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21st June 2023
Contraception
AEDs can affect the effectiveness of contraception or vice versa, so women with epilepsy should be counselled regarding this when prescribing AEDs and/or contraception.
Enzyme-inducing AEDs (see the subsection on Cytochrome P450 under Side Effects) and contraception:
| Effect of the combination of the enzyme-inducing AEDs and contraception | Recommended contraceptives that can be prescribed |
|---|---|
Enzyme-inducing AEDs reduce the effectiveness of oral contraceptives, such as:
|
|
Lamotrigine and contraception:
| Effect of the combination of lamotrigine and contraception | Recommended contraceptives that can be prescribed |
|---|---|
| Contraceptives containing oestrogen only reduce the effectiveness of lamotrigine by 40-60%.
Avoid prescribing the following oestrogen-only contraceptives:
The POP can increase lamotrigine levels, so adverse effects of lamotrigine need to be monitored if the patient chooses to take the POP with lamotrigine. |
|
If a woman with epilepsy plans to get pregnant, she should be referred to an epilepsy specialist for pre-conception counselling and remain on contraception until she has seen that specialist. NICE recommends starting all these women on high dose (5mg) folic acid.
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