Around one-third of Americans with epilepsy are taking hormonal contraceptives that are potentially being made less effective by their antiseizure medication, a new study has found. Researchers at the University of Pittsburgh said that antiseizure medication has the potential to reduce the effectiveness of several kinds of hormonal birth control because the medication can accelerate the breakdown of the hormones in the body, and therefore reduce the protection they offer against unplanned pregnancy. They found that this possible drug interaction could be affecting a considerable number of Americans using Medicaid who had been prescribed both simultaneously.
The study was published in the journal Neurology on October 7. Epilepsy is a brain disorder that causes repeated seizures and affects around 2.9 million Americans. One of the methods used to treat the condition is antiseizure medication, which limits the spread of seizures in the brain.
Previous studies have identified the possible interaction between antiseizure medication and hormonal birth control, and also how some types of antiseizure medication may harm a developing fetus as well. Some antiseizure medication can cause the body to produce more hepatic enzymes, which are produced by the liver. These enzymes "are proteins in the body that break down substances like hormones and medications," study author Dr.
Laura Kirkpatrick, who is also an assistant professor of pediatrics and neurology at the University of Pittsburgh, told Newsweek. This means that they can “break down the hormones found in contraceptives,” and reduce their effect, she said. Building on that existing research, the researchers at the University of Pittsburgh set out to find out just how many people this could be impacting.
They obtained Medicaid claims data from between 2016 and 2021 from more than 110,000 people with epilepsy who were of childbearing age, and found that almost 22,000 of that group had been prescribed a susceptible contraceptive method between 2018 and 2021. The types of contraceptives found to potentially be affected by antiseizure medication were combined and progestin-only pills, contraceptive patches, vaginal rings and subdermal implants, but not IUDs, Kirkpatrick said. One third of the participants in that group had at least one 14-day period or longer where their prescriptions for one of the above contraceptives and a specific antiseizure medication overlapped.
The median duration of time for an overlap of these prescriptions was just over seven months. They also found that certain populations were more likely to experience drug interactions—those with "intellectual disability, drug-resistant epilepsy, or age older than 35 years." The researchers note that limitations include that the "data set lacks information on adherence, counseling, pregnancy intentions, sexual orientation and activity, and barrier use." For Americans with epilepsy, the potential drug interaction could pose various problems. Patients might be "unaware that they are at risk of their contraceptive not working and becoming unintentionally pregnant," Kirkpatrick said.
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