Co-administration of combined oral contraceptives and psychotropic drugs - risk of contraceptive failure and adverse events.

IF 8.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology Pub Date : 2025-06-25 DOI:10.1016/j.ajog.2025.06.048

Tanja Boehnke, Christian Franke, Anja Bauerfeind, Klaas Heinemann, Katja Koelkebeck, Cornelia Kolberg-Liedtke

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引用次数: 0

Abstract

Background: Combined oral contraceptives (COCs) and psychotropic drugs (PDs) are commonly used drugs in the female population. Yet, the quantity and quality of previous studies on drug interactions between these two medications is limited.

Objectives: To provide a detailed overview of the concomitant use of COCs and PDs and its potential risk of contraceptive failure and adverse events (AEs) in routine clinical practice.

Study design: A pooled analysis of four large, prospective, multinational cohort studies comprising new users of COCs with and without concomitant PD intake. We used exact matching (variable 1:10 ratio) on region, smoking status, age, and Body Mass Index (BMI) groups. Contraceptive failure and selected AEs occurring within six months after COC initiation were expressed by incidence rates per 100 women-years, crude, and adjusted Cox regression hazard ratios with 95% confidence intervals (CIs) separately for Europe and the United States.

Results: After matching, 8081 COC+PD users (Europe: 2271, United States: 5810) and 70,009 COC-only users (Europe: 22,685, United States: 47,324) were considered for analysis. No significant difference was found for the risk of contraceptive failure between COC+PD and COC-only users. The hazard ratios adjusted for age, BMI, medical history, oral contraceptive user status (i.e., first-time ever user, switcher, restarter after intake break), and education level were 1.4 (95% CI, 0.56 - 3.52) for Europe and 0.8 (95% CI, 0.55 - 1.09) for the United States. The risk of adverse events was 1.5-fold higher in COC+PD users than in COC-only users (Europe: 1.5 [95% CI, 1.13 - 2.02]; United States: 1.5 [95% CI, 1.22 - 1.88]). Most AEs were related to the digestive and genitourinary systems.

Conclusions: No difference in the risk of contraceptive failure was found for COC+PD and COC-only users, while COC+PD users tend to experience more AEs.

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口服避孕药和精神药物联合使用-避孕失败和不良事件的风险。

背景：复方口服避孕药（COCs）和精神药物（pd）是女性人群中常用的药物。然而，以往关于这两种药物相互作用的研究数量和质量都有限。目的：提供COCs和pd合用的详细概述及其在常规临床实践中避孕失败和不良事件（ae）的潜在风险。研究设计：对四项大型、前瞻性、多国队列研究进行汇总分析，该研究包括COCs的新使用者，并伴有或不伴有PD摄入。我们对地区、吸烟状况、年龄和身体质量指数（BMI）组采用精确匹配（可变1:10比例）。在欧洲和美国，避孕失败和COC开始后6个月内发生的选定ae分别用每100名妇女年的发生率、粗值和校正Cox回归风险比（95%置信区间（ci））表示。结果：匹配后，8081名COC+PD用户（欧洲：2271，美国：5810）和70009名COC纯用户（欧洲：22,685，美国：47,324）被纳入分析。COC+PD组和仅COC组的避孕失败风险无显著差异。经年龄、BMI、病史、口服避孕药使用状况（即首次使用、转换者、服药后重新使用）和教育水平调整后的风险比在欧洲为1.4 (95% CI, 0.56 - 3.52)，在美国为0.8 （95% CI, 0.55 - 1.09）。COC+PD使用者的不良事件风险比仅COC使用者高1.5倍(欧洲：1.5 [95% CI, 1.13 - 2.02]；美国：1.5 [95% CI, 1.22 - 1.88])。大多数ae与消化系统和泌尿生殖系统有关。结论：COC+PD与COC-单纯使用者的避孕失败风险无差异，而COC+PD使用者往往经历更多的ae。

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来源期刊

American journal of obstetrics and gynecology 医学-妇产科学

CiteScore

15.90

自引率

7.10%

发文量

2237

审稿时长

47 days

期刊介绍： The American Journal of Obstetrics and Gynecology, known as "The Gray Journal," covers the entire spectrum of Obstetrics and Gynecology. It aims to publish original research (clinical and translational), reviews, opinions, video clips, podcasts, and interviews that contribute to understanding health and disease and have the potential to impact the practice of women's healthcare. Focus Areas: Diagnosis, Treatment, Prediction, and Prevention: The journal focuses on research related to the diagnosis, treatment, prediction, and prevention of obstetrical and gynecological disorders. Biology of Reproduction: AJOG publishes work on the biology of reproduction, including studies on reproductive physiology and mechanisms of obstetrical and gynecological diseases. Content Types: Original Research: Clinical and translational research articles. Reviews: Comprehensive reviews providing insights into various aspects of obstetrics and gynecology. Opinions: Perspectives and opinions on important topics in the field. Multimedia Content: Video clips, podcasts, and interviews. Peer Review Process: All submissions undergo a rigorous peer review process to ensure quality and relevance to the field of obstetrics and gynecology.