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Contraception
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Why is it important to get the right contraception?
Contraception is important for anyone who is sexually active and wants to avoid an unplanned pregnancy. But it’s particularly important if you take epilepsy medicine, because some epilepsy medicines could harm your baby if you take them during pregnancy. If you’re taking one of these medicines, your doctor should advise you to use highly effective contraception.
If you want to have a baby, it’s important to keep taking your epilepsy medicine and using contraception until you’ve talked to your doctor or epilepsy specialist nurse about your plans. They can give you advice about your treatment options, to give you the best chance of having a healthy pregnancy and baby. For more information, see our page on planning a baby.
Enzyme-inducing epilepsy medicines
Some epilepsy medicines belong to a group of medicines called enzyme-inducers. These medicines can stop hormonal contraception working as well as it should.
They do this by speeding up the way hormones are broken down in the body. This could put you at risk of an unplanned pregnancy.
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The epilepsy medicines that could affect hormonal contraception are:
- Carbamazepine (Tegretol)
- Cenobamate
- Eslicarbazepine acetate (Zebinix)
- Oxcarbazepine (Trileptal)
- Perampanel (Fycompa)*
- Phenobarbital
- Phenytoin (Epanutin)
- Primidone
- Rufinamide (Inovelon)
- Topiramate (Topamax)
*The company that makes perampanel says this medicine is only likely to affect contraception at a daily dose of 12mg or more. However, it’s possible it could affect contraception at lower doses in some people. So, to have the best chance of avoiding pregnancy, you may still choose to follow the advice below.
Types of contraception that can be affected by enzyme inducing epilepsy medicines
If you take an enzyme-inducing epilepsy medicine, these types of contraception may not work as well as they should:
- Combined oral contraceptive pill (the pill)
- Progestogen-only pill (the mini pill or POP)
- The contraceptive implant
- The contraceptive patch
- The vaginal ring
- Emergency contraceptive pill (the morning after pill)
Your doctor is likely to recommend using a different form of contraception that is not affected by your epilepsy medicine. However, if you do decide to use one of these types of contraception, you should also use a barrier method such as condoms to reduce the risk of becoming pregnant.
If you want to use the combined oral contraceptive pill, your doctor may advise you to take a higher dose than usual, and not take a break between packs. This is to make sure you have enough of the hormones in your body to stop you getting pregnant. Your doctor should discuss the options with you and make sure you are aware of the risks and benefits.
Types of contraception that are not affected by enzyme inducing epilepsy medicines
The following types of contraception are not affected by enzyme-inducing medicines:
- Copper IUD (Cu-IUD, copper coil)
- Levonorgestrel IUD (LNG-IUD, hormonal coil)
- Barrier methods (male and female condoms, diaphragm or cap)
- Contraceptive injection
- Sterilisation
Emergency contraception
There are two types of emergency contraception: the morning after pill and the copper intrauterine device (Cu-IUD). The Cu-IUD is the most effective kind of emergency contraception. The morning after pill can be affected by enzyme-inducing medicines, so you may be offered the Cu-IUD instead.
If you want to take the morning after pill, you may be able to take a double dose of levonorgestrel (Levonelle is one of the brand names), or a single dose of ulipristal acetate (ellaOne is one of the brand names). But they may not work as well as the Cu-IUD. Tell your pharmacist, doctor or clinic what medicines you are taking so they can prescribe you the right dose.
The NHS website has more information about emergency contraception and where to get it.
What does IUD mean?
IUD stands for intrauterine device. It’s a small T-shaped plastic device that’s put into your womb (uterus) by a doctor or nurse.
Depending on the type you have, it may release copper or a hormone called Levonorgestrel. Both are designed to stop you getting pregnant and usually last a number of years.
Lamotrigine
Effect of contraception on lamotrigine
The combined oral contraceptive pill (the pill), contraceptive patch and vaginal ring may reduce the amount of lamotrigine in your blood, making you more at risk of having a seizure. These types of contraception are used for 21 days, then you have a week’s break, before using them again. During the week’s break, your dose of lamotrigine could be too high for you, leading to side effects.
