Pharmaceutical care in the treatment with oral contraceptives

Abstract

The key role of pharmacists in treatment with oral contraceptives is to educate the patient about possible adverse drug reactions, interactions and their prevention, and to improve compliance. Usual adverse reactions of oral contraceptives include: nausea, break-through bleedings, tense breasts, changes of mood and depression, decreased libido, skin changes, although serious adverse reactions such as myocardial infarction and stroke, venous tromboembolism and hypertension may occur as well. Oral contraceptives are metabolised by several isoenzymes of the cytochrome P-450 which they can also induce or inhibit. Most important interactions occur following coadministration of oral contraceptives and CYP3A4 inducers or CYP2B6 and CYP2C19 substrates. Compliance plays the key role in effective treatment with oral contraceptives but it is commonly unsatisfactory, especially in the adolescent population. Counseling about the importance of adequate administration of oral contraceptives, adverse drug reactions and interactions enables the pharmacist to contribute substantially to effective and safe use of oral contraceptives.

Ključna uloga farmaceuta u terapiji oralnim kontraceptivima je ukazivanje na moguća neželjena dejstva, klinički značajne interakcije i njihovu prevenciju i poboljšanje komplijanse. Uobičajeni neželjeni efekti oralnih kontraceptiva su: mučnina, probojna krvarenja, napetost dojki, promene raspoloženja i depresija, smanjen libido, promene na koži, mada se mogu javiti i veoma ozbiljna neželjena dejstva poput srčanog i moždanog udara, venskog tromboembolizma i hipertenzije. Oralni kontraceptivi se metabolizuju posredstvom niza izoenzima citohroma P 450 koje, takođe, mogu indukovati ili inhibirati. Najznačajnije interakcije nastaju prilikom istovremene primene oralnih kontraceptiva i induktora CYP3A4 ili supstrata CYP2B6 i CYP2C19. Komplijansa u primeni oralnih kontraceptiva je od ključnog značaja za efikasnost lekova ali je često nezadovoljavajuća posebno u populaciji adolescenata. Savetovanjem o značaju pravilne primene oralnih kontraceptiva, neželjenim reakcijama i interakcijama, farmaceut u velikoj meri može doprineti efikasnoj i bezbednoj primeni oralnih kontraceptiva.