The manufacturers state that drospirenone is metabolized only to a minor extent in vitro, mainly by CYP3A4. Although the FDA does not recommend that women currently using oral contraceptives containing desogestrel discontinue such use or switch to another estrogen-progestin combination contraceptive, the FDA states that women using an oral contraceptive containing desogestrel should be advised to discuss such use with their clinician, taking into consideration the relative risks and benefits associated with these oral contraceptives.
However, cohort studies suggest that the overall relative risk is somewhat lower, ranging from 3 times greater for new cases to 4.5 times greater for new cases requiring hospitalization in oral contraceptive users when compared with nonusers. Patients should be informed that as with all estrogen-progestin contraceptives and other nonbarrier contraceptive methods, emergency contraceptive regimens do not protect against human immunodeficiency virus (HIV) infection or other sexually transmitted diseases.Women receiving estrogen-progestin contraceptives should be under supervision of a physician who should inform them of the possible risks involved. If there is no withdrawal bleeding within 5 days of the last hormonally active tablet, pregnancy must be ruled out. Although the clinical importance of many of these interactions has not been determined, the manufacturers caution that concomitant use of oral contraceptives with oral anticoagulants, anticonvulsants, hypotensive agents (e.g., guanethidine), vitamins, or oral antidiabetic agents may result in decreased or increased effects of these drugs. It has been suggested that similar effects may occur during concomitant therapy with other known inducers of hepatic microsomal enzymes, including barbiturates, bosentan, carbamazepine, dexamethasone, griseofulvin, phenylbutazone (no longer commercially available in the US), phenytoin, felbamate, oxcarbazepine, rifabutin, modafinil, topiramate, and primidone. While the clinical importance of these findings is unknown, the efficacy of the contraceptive vaginal ring is not expected to be affected. Women who are receiving estrogen-progestin contraceptives should be Because of dose-related risks of vascular disease from oral contraceptives, the dosage regimen prescribed should contain the least amount of estrogen and progestin that is compatible with a low failure rate and the needs of the patient.Adverse effects similar to those with oral combination estrogen-progestin contraceptives generally are expected with vaginal or transdermal estrogen-progestin contraceptives.No data are available concerning the risk of using short-course, high-dose estrogen-progestin combinations for emergency contraception among women with contraindications to routine use of cyclic estrogen-progestin combinations for contraception. In women who develop breakthrough bleeding while receiving a biphasic oral contraceptive, switching to a triphasic oral contraceptive may control or alleviate bleeding since the progestin dose is increased after day 7 with the triphasic regimen. The effects of long-term administration of miconazole nitrate vaginal suppositories in women using the contraceptive vaginal ring are not known.Fluconazole, itraconazole and ketoconazole also may increase plasma concentrations of contraceptive steroids.Concurrent use of oral contraceptives and troleandomycin may increase the risk of cholestatic jaundice; therefore, the drugs should be used together cautiously.Oral contraceptives appear to decrease oxidative metabolism by the liver of some benzodiazepines (e.g., diazepam, chlordiazepoxide), while they may increase metabolism of other benzodiazepines (e.g., lorazepam, oxazepam, temazepam) that undergo glucuronide conjugation in the liver. Overall exposure to ethinyl estradiol and norelgestromin is higher in women receiving Ortho Evra than in women receiving an oral contraceptive preparation containing ethinyl estradiol 35 mcg and norgestimate 0.25 mg.
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