Epilepsy and contraception
Revisado por pares por Prof. Cathy Jackson, MRCGPÚltima actualización por Dr Colin Tidy, MRCGPLast updated 26 Jan 2018
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It's best to seek advice from a doctor or epilepsy nurse when you are planning to start using contraception or when considering starting a family.
At a glance
Some anti-epilepsy medicines can affect how some contraception works.
These medicines, called liver enzyme inducers, speed up how the liver processes contraception.
If taking certain anti-epilepsy medicines, some contraceptive pills, patches, and implants are not recommended.
Barrier methods or coils are usually the most suitable contraception if on a liver enzyme-inducing medicine.
The combined pill may also interact with lamotrigine, affecting both medicines.
Always get advice from a doctor or nurse about contraception if you take anti-epilepsy medicines.
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Some anti-epilepsy medicines have a side-effect of increasing the speed in which some contraceptive pills and injections are processed by the liver. These medicines are known as liver enzyme inducers, as they speed up certain processes in the liver cells.
The following anti-epilepsy medicines are liver enzyme inducers:
The other anti-epilepsy medicines, including valproato de sodio, lamotrigina y ethosuximide, are not liver enzyme inducers. If you are taking an anti-epilepsy medicine which is not a liver enzyme inducer then your contraceptive choices, doses, etc, are usually the same as for any other women (although see below about lamotrigine).
However, if you are taking an anti-epilepsy medicine that is a liver enzyme inducer, the following is recommended:
If you take the combined oral contraceptive (COC) pill ('the pill') - the dose of the oestrogen part needs to be at least 50 micrograms, which is more than the usual dose. However, it is usually preferable to use alternative contraception, if possible.
The combined transdermal contraceptive patch is not recommended.
If you use emergency contraception tablets - the initial dose of levonorgestrel should be increased to 3 mg (you will need to take two tablets instead of one).
The progestogen injection called Depo-Provera® can be used but the injections need to be given more frequently.
Using either barrier methods of contraception or having any type of coil inserted (including the intrauterine system) are usually the most suitable forms of contraception to consider if you are taking a liver enzyme-inducing medicine for your epilepsy.
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Lamotrigine and the pill
There is some evidence that the COC may interact with lamotrigine (Lamictal®) in some women. Lamotrigine is an anti-epilepsy medicine. It is not a liver enzyme inducer but may interact with the COC in another way. The interaction may work both ways. That is, the lamotrigine may make the pill less effective and the pill may also make the lamotrigine less effective and increase your risk of seizures. Therefore, the doses of both medications may need to be adjusted.
It may be preferable to consider an alternative method of contraception if you are taking lamotrigine and need to use contraception.
For reliable contraception, it is best to seek advice from a doctor or nurse. They will be able to tell you if your epilepsy treatment affects any methods of contraception.
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Preguntas frecuentes
What are liver enzyme inducers?
Liver enzyme inducers are certain anti-epilepsy medicines that speed up how quickly some contraceptive pills and injections are processed by the liver. This can make these contraceptives less effective.
Which specific anti-epilepsy medicines are considered liver enzyme inducers?
The anti-epilepsy medicines that are liver enzyme inducers include carbamazepine, eslicarbazepine, oxcarbazepine, phenobarbital, phenytoin, primidone, and topiramate.
What if my anti-epilepsy medicine is not a liver enzyme inducer? Are my contraceptive options still affected?
If you are taking an anti-epilepsy medicine that is not a liver enzyme inducer, such as sodium valproate or ethosuximide, your contraceptive choices, doses, and recommendations are usually the same as for any other woman. However, lamotrigine is an exception and may still interact with the combined oral contraceptive pill.
What types of contraception are generally recommended if I am taking a liver enzyme-inducing medicine for epilepsy?
If you are taking a liver enzyme-inducing medicine, barrier methods of contraception (like condoms), or any type of coil (including the intrauterine system), are usually the most suitable options.
If I'm using emergency contraception and taking a liver enzyme inducer, do I need to do anything differently?
Yes, if you use emergency contraception tablets, the initial dose of levonorgestrel needs to be increased to 3 mg. This means you will need to take two tablets instead of the usual one.
Can I use the Depo-Provera® injection if I am taking a liver enzyme-inducing medicine?
Yes, the progestogen injection called Depo-Provera® can be used, but the injections will need to be given more frequently than usual to maintain effectiveness.
Why is lamotrigine mentioned separately, even though it's not a liver enzyme inducer?
Lamotrigine may interact with the combined oral contraceptive (COC) pill in a different way. This interaction can make both the pill and lamotrigine less effective, potentially increasing your risk of seizures. Due to this, adjusting medication doses may be necessary, or an alternative contraceptive method might be preferred.
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About the authorView full bio
Dr Colin Tidy, MRCGP
Médico General, Autor Médico
MBBS, MRCGP, MRCP (Paediatrics), DCH
Dr Colin Tidy is an NHS Doctor, based in Oxfordshire.
About the reviewerView full bio
Prof. Cathy Jackson, MRCGP
Medical Author
BSc (Hons) Physiology, MB, ChB, MRCGP, MD
Professor Cathy Jackson graduated from Manchester Medical School having gained a first-class honours degree in physiology along the way.
Historial del artículo
La información en esta página está escrita y revisada por pares por clínicos calificados.
26 Jan 2018 | Última versión
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