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Topiramate teratogenicity and contraception — DFSRH MCQ

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HardPharmacology of contraceptionTopiramate teratogenicity and contraceptionDFSRH

A 30-year-old with migraine uses topiramate 100 mg daily and asks for contraception. She has migraine with aura and wants a highly effective reversible method. What is the most appropriate advice?

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Correct answer: A — Offer Cu-IUD, LNG-IUD or DMPA as reliable options

Topiramate may reduce some hormonal contraceptive effectiveness at higher doses and is teratogenic, so highly effective methods unaffected by enzyme induction, such as intrauterine methods or DMPA, are suitable. CHC is contraindicated because of migraine with aura. Condoms alone may not be adequate where pregnancy must be avoided.

Reference: FSRH Drug Interactions with Hormonal Contraception; FSRH UKMEC; BNF