Interactions Between Anti-Epileptic Drugs and Contraceptives: A Review

Around half of the pregnancies in women with epilepsy are unplanned and the choice of contraceptive method in epileptic women is important, since it requires considering their possible pharmacological interactions with certain types of anti-epileptic drugs. Drugs from this class which induce hepatic enzyme activity may alter the metabolism of most hormonal methods of contraception, and this may affect their contraceptive efficacy. Hormonal contraception is regarded as highly effective, but its interaction with anti-epileptics may accelerate the metabolism of the latter with the consequent risk of failure, reduction of plasma concentration predisposing to seizures, risk of unwanted pregnancies, abortions, teratogenicity, maternal or fetal complications and difficulty in the management of epilepsy during pregnancy. In case of prescribing both medications, the combined use with a barrier method should be considered. Family planning counseling at the first visit has been shown to influence the choice of the contraceptive method. In conclusion, the different therapeutic options should be analyzed together with the epileptic patients in order to achieve and optimize the best goal for each one This article reviews these issues and offers practical recommendations for the management of contraception in epileptic patients.