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Although drug interactions are reviewed with patients preoperatively, gaps exist in counseling regarding anesthesia’s impact on hormonal contraception.

Although drug interactions are commonly reviewed with patients before undergoing surgical procedures, studies have shown gaps in counseling regarding certain perioperative medications and their potential for compromising hormonal contraceptives (HCs). In particular, patients may not be aware of sugammadex, aprepitant, and fosaprepitant’s impacts on HC, which could lead to unintended pregnancy and the risk for preventable health consequences.

Molly B. Kraus, MD, and colleagues developed a survey to gauge anesthesia clinicians’ awareness regarding the drug interactions of sugammadex and aprepitant with HC and if this knowledge was shared with the patient ahead of surgery. The results of the survey were published in Anesthesia & Analgesia.

Of 1,092 anesthesia professionals approached for participation, 337 completed the survey, including 98 attending anesthesiologists, 34 anesthesiology residents/fellows, 179 certified registered nurse anesthetists (CRNAs), and 26 student registered nurse anesthetists (SRNA).

Sugammadex

In current practice, 88% of practitioners indicated a preference for sugammadex for neuromuscular blockade (NMB) reversal. In addition, 96% of participants knew that sugammadex interferes with oral contraceptives. In terms of other types of HC, 61% were aware of interactions with levonorgestrel intrauterine devices (IUDs) (Mirena), 70% were aware of interactions with etonogestrel implants (Nexplanon), and 66% were aware of interactions with medroxyprogesterone injections (Depo-Provera).

According to labeling information, patients taking HC should use an alternative form of birth control to prevent unintended pregnancy for 7 days after receiving sugammadex. Fifty-two percent of participants gave this correct time frame; 5.4% answered 10 days; 20.9% answered 14 days; and 14% answered 30 days. Forty-nine percent of participants were satisfied with the level of training regarding sugammadex as compromising HC.

Aprepitant

In terms of aprepitant’s use, 48% of participants answered that they had never or rarely used aprepitant in the past year. Regarding knowledge of aprepitant’s interactions with HC, 46.8% of participants knew this to be true with oral birth control pills. However, only 32% knew about interactions with levonorgestrel IUDs, 36% knew about etonogestrel implants, and 34% knew about medroxyprogesterone injections.

The recommended amount of time patients should use alternative forms of birth control after treatment with aprepitant is from 28 to 31 days; 38.5% of participants correctly identified this time frame; 6.5% said zero days, 24.9% said seven days, 3.2% said 10 days, and 16.8% said 14 days. In terms of this drug interaction being properly taught to trainees, only 11% believed this training to be sufficient.

“Perioperative clinicians should consider drug interactions with HCs when preparing an anesthetic plan, discuss options with the patient preoperatively, and consider alternative medications if necessary. Clear communication is essential, as patients may be unaware of these interactions,” Dr. Kraus and colleagues concluded.