Abstract Details

Title Awareness of Drug-Drug Interactions between Synthetic Hormones and Anti-Epileptic Medications: A Survey of Neurology, Obstetrics and Gynecology, Internal Medicine, and Psychiatry Residents

Topic Clinical Neurophysiology

Presentation(s) P01 - (-)

Poster/Presentation
Number 034

Objective

Background Choosing an appropriate form of contraception is difficult for women taking anti-epileptic medications as many of these drugs have significant interactions with hormonal contraception. It is critical for providers to be aware of these drug-drug interactions as AEDs are one of the most frequently prescribed medications. Studies have shown that physician knowledge of the effect of enzyme-inducing AEDs (EI-AEDs) on oral contraceptive pills (OCPs) is poor. Prior studies did not address the interactions of EI-AEDs on other forms of contraception or the interactions of hormonal contraception with lamotrigine.

Design/Methods A survey of drug-drug interactions between hormonal contraception and anti-epileptic medications was distributed to residents at our institution.

Results Nineteen neurology, 22 ob/gyn, 29 internal medicine, and 15 psychiatry residents responded. The majority of internal medicine and psychiatry residents indicated that they did not know the answers to all questions. Most of the ob/gyn and neurology residents knew that carbamazepine and phenytoin decreased the efficacy of OCPs. However, both groups were not aware that carbamazepine interacts with other forms of hormonal contraception. Furthermore, 85% of ob/gyn and 63% of neurology residents did not know that topiramate may decrease the efficacy of OCPs. Sixty-five percent of ob/gyn and 47% of neurology residents were unaware that oral contraception can lower lamotrigine levels.

Conclusions Awareness regarding important interactions between AEDs and hormonal contraception is low in all specialties. As these medications continue to be prescribed for conditions other than epilepsy, it is vital that physicians become aware of these interactions in order to provide optimal care to women of childbearing age. Further education through the development of guidelines and interactive educational materials is important and recommended during residency training.

Authors/Disclosures
Manisha Sahay, MD (Northwest Neurology) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Jeffrey D. Kennedy, MD (University of California, Davis)	Dr. Kennedy has nothing to disclose.
Michael P. Macken, MD, MRCPI (Northwestern Medical Faculty Foundation)	Dr. Macken has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz Pharma. Dr. Macken has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB. Dr. Macken has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for SK LifeSciences. Dr. Macken has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for LivaNova. The institution of Dr. Macken has received research support from LivaNova.
Alberto Ascherio, MD, PhD	Dr. Ascherio has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer. Dr. Ascherio has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Dr. Ascherio has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. The institution of Dr. Ascherio has received research support from NIH and US Department of Defense .
Stephan Schuele, MD, FAAN (Northwestern Memorial Hospital)	Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Monteris. Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurelis. Dr. Schuele has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Life Science. Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Jazz. Dr. Schuele has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neurophysiology. Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Thomas Needham. Dr. Schuele has received research support from National Institute of Health.
	No disclosure on file
	No disclosure on file
Elizabeth Gerard, MD (Northwestern University)	Dr. Gerard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Xenon. The institution of Dr. Gerard has received research support from NIH/NINDS. The institution of Dr. Gerard has received research support from Xenon Pharmaceuticals. The institution of an immediate family member of Dr. Gerard has received research support from NIH. The institution of Dr. Gerard has received research support from Eisai, Inc. (via Stanford University). Dr. Gerard has received publishing royalties from a publication relating to health care.

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