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Drug Interactions between brivaracetam and ethinyl estradiol / ethynodiol

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Minor

ethinyl estradiol brivaracetam

Applies to: ethinyl estradiol / ethynodiol and brivaracetam

Coadministration with brivaracetam at higher than recommended dosages may decrease the plasma concentrations of contraceptive hormones. The mechanism may involve weak induction of CYP450 3A4 metabolism by brivaracetam. In 24 healthy premenopausal women given an oral contraceptive containing ethinyl estradiol 30 mcg and levonorgestrel 150 mcg in combination with brivaracetam 200 mg twice daily (twice the recommended maximum daily dosage), a reduction in estrogen and progestin systemic exposure (AUC) of 27% and 23%, respectively, was observed without impact on suppression of ovulation. There was generally no difference in levels of the endogenous hormones estradiol, progesterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), and sex hormone binding globulin (SHBG) during the cycle with brivaracetam compared to the control cycle, and the combination was well tolerated. When the oral contraceptive was administered with brivaracetam 50 mg twice daily, no significant effects were observed on the pharmacokinetics of either ethinyl estradiol or levonorgestrel. Steady-state brivaracetam trough levels were also not affected by the oral contraceptive. Based on existing data, the interaction is not expected to be clinically relevant, and no particular precaution appears necessary when brivaracetam is used with oral contraceptives.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Stockis A, Watanabe S, Fauchoux N (2014) "Interaction between brivaracetam (100 mg/day) and a combination oral contraceptive: a randomized, double-blind, placebo-controlled study." Epilepsia, 55, e27-31
  3. Stockis A, Rolan P (2013) "Effect of brivaracetam (400 mg/day) on the pharmacokinetics and pharmacodynamics of a combination oral contraceptive in healthy women." J Clin Pharmacol, 53, p. 1313-21
  4. (2016) "Product Information. Briviact (brivaracetam)." UCB Pharma Inc
View all 4 references

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Minor

ethynodiol brivaracetam

Applies to: ethinyl estradiol / ethynodiol and brivaracetam

Coadministration with brivaracetam at higher than recommended dosages may decrease the plasma concentrations of contraceptive hormones. The mechanism may involve weak induction of CYP450 3A4 metabolism by brivaracetam. In 24 healthy premenopausal women given an oral contraceptive containing ethinyl estradiol 30 mcg and levonorgestrel 150 mcg in combination with brivaracetam 200 mg twice daily (twice the recommended maximum daily dosage), a reduction in estrogen and progestin systemic exposure (AUC) of 27% and 23%, respectively, was observed without impact on suppression of ovulation. There was generally no difference in levels of the endogenous hormones estradiol, progesterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), and sex hormone binding globulin (SHBG) during the cycle with brivaracetam compared to the control cycle, and the combination was well tolerated. When the oral contraceptive was administered with brivaracetam 50 mg twice daily, no significant effects were observed on the pharmacokinetics of either ethinyl estradiol or levonorgestrel. Steady-state brivaracetam trough levels were also not affected by the oral contraceptive. Based on existing data, the interaction is not expected to be clinically relevant, and no particular precaution appears necessary when brivaracetam is used with oral contraceptives.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Stockis A, Watanabe S, Fauchoux N (2014) "Interaction between brivaracetam (100 mg/day) and a combination oral contraceptive: a randomized, double-blind, placebo-controlled study." Epilepsia, 55, e27-31
  3. Stockis A, Rolan P (2013) "Effect of brivaracetam (400 mg/day) on the pharmacokinetics and pharmacodynamics of a combination oral contraceptive in healthy women." J Clin Pharmacol, 53, p. 1313-21
  4. (2016) "Product Information. Briviact (brivaracetam)." UCB Pharma Inc
View all 4 references

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Drug and food interactions

Minor

ethinyl estradiol food

Applies to: ethinyl estradiol / ethynodiol

Coadministration with grapefruit juice may increase the bioavailability of oral estrogens. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits. In a small, randomized, crossover study, the administration of ethinyl estradiol with grapefruit juice (compared to herbal tea) increased peak plasma drug concentration (Cmax) by 37% and area under the concentration-time curve (AUC) by 28%. Based on these findings, grapefruit juice is unlikely to affect the overall safety profile of ethinyl estradiol. However, as with other drug interactions involving grapefruit juice, the pharmacokinetic alterations are subject to a high degree of interpatient variability. Also, the effect on other estrogens has not been studied.

References

  1. Weber A, Jager R, Borner A, et al. (1996) "Can grapefruit juice influence ethinyl estradiol bioavailability?" Contraception, 53, p. 41-7
  2. Schubert W, Eriksson U, Edgar B, Cullberg G, Hedner T (1995) "Flavonoids in grapefruit juice inhibit the in vitro hepatic metabolism of 17B-estradiol." Eur J Drug Metab Pharmacokinet, 20, p. 219-24

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Minor

ethinyl estradiol food

Applies to: ethinyl estradiol / ethynodiol

The central nervous system effects and blood levels of ethanol may be increased in patients taking oral contraceptives, although data are lacking and reports are contradictory. The mechanism may be due to enzyme inhibition. Consider counseling women about this interaction which is unpredictable.

References

  1. Hobbes J, Boutagy J, Shenfield GM (1985) "Interactions between ethanol and oral contraceptive steroids." Clin Pharmacol Ther, 38, p. 371-80

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Minor

ethynodiol food

Applies to: ethinyl estradiol / ethynodiol

The central nervous system effects and blood levels of ethanol may be increased in patients taking oral contraceptives, although data are lacking and reports are contradictory. The mechanism may be due to enzyme inhibition. Consider counseling women about this interaction which is unpredictable.

References

  1. Hobbes J, Boutagy J, Shenfield GM (1985) "Interactions between ethanol and oral contraceptive steroids." Clin Pharmacol Ther, 38, p. 371-80

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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