The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for September 2016 (PDF).
This issue contains updated advice on emergency hormonal contraception in patients taking hepatic enzyme inducers. It is now advised that women taking hepatic enzyme inducers, or who have taken them in the previous 4 weeks, are recommended to preferably use a non-hormonal emergency contraceptive - i.e. a copper intrauterine device. Where this is not possible a double dose of levonorgestrel must be used. It is also advised that a pregnancy test is performed to exclude pregnancy after use of levonorgestrel-containing emergency contraception and advice sought if they do become pregnant.
Hepatic enzyme inducers include medicines used to treat:
- epilepsy (e.g. barbiturates, primidone, phenytoin, carbamazepine)
- tuberculosis (e.g. rifampicin, rifabutin)
- HIV (e.g. ritonavir, efavirenz)
- fungal infections (e.g. griseofulvin)
- and Herbal remedies that contain St John’s wort (Hypericum perforatum)
This issue also contains additional information that posaconazole suspension and tablets are not dose equivalent as noted in the summary of letters to healthcare professionals in last month's update.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
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