Effects of Antiepileptics on oral contraceptives and teratogenicity

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

AEDOral Contraceptive EfficacyPregnancy Category Known Teratogenicity Issues
PhenobarbitalDecreaseDCleft lip and palate and heart defects
PhenytoinDecreaseDHypoplasia of the nails plus stiff joints, cleft lip and palate
PrimidoneDecreaseDCleft lip and palate
CarbamazepineDecreaseDNeural tube defects 0.5%-1%, other major malformations, microcephaly, and growth retardation
Valproic acidNoneDNeural tube defects 1%-2%, also cardiac anomalies, hypospadias, polydactyly, bilateral inguinal hernia, dysplastic kidney, and equinovarus clubfoot
FelbamateNoneCUncertain
GabapentinNoneCUncertain
LamotrigineNoneCUncertain
TopiramateDecreaseCUncertain
TiagabineNoneCUncertain
LevetiracetamNoneCUncertain
OxcarbazepineDecreaseCMay be more favorable than carbamazepine (no epoxide metabolite)
ZonisamideNoneCUncertain
LacosamideNoneCUncertain
PregabalinNoneCUncertain
RufinamideDecreaseCUncertain
VigabatrinNoneCUncertain

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.
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