Tirzepatide and oral contraception — DFSRH MCQ

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HardPharmacology of contraceptionTirzepatide and oral contraceptionDFSRH

A 35-year-old starts tirzepatide for weight loss and uses a combined oral pill. She has nausea after dose escalation and had diarrhoea last week. She wants to avoid pregnancy. What is the most appropriate advice?

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Correct answer: A — Use non-oral or additional contraception around initiation and dose increases

The best answer is “Use non-oral or additional contraception around initiation and dose increases”. Tirzepatide is the GLP-1/GIP agonist with evidence of a clinically important reduction in oral-contraceptive exposure. She should use a non-oral method or add condoms for four weeks after starting tirzepatide and for four weeks after every dose increase. Vomiting or severe diarrhoea can additionally impair pill absorption, so the usual missed-pill or gastrointestinal-illness rules apply. Combined hormonal contraception must be assessed by applying oestrogen-related arterial and venous risk, the exact timing of incorrect use, drug interactions and the need for emergency contraception. A non-oestrogen method may be acceptable even when CHC is not. Missed-use advice depends on whether the hormone-free interval was extended, rather than simply on the number of tablets mentioned.

Reference: CoSRH/FSRH, Recommended Actions after Incorrect Use of Combined Hormonal Contraception: https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-ceu-recommended-actions-after-incorrect-use-of-chc-march-2020-amended-jul-2021-.pdf