Magazine article Drug Topics

Groups Pushing Use of OCs for Emergency Contraception

Magazine article Drug Topics

Groups Pushing Use of OCs for Emergency Contraception

Article excerpt

Several major health organizations are teaming up in a national campaign to alert physicians and their patients to the use of high doses of oral contraceptives (OCs) for preventing an unplanned pregnancy.

"Although available since the 1970s, emergency contraception remains underutilized," said Stanley Zinberg, M.D., director of the Practice Activities Division of the American College of Obstetricians & Gynecologists (ACOG) in Washington, D.C.

Speaking during ACOG's annual meeting in Las Vegas recently, Zinberg asserted that maximum use of emergency contraception "could reduce the number of unplanned pregnancies by about 1.7 million and the number of abortions by 800,000 per year." He added that the effectiveness of the pilltaking regimen, which has been approved for this indication by the Food & Drug Administration, is about 75%, but that no untoward effects have been described in women who remain pregnant.

Pills must be started within 72 hours of unprotected intercourse for maximum effectiveness, according to Ronald Chez, M.D., professor of obstetrics and gynecology at the University of South Florida. "It does not matter what time it is in the menstrual cycle, because it does not depend on the menstrual cycle."

Chez said that although the use of these pills in this respect is considered "off label," since no manufacturer has requested a change in labeling, "physicians have the right to prescribe it now." As for contraindications, he said, "the one that stands out, of course, is pregnancy. But having said that, there is no evidence that emergency contraception can interrupt a normal pregnancy." He went on to explain that the method works either by preventing an egg from being fertilized or by preventing its implantation on the uterine wall. Further, he said, there is no evidence that emergency use of OCs in this fashion has caused congenital anomalies when they failed to work.

"There also are no reports of major cardiac or neurologic side effects" on the woman with this regimen, Chez indicated. The major side effect, he said, is nausea, which occurs in about half the women who follow the regimen. About 20% will also vomit, so clinicians are now recommending the use of an antiemetic to be taken about an hour before each dose. A clinical trial of meclizine hydrochloride medications is under way to determine just how effective these OTCs are in preventing feelings of nausea.

"The question always comes up that if a woman vomits, has she lost the dose?" Chez continued. "There are no data on this, but my feeling is that if vomiting has occurred, it is because there is absorption already. …

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