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Effects of Antiepileptics on oral contraceptives and teratogenicity
Enzyme-inducing Antiepileptics (AEDs) can induce the metabolism of oral contraceptives, leading to failure of contraception.
An implant or intrauterine device might provide better protection in this instance.
Some AEDs used during pregnancy, particularly valproate, have been associated with increased incidence of birth defects.
Because some AEDs cause neural tube defects, all sexually active and fertile women with epilepsy should be taking folate on a daily basis (0.4 to 5 mg/day).
Antiepileptic Drugs in Contraception and Pregnancy
AED | Oral Contraceptive Efficacy | Pregnancy Category ∗ | Known Teratogenicity Issues |
---|---|---|---|
Phenobarbital | Decrease | D | Cleft lip and palate and heart defects |
Phenytoin | Decrease | D | Hypoplasia of the nails plus stiff joints, cleft lip and palate |
Primidone | Decrease | D | Cleft lip and palate |
Carbamazepine | Decrease | D | Neural tube defects 0.5%-1%, other major malformations, microcephaly, and growth retardation |
Valproic acid | None | D | Neural tube defects 1%-2%, also cardiac anomalies, hypospadias, polydactyly, bilateral inguinal hernia, dysplastic kidney, and equinovarus clubfoot |
Felbamate | None | C | Uncertain |
Gabapentin | None | C | Uncertain |
Lamotrigine | None | C | Uncertain |
Topiramate | Decrease | C | Uncertain |
Tiagabine | None | C | Uncertain |
Levetiracetam | None | C | Uncertain |
Oxcarbazepine | Decrease | C | May be more favorable than carbamazepine (no epoxide metabolite) |
Zonisamide | None | C | Uncertain |
Lacosamide | None | C | Uncertain |
Pregabalin | None | C | Uncertain |
Rufinamide | Decrease | C | Uncertain |
Vigabatrin | None | C | Uncertain |
C: Risk not ruled out.D: Positive evidence of risk.
∗ Pregnancy categories.
Sources
- Harden CL, Pennell PB: Neuroendocrine considerations in the treatment of men and women with epilepsy. Lancet Neurol 12:72–83, 2013.
- Harden CL, Pennell PB, Koppel BS, et al: Practice parameter update: Management issues for women with epilepsy: focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 73:142-149, 2009.