Doxycyclone and oral contraception
Replies: 8 - Last Post: Apr 10, 2012 11:02 PM Last Post By: hellz55
Apr 29, 2011 1:48 PM
Doxycyclone and oral contraceptionHi all,
I'm leaving to travel SE Asia in 3 weeks, and will be traveling the area for 9 months. After checking the areas I'm going to, my GP recommended Doxycyclone as the best anti-malarial tablet for me, and I will need to be on it pretty consistently due to the 4 weeks you need to take it after leaving a malarial area.
However, I'm using oral contraceptives and have found conflicting info everywhere regarding Doxycyclone rending it ineffective. My GP said that if I wanted to be "overly cautious" I should use additional protection for the first month, but to be honest his advice of "it should be ok" regarding my chances of unintentionally falling pregnant is not very confidence inspiring! The travel clinic told me definitely not to take Doxycyclone while using oral contraception.
Who is correct? What difference does using extra protection for the first month make? ....does your body get used to taking both the oral contraceptive and the Doxycyclone together and thus make them work in harmony after 1 month?
The contraceptive is Microgynon 30 if that makes any sort of difference.
Thanks in advance :)
Apr 29, 2011 8:37 PM
1When taking any oral contraceptive in combination with antibiotics and malaria treatment, you should ALWAYS use a backup method of birth control, not just for the first month. Use a condom in addition to the pill, not just to prevent pregnancy but sexually transmitted diseases. Many STDs are becoming resistant to treatment, so getting infected would really ruin your travel experience. Not to mention, treatment options may be limited depending on where you travel. I'm surprised that a doctor would give you such poor advice. Always use a backup! Good luck and happy travels!
Donna B., RN
Apr 30, 2011 2:17 AM
2There is a lot of debate about using doxycycline as malaria prophylaxis when taking oral contraceptives. In theory, all antibiotics have the potential to interact with antibiotics - they can compete in the liver to be metabolised. Therefore the OCP will not have guaranteed blood levels and effectiveness. There is the added side effect with doxycyclne that some people get of nausea +/- vomiting which could also affect whether the pill is absorbed. And finally, if you fall pregnant and were still on doxycycline, that could be harmful to the unborn baby. After saying this, in reality most people who take both and are sexually active, don't fall pregnant.
These are all potential risks and may not happen in you, but how do you know and are you willing to take the chance? As a female doctor, I advise my patients to always use another form of contraception whilst on doxycycline just to be on the safe side. This is good advice anyway to protect from (some) STI's as well. The pill will still provide you with menstrual regulation.
BTW the "use protection for the first month" statement - I can't understand the logic behind that - it is all or nothing.
Hope this helps.
Apr 30, 2011 7:03 AM
3Here is what the UK Health Protection Agency says (since they give different advice for different kinds of contraceptives, you would need ot ask your own doctor which class of contraceptives you are using):
Q. What are the issues regarding the concomitant use of contraceptive pills or patches and doxycycline for malaria prevention?
This guidance has been developed by the HPA Advisory Committee on Malaria Prevention in conjunction with the Faculty of Family Planning and Reproductive Health Care.
Travellers who use doxycycline as prevention against malaria normally start the drug 1 to 2 days prior to arrival in the malaria risk region, continue whilst there, and discontinue the drug 4 weeks after they leave the risk area. Women who are also using contraception medications need to be aware of special precautionary measures.
Why can doxycycline affect combined hormonal contraception?
Doxycycline can temporarily decrease colonic bacteria thus inhibiting the enterohepatic circulation of ethinylestradiol, the semi-synthetic oestrogen contained in all combined hormonal contraceptives. This effect can also occur with other antibiotics.
There is no secondary re-absorption of progesterones via the enterohepatic circulation and therefore doxycycline (and other antibiotics) has no effect on the efficacy of progesterone-only contraceptives (including the pill, injectables, implants, the levonorgestrel releasing intrauterine system, or progesterone only emergency contraception). Therefore, this advice only applies to those taking combination contraception.
Women using combined hormonal contraception (pill or patch) who are starting doxycycline should be informed that:
Doxycycline may reduce the efficacy of combined hormonal contraception
When starting doxycycline, additional contraceptive protection, such as condoms or abstinence, is advised for 3 weeks.
If the pill free interval or patch free week coincides with the first 3 weeks of doxycycline, the pill or patch free week should be omitted
After using doxycycline for 3 or more weeks colonic bacteria will have recovered and the enterohepatic circulation for ethinylestradiol restored. Additional contraception can be stopped for the remaining duration of doxycycline use.
If a course of doxycycline for malaria prevention is completed but the woman moves to another area where doxycycline is required, the same procedure needs to be followed.
Women already taking doxycycline for malaria prophylaxis who are starting combined hormonal contraception should be advised:
If the doxycycline has been taken for more than 3 weeks there will be no effect on the enterohepatic circulation of semi-synthetic oestrogens. The combined pill or patch can be started according to the normal procedure. There will be the need for additional contraceptive protection for 7 days (such as condoms or abstinence) if the woman starts contraception after day 5 of the menstrual cycle.
If doxycycline has been used for less than 3 weeks additional contraceptive protection such as condoms will be required when starting the combined pill or patch until the doxycycline has been taken for 3 weeks.
Women using progesterone only contraception (which includes progesterone only pill, injectable, implant, the levonorgestrel releasing intrauterine system and the progesterone only emergency contraceptive) should be informed that:
Progesterones do not undergo secondary re-absorption via the enterohepatic circulation and antibiotic use does not reduce efficacy.
Additional contraception or an alteration in dose is not necessary.
In all situations, female travellers should follow manufacturer’s instructions on the use of contraceptives.
Faculty of Family Panning and Reproductive Health Care Clinical Effectiveness Unit. FFPRHC Guidance (April 2005). Drug interactions with hormonal contraception. J Fam Plann Reprod Health Care 2005; 31:139-51.
May 2, 2011 12:45 AM
May 8, 2011 12:20 AM
5My travel doc gave me the following advice:
In 3 months time, youre going to be in asia, youre going to want to stick it in something.
I suggest you don't
In 6 months time youll be in Africa, youre really going to want to stick it in something
I really highly suggest you don't"
I guess he was of the abstinence view :)
When i ended up in Hospital in Argentina with Malaria from africa..
I was quite happy to know that "I didnt stick it in anything in africa". They thought I had AIDS as my bloodwork was so bad.
Mar 27, 2012 1:02 PM
6Does anyone have any idea how effective 'it goes down too'?
I'm travelling with my husband, and we both have had STI checks, so all I'm really worried about is a pregnancy with my husband.
I've been on the pill forever, and I can't use condoms because I'm allergic to latex and non latex ones are too bloody expensive! I just want to know whether we will have to fork out the money?
Btw we will be in Africa for a little over 2 months and are on doxy (my pill is Brevinor 1)
Mar 28, 2012 7:36 AM
Apr 10, 2012 11:02 PM
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