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Rifampicin contraception — GPhC CRA MCQ

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HardInfectionsRifampicin contraceptionGPhC CRA

A 29-year-old using an etonogestrel implant will start six months of rifampicin-based tuberculosis treatment. She wishes to avoid pregnancy and does not want to rely on condoms alone. Which contraceptive plan is least affected by the interaction?

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Correct answer: A — Arrange depot medroxyprogesterone acetate or intrauterine contraception before rifampicin

Rifampicin is a potent enzyme inducer that reduces exposure to combined hormonal contraceptives, progestogen-only pills and progestogen implants. SPS recommends DMPA or intrauterine contraception because their effectiveness is not reduced by enzyme induction. There is no evidence-based strategy of replacing the implant early, doubling a POP or adding a standard combined pill briefly. For short courses, a barrier method can sometimes supplement an existing method, but this patient wants a method not dependent on condoms and will receive a potent inducer for six months.

Reference: NHS SPS: Using contraception with enzyme-inducing medicines. https://www.sps.nhs.uk/articles/using-contraception-with-enzyme-inducing-medicines/