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Topiramate interaction — DFSRH MCQ

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HardPharmacologyTopiramate interactionDFSRH

A patient taking topiramate for migraine prevention requests an etonogestrel implant and wants the most reliable contraception. What is the best plan?

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Correct answer: A — Use the Pregnancy Prevention Programme and offer an unaffected IUD

The best answer is “Use the Pregnancy Prevention Programme and offer an unaffected IUD”. Topiramate in a person who can become pregnant requires the MHRA Pregnancy Prevention Programme, including pregnancy exclusion, risk counselling and highly effective contraception during treatment and for 4 weeks afterwards. Topiramate can compromise some hormonal methods, including the implant. A copper or levonorgestrel IUD is not affected by enzyme induction and meets the reliability objective.

Reference: MHRA, Topiramate Pregnancy Prevention Programme safety measures (June 2024): https://www.gov.uk/drug-safety-update/topiramate-topamax-introduction-of-new-safety-measures-including-a-pregnancy-prevention-programme