Changes In The Prescription Of Progestin Sub-dermal Implants (Implanon) In Women Who Are Taking Enzyme Inducing Drugs. 16/10/2014

Circular: Changes In The Prescription Of Progestin Sub-dermal Implants (Implanon) In Women Who Are Taking Enzyme Inducing Drugs Such As Efavirenz For HIV, Rifampicin For TBb, And Certain Drugs Used For Epilepsy (Carbamazepine, Phenytoin, and Phenobarbital). 16/10/2014

To all public health nurses, doctors and managers

New evidence has emerged that certain enzyme inducing drugs, such as Efavirenz for women who are HIV positive, Rifampicin for women who have TB, and Carbamazepine, Phenytoin, and Phenobarbital for women with epilepsy can interfere with the action and effectiveness of progestin subdermal implants.

It is therefore recommended:

1) Women who are on the enzyme inducing drugs listed above should not use Progestin subdermal implants (Implanon) but rather use another method, e.g. intrauterine devices or Depot Medro Xyprogesterone Acetate (DMPA). The effectiveness of combined oral contraceptives may be impaired by the enzyme inducing drugs, but could be used together with condoms if the women prefer this method.

2) Women who are HIV infected and on Efavirenz, or who are epileptic and on Carbamazepine, Phenytoin, or Phenobarbital, and already have the Progestin sub-dermal implants (Implanon) inserted should be covered with another non-hormonal contraceptive method (intrauterine devices or condoms). They should be given the option of having the Progestin sub-dermal implants (Implanon) removed and replaced with an alternative method as in 1) above.

3) Women who are infected with TB and on Rifampicin and already have the Progestin sub-dermal implants (Implanon) inserted should be covered with another non-hormonal contraceptive method (intrauterine devices or condoms) for the duration of their TB treatment.

For more information please contact Dr Pearl Holele on Holelp@health.gov.za or 012 395 9736 or Dr Zuki Pinini on PininZ@health.gov.za or 012 395 9157 in the National Department of Health.

DR Y PILLAY
DEPUTY DIRECTOR-GENERAL: HIV/AIDS, TB and MCWH
 

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