5 years ago

Drug interactions between rifamycin antibiotics and hormonal contraception: A systematic review

Kavita Nanda, Katharine B Simmons, Kathryn M Curtis, Lisa B Haddad
Background Rifamycin antibiotics are commonly used for treatment of tuberculosis, but may reduce effectiveness of hormonal contraception (HC). Objectives To determine whether interactions between rifamycins and HC result in decreased effectiveness or increased toxicity of either therapy. Search strategy We searched MEDLINE, Embase, Cochrane and clinicaltrials. gov through May, 2017. Selection criteria We included trials, cohort, and case-control studies addressing pregnancy rates, pharmacodynamics, or pharmacokinetic (PK) outcomes when HC and rifamycins were administered together versus apart. Of 7291 original records identified, 11 met inclusion criteria after independent review by two authors. Data collection and analysis Two authors independently abstracted study details and assessed study quality using the United States Preventive Services Task Force grading system. Findings are reported descriptively. Main results Studies only addressed combined oral contraceptives (COCs) and none reported pregnancy rates. Quality ranged from good to poor. Rifampin increased the frequency of ovulation in two of four studies, and reduced estrogen and/or progestin exposure in five studies. Rifabutin led to smaller PK changes than rifampin in two studies. Rifaximin and rifalazil did not alter hormone PK in one study each. Conclusions No studies evaluated pregnancy risk or non-oral HCs. PK and ovulation outcomes support a clinically concerning drug interaction between COCs and rifampin, and to a lesser extent rifabutin. Data are limited for other rifamycins. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/1471-0528.15027

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