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Contraception - Management
Drug interactions with the combined contraceptive patch: how should I manage?

  • The efficacy of the combined contraceptive patch can be reduced by liver enzyme–inducing drugs (including the antibiotics rifampicin and rifamycin) and non-liver enzyme–inducing antibiotics.
  • Precautions to be taken are the same as for women taking a combined oral contraceptive. For details, see:
Clarification / Additional information
  • Interactions of the combined contraceptive patch with lamotrigine are similar as for combined oral contraceptives (COCs):
    • When women using lamotrigine start using COCs, seizure control can worsen.
    • When women using lamotrigine discontinue COCs, the adverse effects associated with lamotrigine can increase.
    • The manufacturer of lamotrigine warns that other hormonal contraceptives may have similar interactions with lamotrigine, although this has not been studied [ABPI Medicines Compendium, 2007b].
  • For further information, see Lamotrigine.
Basis for recommendation
  • These recommendations are based on guidelines from the Faculty of Sexual and Reproductive Health Care (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2004c; FFPRHC, 2005d; FFPRHC, 2007b; FSRH, 2010a].
  • No good specific data are available to guide the use of the combined contraceptive patch by women using liver enzyme inducers or antibiotics [FFPRHC, 2004c]. Recommendations therefore follow those for women using combined oral contraceptives.
  • The Summary of Product Characteristics for the combined contraceptive patch suggests that barrier contraception should be used in addition to the patch when liver enzyme–inducing drugs are used, or that an alternative method should be considered [ABPI Medicines Compendium, 2007a].
  • The situation where a woman is using a combined contraceptive patch and a liver enzyme–inducing drug is classified as a category 3 condition in the UK Medical Eligibility Criteria for use of combined hormonal methods. With category 3 conditions, the theoretical or proven risks usually outweigh the advantages of using the method. Provision of a method to a woman with a UKMEC category 3 condition requires expert clinical judgement and/or referral to a specialist contraceptive provider because use of the method is not usually recommended unless other methods are not available or not acceptable.

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