OCs, coexisting medical conditions: What to do?

Check options for scleroderma, antacid use

What are some of your questions when it comes to hormonal contraceptive use? Two readers’ questions are tackled below by Leon Speroff, MD, associate director of the Women’s Health Research Unit at Oregon Health & Science University in Portland, and David Archer, MD, professor of obstetrics and gynecology and director of the Clinical Research Center at the Eastern Virginia Medical Center in Norfolk.

Question: Should scleroderma patients should use combined birth control (pills, patch, or ring)?

Speroff: I know of no study that has addressed this question. In my opinion, if there is no clinical or laboratory evidence of vascular disease, low-dose estrogen-progestin contraception can be used.

Question: I hear some practitioners telling patients that they can’t take antacids within a couple of hours of taking oral contraceptive pills. Is this true, and what is the rationale? Are there any other medications that may interact with oral contraceptives?

Archer: There is no convincing evidence in the medical literature of an adverse interaction between antacids and oral contraceptives.1 I would answer that oral contraceptives can be taken with antacids and antibiotics, two of the more commonly prescribed agents used by women. Anti-epileptics and rifampin, the anti-tuberculosis drug, do have an effect on oral contraceptives, reducing the absorption and/or increasing the metabolism of ethinyl estradiol and the progestin.

Reference

1. Joshi JV, Sankolli GM, Shah RS, et al. Antacid does not reduce the bioavailability of oral contraceptive steroids in women. Int J Clin Pharmacol Ther Toxicol 1986; 24:192-195.