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Nearly one-third of people with epilepsy who were prescribed certain hormonal contraceptives also received antiseizure medications that may make those contraceptives less effective, according to a University of Pittsburgh–led study published in Neurology.

Some epilepsy medications may harm a developing fetus, so the findings point to a need for greater awareness of interactions between enzyme-inducing antiseizure medications and some hormonal contraceptives. These medications can accelerate the breakdown of contraceptive hormones in the body, potentially reducing protection against an unplanned pregnancy.

The researchers emphasize the importance of informed counseling and shared decision-making so that people with epilepsy can choose medication and contraceptive options that reflect their health needs and preferences.

"Pregnancy planning is especially important for people with epilepsy, but patients may not realize that some antiseizure medications can interact with some forms of hormonal contraception," said senior author Page B. Pennell, M.D., chair of the Department of Neurology at Pitt's School of Medicine.

"This study highlights an opportunity for neurologists, reproductive health clinicians, pharmacists and patients to have more coordinated conversations about medications, contraception and reproductive goals."

S. Medicaid claims data, the researchers identified 110,976 people with epilepsy of childbearing potential who were receiving antiseizure medications. Nearly 1 in 5 had received a hormonal contraceptive that could be affected by enzyme-inducing antiseizure medications between 2018 and 2021. The contraceptive methods included combined and progestin-only pills, contraceptive patches, vaginal rings and subdermal implants.

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