Contraception for Women

The Combined Oral Contraceptive Pill (COCP)

25 March 2009
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There is no evidence to suggest that taking the pill adversely affects epilepsy. However, it is of vital importance that you tell your GP that you are taking anti-epileptic medication (AEDs). Some of the anti-epileptic medication can metabolise (break down) the COCP faster, therefore reducing its effectiveness. These particular medications are known as enzyme inducing anti-epileptic drugs.

They include: Phenytoin (Epanutin), Phenobarbitone, Primidone (Mysoline), Carbamazapine (Tegretol), Oxcarbazepine (Trileptal) and Topiramate (Topamax) in doses of 200mg or more daily. 

If you are taking any of these drugs, you should be on a COCP with a minimum of 50 micrograms oestrogen content or a combination of the COCP to obtain a minimum dose of 50 micrograms of oestrogen. Any evidence of breakthrough bleeding would suggest that this method is not effective and should be reported to your GP immediately: it may be necessary to increase the dose of the COCP to 75 or 100 micrograms/day. Women need to be advised that even on the higher dose contraception efficiency cannot be guaranteed.

Anti-epileptic medications, which are non enzyme inducing anti-epileptic drugs include: Sodium Valporate (Epilim), Clobazam (Frisium), Tiagabine (Gabatril), Levetiracetam (Keppra), *Lamotrigine (Lamictal), Gabapentin (Neurontin), Vigabatrin (Sabril) and Topiramate (Topamax) in doses lower than 200mg daily. The lower dose pill (25-35 micrograms/day of oestrogen) can be taken as usual if you are taking any of these drugs. Any evidence of breakthrough bleeding would suggest that this method is not effective and should be reported to your GP immediately.

*OF NOTE: Some research has suggested that Lamotrigine may interact with the COCP and reduce its effectiveness.

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