Re: Diflucan and OCs

From: art fougner, md (evsono@pipeline.com)
Fri Nov 14 06:32:29 2003


Bernard -

i think this is the article -

1: Obstet Gynecol. 2001 Aug;98(2):218-23.

Evaluation of interaction between fluconazole and an oral contraceptive in healthy women.

Hilbert J, Messig M, Kuye O, Friedman H.

Clinical Pharmacology, Pfizer Global Research and Development, Pfizer, Inc., Groton, Connecticut 06340, USA. james_hilbert@groton.pfizer.com

OBJECTIVE: To evaluate the potential pharmacokinetic interaction between 2 x 150 mg fluconazole administered once weekly and an oral contraceptive (OC) containing ethinyl estradiol and norethindrone. METHODS: A placebo-controlled, double-masked, randomized, two-way crossover study was used to investigate the pharmacokinetic interaction between 300 mg fluconazole once weekly and the OC Ortho Novum 7/7/7 (Ortho-McNeil Pharmaceutical, Inc., Raritan, NJ) in 26 healthy women, 18-36 years old. In the first cycle (28 days), subjects received OC only. In the second cycle, subjects were assigned randomly to receive OC-fluconazole or OC-placebo. In the third cycle, subjects were crossed over to the opposite treatment. RESULTS: Data for 21 subjects who completed the study were included in the pharmacokinetic analysis; data for all 26 subjects were included in the safety analysis (26 OC only; 24 OC-fluconazole; 23 OC-placebo). Treatment with OC-fluconazole resulted in small but statistically significant increases in 0-24 hour area under the plasma concentration-time curve (AUC(0-24)) for both ethinyl estradiol (mean 24%, 95% confidence interval [CI] 18%, 31%) and norethindrone (mean 13%, 95% CI 8%, 18%) as compared with treatment with OC-placebo. Ethinyl estradiol maximum plasma concentration (C(max)) was slightly (mean 8%, 95% CI 2%, 15%) though statistically significantly higher for OC-fluconazole treatment as compared with OC-placebo treatment. Norethindrone C(max) was not different (95% CI -6%, 11%) between the two treatment groups. No adverse events related to treatment were seen in the fluconazole treatment group. CONCLUSION: The concomitant administration of 300 mg fluconazole once weekly, twice the recommended dose for vaginal candidiasis, to women using OCs results in a slight increase in OC concentrations. Therefore, it appears that there is no threat of contraceptive failure because of concomitant fluconazole administration.

One caveat tho - the research is Pfizer's.

art

At Fri, 14 Nov 2003, Bernard Cristalli wrote: >
>There was an article lately in the green journal saying that there was no
>interaction.
>
>--
>Bernard Cristalli MD AMACOG
>AIHP - ACCA
>Paris France
>http://www.CliniquedelEssonne.fr
>http://www.obgyn.net/corresp/cristalli.htm
>http://www.gyneweb.fr
>'64 Mk2 3.8
>
>> De : islesannie@yahoo.com (Joanne Bulley, MD)
>> Répondre à : ob-gyn-l@obgyn.net
>> Date : Thu, 13 Nov 2003 17:28:33 -0600
>> À : Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> Objet : Re: Diflucan and OCs
>>
>> I don't either - for it to affect the OC's - you have to be on it long
>> enough to induce the liver enzymes - and a single dose just doesn't do
>> it.
>>
>> Joanne
>>
>> At Thu, 13 Nov 2003, Dr. Ainsworth wrote:
>>>
>>> A pharmacist recently sent me a note to find out if I "really wanted to
>>> prescribe Diflucan, 150mg" for a uncomplicated yeast infection on a
>>> patient on OCs. He sent me a drug interaction monograph that reported
>>> several pregnancies in patients on OCs. On reviewing it, all of the
>>> patients they discussed were on long-term Diflucan, not a single daily
>>> dose. Do any of you have concerns about Diflucan and OCs? I don't.
>>
>> --
>> Joanne Bulley, MD
>> Keene, NH, USA
>>
>> -----
>> Work to create peace everywhere you go and with everything you do.
>> -----
>> Let us accept truth, even when it surprises us and alters our views.
>> -George Sand
>>

--
art fougner, md
ich bin ein New Yorker




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