The progestogen-only pill (POP or mini-pill) may increase the amount of lamotrigine in your blood. This could increase your risk of side effects.
Effect of lamotrigine on contraception
There is some evidence that lamotrigine may make some hormonal contraceptives, such as the pill, less effective.
Ideally you should use one of the types of contraception that is not affected by enzyme inducers. If you choose to use the combined contraceptive pill, patch or ring, the progestogen-only contraceptive pill or the progestogen-only implant, you should also use a barrier method, such as condoms, to reduce the risk of becoming pregnant.
Types of contraception that could be affected by lamotrigine
- Combined oral contraceptive pill (the pill)
- Progestogen-only pill (the mini pill or POP)
- The contraceptive implant
- The contraceptive patch
- The vaginal ring
- Oral emergency contraception
Types of contraception that should not be affected by lamotrigine
- Copper IUD (Cu-IUD, copper coil)
- Levonorgestrel IUD (LNG-IUD, hormonal coil)
- Barrier methods (male and female condoms, diaphragm or cap)
- Contraceptive injection
- Sterilisation
Sodium valproate
If you are at an age where you could get pregnant, your doctor should only prescribe you sodium valproate if it is the only medicine that works to control your seizures. This is because taking sodium valproate during pregnancy can harm your baby.
If you need to take sodium valproate, your doctor will advise you to use a form of highly effective contraception to stop you getting pregnant.
Types of contraception that are highly effective are:
- Copper IUD (Cu-IUD, copper coil)
- Levonorgestrel IUD (LNG-IUD, hormonal coil)
- The contraceptive implant
- Female sterilisation (if you want a permanent method of contraception)
The combined contraceptive pill, patch and ring, the progestogen-only pills and the contraceptive injection are less effective than the methods above and are not recommended for people using valproate medicines. If you want to use one of these less effective contraceptives you must use a barrier method as well, such as condoms. Your doctor will also advise you to take regular pregnancy tests.
Topiramate
You should use effective contraception if you take topiramate and you’re able to become pregnant. You should use contraception even if you’re not sexually active. This is because topiramate can be harmful to a baby if taken during pregnancy. You can find out more on our page about topiramate and risks in pregnancy.
The type of contraception to use can be complicated because topiramate could make some kinds of contraception less effective.
Types of contraception recommended for people taking topiramate:
- Copper IUD (Cu-IUD, copper coil)
- Levonorgestrel IUD (LNG-IUD, hormonal coil)
- If these are not acceptable, the progestogen-only contraceptive injection, which must be used with condoms
Other epilepsy medicines
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These epilepsy medicines should not affect how well any type of contraception works:
- Acetazolamide
- Brivaracetam (Briviact)
- Cannabidiol (Epidyolex)
- Clobazam (Frisium)
- Clonazepam
- Ethosuximide (Emeside, Epesri)
- Everolimus (Votubia)
- Gabapentin (Neurontin)
- Lacosamide (Vimpat)
- Levetiracetam (Keppra)
- Piracetam (Nootropil)
- Stiripentol (Diacomit)
- Tiagabine (Gabitril)
- Vigabatrin (Sabril)
- Zonisamide (Zonegran)
It’s still a good idea to discuss your choice of contraception with your doctor or epilepsy specialist nurse. This is particularly important if you are taking a medicine that has a higher risk of causing birth defects or other problems when taken during pregnancy.
See our webpage to find out more about epilepsy medicines in pregnancy.
Where can I find out more?
The NHS website has a guide to contraception.
The Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Effectiveness Unit Guidance: Drug Interactions with Hormonal Contraception
Valproate Use in Women and Girls of Childbearing Years (guidance document)
The Medicines and Healthcare products Regulatory Agency (MHRA):
You could also speak to your doctor, epilepsy specialist nurse or your local sexual health clinic.
This information has been produced under the terms of the PIF TICK. The PIF TICK is the UK-wide Quality Mark for Health Information. Please contact website@epilepsy.org.uk if you would like a reference list for this information.
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