Increased Apparent Oral Clearance of Valproic Acid during Intake of Combined Contraceptive Steroids in Women with Epilepsy

Galimberti, Carlo; Mazzucchelli, Iolanda; Arbasino, Carla; Canevini, Maria Paola; Fattore, Cinzia; Perucca, Emilio

doi:10.1111/j.1528-1167.2006.00629.x

Cited by 56 publications

(20 citation statements)

References 13 publications

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“…Similar observations about increased clearance with possible worsening seizure control, have been made about OXC during pregnancy, but reports about effects of concomitant OCP use are lacking [1,65]. Findings of a study of VPA with OCP use in women were that total and unbound VPA concentrations were higher during the OCP-free interval than during the OCP interval [21]. VPA clearance increased by 21.5% for total VPA and 45% for free VPA.…”

Section: Antiepileptic Drugs and Hormonal Contraceptive Interactionsmentioning

confidence: 70%

Hormonal Aspects of Epilepsy

Pennell

2009

Neurologic Clinics

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Synopsis The interactions between hormones, epilepsy, and the medications used to treat epilepsy are complex, with tridirectional interactions which affect both men and women in various ways. Abnormalities of baseline endocrine status occur more commonly in people with epilepsy, and are most often described for the sex steroid hormone axis. Common symptoms include sexual dysfunction, decreased fertility, premature menopause, and polycystic ovarian syndrome. Antiepileptic drugs and hormones have a bidirectional interaction, with a decrease in the efficacy of hormonal contraceptive agents with some AEDs and a decrease in the concentration and efficacy of other AEDs with hormonal contraceptives. Endogenous hormones can influence seizure severity and frequency, resulting in catamenial patterns of epilepsy. However, this knowledge can be used to develop hormonal strategies to improve seizure control in people with epilepsy.

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Section: Antiepileptic Drugs and Hormonal Contraceptive Interactionsmentioning

confidence: 70%

Hormonal Aspects of Epilepsy

Pennell

2009

Neurologic Clinics

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“…Lamotrigine -see below Sodium valproate -not clinically significant 4,5 AEDs that cause liver enzyme inhibition: Sodium valproate -may raise the blood levels of hepatically metabolised drugs, with important effects on some other AEDs, particularly lamotrigine; but this would tend to make hormonal contraceptives more effective, without evidence of any clinically important added risk of adverse effects Table 6 Contraceptive preparations that inhibit ovulation Combined hormonal contraceptives Desogestrel (Cerazette ® ) Etonogestrel (Implanon ® ) -the active metabolite of desogestrel Medroxyprogesterone acetate (Depo-Provera ® )…”

Section: Aeds Affected By Hormonal Contraceptionmentioning

confidence: 99%

Contraception for women taking antiepileptic drugs

O'Brien¹,

Guillebaud²

2010

j fam plann reprod health care

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Antiepileptic drugs (AEDs) that induce hepatic enzyme activity may alter the metabolism of most hormonal methods of contraception, and this may affect their contraceptive efficacy. There is also the potential for the hormonal method to affect the AED. Women may also be prescribed AEDs to treat conditions other than epilepsy, such as chronic pain and migraine. These effects should be considered in the choice of both the treatment of the 239 IntroductionEpilepsy affects up to 1.0% of the population. About half of these patients are women, many of childbearing age, and most of them will seek advice about contraception at some time. The choice of contraceptive method is influenced by many factors, and women will expect, and should receive, appropriate information about the various options for safe and effective contraception. 1 This counselling requires a consideration of the age of the patient, their socioeconomic and educational status, the type of epilepsy and the most suitable antiepileptic drug (AED) treatment. This short review summarises those factors specific to epilepsy that influence this choice and makes recommendations about contraceptive practice for these patients. This information also applies to women prescribed AEDs for the treatment of chronic pain conditions and migraine. In general, women on AEDs may use a hormonal contraceptive if they wish to do so, after a full discussion with their physician of the alternatives available and any recommended modifications of the chosen regimen that may be necessary.The optimal choice of hormonal contraceptive is affected by whether or not the prescribed antiepileptic medication induces liver enzyme activity [i.e. an enzymeinducing antiepileptic drug (EIAED)].Important Note: Some of the practical management suggestions in this review are not licensed and if used they should be prescribed on a 'named patient basis' 2 by a registered medical practitioner. These recommendations are indicated in the text by the abbreviation NL. Interaction of hormonal contraceptives with AEDsSome AEDs induce cytochrome P450 hepatic enzyme activity, which increases the rate of metabolism of both ethinylestradiol (EE) and progestogens, thereby lowering the blood levels of these hormones, perhaps by 50% or more (Tables 1 and 2), dependent on individual variation.It is therefore very important to know whether a patient is taking an AED that affects hormonal contraception (i.e. an EIAED) before prescribing a hormonal contraceptive, Contraception for women taking antiepileptic drugs

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“…These fluctuations are most likely due to an induction of UGT1A4, the enzyme responsible for the glucoronidation of lamotrigine, by EE. VPA levels also seem to be reduced by the concomitant use of hormonal contraceptives Galimberti, 2006). Just as with lamotrigine the magnitude of observed fluctuations of the VPA levels appear to vary interindividually.…”

Section: Contraception and Epilepsymentioning

confidence: 95%