormonal contraceptive effect with the concurrent use of non-rifamycin antibiotics.

Drug interactions between rifamycin antibiotics and hormonal contraception: a systematic review

“…We searched MEDLINE, Embase, Clinicaltrials.gov, and Cochrane libraries for articles in any language from database inception to May 2017 using search terms developed with a reference librarian (Supporting Information Appendix S1), and scanned references sections of included articles and relevant review articles to identify additional studies. Studies of non‐rifamycin antibiotics are reported separately …”

Women’s health 2019: Osteoporosis, breast cancer, contraception, and hormone therapy

“…Despite the lack of compelling evidence that broad-spectrum antibiotics interfere with the effi cacy of hormonal contraception, most pharmacists recommend backup contraception for women who use concomitant antibiotics. 3 This practice could lead to poor compliance with the contraceptive regimen, the antibiotic regimen, or both. 3 Simmons et al 3 conducted a systematic review of randomized and nonrandomized studies that assessed pregnancy rates, breakthrough bleeding, ovulation suppression, and hormone pharmacokinetics in women taking oral or vaginal hormonal contraceptives in combination with nonrifamycin antibiotics, including oral, intramuscular, and intravenous forms.…”

“…3 This practice could lead to poor compliance with the contraceptive regimen, the antibiotic regimen, or both. 3 Simmons et al 3 conducted a systematic review of randomized and nonrandomized studies that assessed pregnancy rates, breakthrough bleeding, ovulation suppression, and hormone pharmacokinetics in women taking oral or vaginal hormonal contraceptives in combination with nonrifamycin antibiotics, including oral, intramuscular, and intravenous forms. Oral contraceptives used in the studies included a range of doses and progestins, but lowest-dose pills, such as those containing less than 30 μg ethinyl estradiol or less than 150 μg levonorgestrel, were not included.…”

“…The contraceptive formulations in this systematic review 3 included oral contraceptive pills, emergency contraception pills, and the contraceptive vaginal ring. The effect of antibiotics on other nonoral contraceptives, such as the transdermal patch, injectables, and progestin implants was not studied.…”

“…However, ethinyl estradiol was shown to have increased clearance when administered with dirithromycin (a macrolide). 3 Twenty-fi ve of the studies reported measures of contraceptive effectiveness (ovulation) and pharmacokinetic outcomes.…”