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Modafinil interaction — DFSRH MCQ

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HardPharmacology of hormonal contraceptionModafinil interactionDFSRH

A 31-year-old woman taking modafinil for narcolepsy uses a combined pill and reports UPSI during the last week. She did not know modafinil could affect contraception. What is the most appropriate management?

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Correct answer: C — Assess EC and move to contraception unaffected by enzyme induction

The best answer is “Assess EC and move to contraception unaffected by enzyme induction”. Modafinil can reduce the effectiveness of steroidal contraception, so EC assessment and switching to an unaffected method should be discussed. Reassurance would miss a recognised interaction. Higher-dose CHC, patch use or brief modafinil interruption do not reliably address the risk. The pearl is to check contraception whenever prescribing medicines with enzyme-inducing potential.

Reference: CoSRH/FSRH, Emergency Contraception (amended July 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-emergency-contraception03dec2020-amendedjuly2023-11jul.pdf