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Epilepsy in WomenAka: Contraception Selection in Seizure Disorder, Antiepileptic Drug Interactions in Contraception, Catamenial Seizure

See Also
Associated Conditions in Women with Epilepsy
1. Catamenial Seizure
  1. Occurs in up to 50% of women with Epilepsy
  2. Seizure related to Menstrual Cycle
    1. Onset of Menses due to Progesterone withdrawal
    2. Mid-cycle at Ovulation due to Estrogen surge
2. Polycystic Ovary Disease
  1. Occurs in up to 40% of women with Epilepsy
  2. Subset related to Valproate
    1. Improves with medication change
Contraceptive Selection in Epilepsy
1. Consider non-Hormonal Contraception
2. Avoid OCP with antiepileptics that induce CYP P450
  1. These agents listed below render OCPs less effective
  2. OCP failure rate with these agents >6%
  3. Norplant also less effective with these agents
  4. Use 50 ug Estrogen pill if OCP used for Contraception
Oral Contraceptives (OCP)
1. Antiepileptics that induce P450 system (avoid with OCP)
  1. Carbamazepine (Tegretol)
  2. Ethosuximide (Zarontin)
  3. Felbamate
  4. Phenobarbital
  5. Phenytoin (Dilantin)
  6. Primidone (Mysoline)
  7. Oxcarbazepine (Trileptal)
  8. Topiramate (Topamax)
2. Antiepileptics that do not affect OCP efficacy
  1. Gabapentin (Neurontin)
  2. Levetiracetam (Keppra)
  3. Lamotrigine (Lamictal)
  4. Tiagabine (Gabitril)
  5. Valproate (Depakote)
  6. Zonisamide (Zonegran)
References
1. Morrell (2002) Am Fam Physician 66(8):1489
2. Zahn (1998) Neurology 51:949

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.