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Rifampicin and CHC — DFSRH MCQ

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HardCombined hormonal contraceptionRifampicin and CHCDFSRH

A 26-year-old woman using a combined pill is prescribed rifampicin for 6 months. She has UPSI intermittently and wants to avoid pregnancy during treatment. What is the most appropriate management?

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Correct answer: D — Advise switching to a method unaffected by enzyme induction, such as Cu-IUD, LNG-IUD or DMPA

Rifampicin is a potent enzyme inducer and can reduce CHC effectiveness, so a method unaffected by enzyme induction should be recommended. Patch use and dose doubling do not reliably overcome the interaction. Repeated UPA is not a planned contraception strategy and may also be affected by enzyme induction. The pearl is that long courses of enzyme-inducing drugs should trigger a planned method switch rather than repeated rescue care.

Reference: FSRH Drug Interactions with Hormonal Contraception; FSRH Guideline: Combined Hormonal Contraception