Objective
The purpose of this study was to determine whether interactions between non-rifamycin
antibiotics and hormonal contraceptives result in decreased effectiveness or increased
toxicity of either therapy.
Study Design
We searched MEDLINE, Embase, clinicaltrials.gov, and Cochrane libraries from database inception through June 2016. We included trials,
cohort, case-control, and pharmacokinetic studies in any language that addressed pregnancy
rates, pharmacodynamics, or pharmacokinetic outcomes when any hormonal contraceptive
and non-rifamycin antibiotic were administered together vs apart. Of 7291 original
records that were identified, 29 met criteria for inclusion.
Study Appraisal and Synthesis Methods
Two authors independently assessed study quality and risk of bias using the United
States Preventive Services Task Force evidence grading system. Findings were tabulated
by drug class.
Results
Study quality ranged from good to poor and addressed only oral contraceptive pills,
emergency contraception pills, and the combined vaginal ring. Two studies demonstrated
no difference in pregnancy rates in women who used oral contraceptives with and without
non-rifamycin antibiotics. No differences in ovulation suppression or breakthrough
bleeding were observed in any study that combined hormonal contraceptives with any
antibiotic. No significant decreases in any progestin pharmacokinetic parameter occurred
during co-administration with any antibiotic. Ethinyl estradiol area under the curve
decreased when administered with dirithromycin, but no other drug.
Conclusion
Evidence from clinical and pharmacokinetic outcomes studies does not support the existence
of drug interactions between hormonal contraception and non-rifamycin antibiotics.
Data are limited by low quantity and quality for some drug classes. Most women can
expect no reduction in hormonal contraceptive effect with the concurrent use of non-rifamycin
antibiotics.
Key words
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Article info
Publication history
Published online: July 07, 2017
Footnotes
The authors report no conflict of interest.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.
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