Topamax + Cerazette

[shan]

I did an MUR today on a young woman who is on Topamax for migrane prophylaxis (and also to lose weight !!!) and on Cerazette. The GP has asked her to observe extra precautions. As she is on long term treatment, she asked me why should she ever use Cerazette if she has to always use other methods of contraception (condoms) ??? I checked with the manufacturers of Topamax and they have no evidence to support or deny any interaction between the progestogen only contraceptives and Topamax. Even they said it is up to the clinician to decide. In this scenario I suggested she uses a depo preperation, which she is not comfortable with.

What would you suggest ??

Shan

[DavidS]

I would suggest that cerazette may not be as effective for her, because she is taking Topamax. I would point out that she is the one doing the research on this, effectively, and although it may not be necessary, it may.

I would say that a "belt and braces" approach, involving condom use, would be advisable for her health, if she was likely to ask for an abortion should she become pregnant.

[Pharmanaut]

I did an MUR today on a young woman who is on Topamax for migrane prophylaxis (and also to lose weight !!!) and on Cerazette. The GP has asked her to observe extra precautions. As she is on long term treatment, she asked me why should she ever use Cerazette if she has to always use other methods of contraception (condoms) ??? I checked with the manufacturers of Topamax and they have no evidence to support or deny any interaction between the progestogen only contraceptives and Topamax. Even they said it is up to the clinician to decide. In this scenario I suggested she uses a depo preperation, which she is not comfortable with.

What would you suggest ??

Shan

I might have a bookmarked link on our dispensary computer that might help you.
Will post it here tomorrow.

Although the social consequences of an unwanted pregnancy would warrant additional precautions.
Especially if they did become pregnant and put a damages claim in.
If they are told they needed extra precautions and didn't bother, then it is down to the patient.

...a sign of the times we live in I'm afraid.

[Pharmanaut]

Here we are - the link as promised.
Also a CPD goldmine : so make sure you log what you have read my brothers and sisters of pharmacy.

Faculty of Sexual & Reproductive Healthcare

[lamzee]

Why doesn't she just get a mirena fitted and save any hassle.

[Fleegle]

I just love the way an Irish girl thinks!

[shan]

She doesn't like the idea of any thing being inserted in to or on her body

My question here still is -- if someone is on a long term treatment of a drug found to have interaction with a contraceptive, then, is it safe to continue using the contraceptive ?? How effective is it ?? 80%, 90%, 99% ???? If extra precautions are necessary then why use the contraceptive pills at all ??? you can as well take extra precaution every time you have intercourse ( for example a healthy young couple would make out atleast 2 or 3 times a week or may be more)

Shan

[Pharmanaut]

She doesn't like the idea of any thing being inserted in to or on her body

My question here still is -- if someone is on a long term treatment of a drug found to have interaction with a contraceptive, then, is it safe to continue using the contraceptive ?? How effective is it ?? 80%, 90%, 99% ???? If extra precautions are necessary then why use the contraceptive pills at all ??? you can as well take extra precaution every time you have intercourse ( for example a healthy young couple would make out atleast 2 or 3 times a week or may be more)

Shan

Unless they are pharmacists as they are too tired!

[johnep]

I think was Marie Stopes who said you should not allow anything that you would not put in your mouth. Authorities advice is that anything inserted into the body should be boiled to sterilise first.
Both of these comments source of many a joke.
johnep

[shan]

Tired or not, where there is will there is a way

Shan