CDC Article-US Medical Eligibility Criteria for Contraceptive Use, 2010

Vol. 59 / RR-4 Recommendations and Reports 83
TABLE 2. Drug interactions between DMPA and ARV drugs*
ARV Contraceptive effects † ARV effects †
Nucleoside reverse transcriptase inhibitors (NRTIs)
Zidovudine No data Zidovudine ↔ (2)
No change in viral load
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Efavirenz MPA ↔ (18,19)
No ovulations during 3 cycles(18,19)
Pregnancy rate 2.6/100 woman-years in 1 study where
up to 80% used hormonal contraceptives (65% used
POIs) (5)
Nevirapine MPA ↔ (18)
No ovulations during 3 cycles(18)
Efavirenz ↔ (18)
No change in viral load or CD4+, no grade 3- or 4-related adverse
events § (20)
Nevirapine ↑ (18)
No change in viral load or CD4+, no grade 3- or 4-related adverse
events § (20)
Protease inhibitors and ritonavir-boosted protease inhibitors
Nelfinavir MPA ↔ (18) Nelfinavir ↔ (18)
No change in viral load or CD4+, no grade 3- or 4-related adverse
events § (20)
* Abbreviations: DMPA = depot medroxyprogesterone acetate; ARV = antiretroviral; NRTI = nucleoside reverse transcriptase inhibitor; NNRTI = non-nucleoside
reverse transcriptase; MPA = medroxyprogesterone acetate; POI = progestin-only injectables.
†
↔, no change or change ≤30%; ↑, increase > 30%.
§
The trial applied the standardized National Institutes of Health Division of AIDS Table for Grading Severity of Adult and Pediatric Adverse Events, 2004
(http://rcc.tech-res.com/Document/safetyandpharmacovigilance/DAIDS_AE_GradingTable_Clarification_August2009_Final.pdf). Grade 3 events are classified
as severe. Severe events are defined as symptoms that limit activity or might require some assistance; require medical intervention or therapy; and
might require hospitalization. Grade 4 events are classified as life threatening. Life-threatening events include symptoms that result in extreme limitation
of activity and require substantial assistance; require substantial medical intervention and therapy; and probably require hospitalization or hospice.
References
1. Kearney BP, Isaacson E, Sayre J, Cheng AK. Tenofovir DF and oral
contraceptives: lack of a pharmacokinetic drug interaction [Abstract
A-1618]. In: Program and abstracts of the 43rd Interscience Conference on
Antimicrobial Agents and Chemotherapy, Chicago, IL, September 14–17,
2003. Washington, DC: American Society for Microbiology; 2003.
2. Aweeka FT, Rosenkranz SL, Segal Y, et al. The impact of sex and contraceptive
therapy on the plasma and intracellular pharmacokinetics of
zidovudine. AIDS 2006;20:1833–41.
3. Joshi AS, Fiske WD, Benedek IH, et al. Lack of a pharmacokinetic
interaction between efavirenz (DMP 266) and ethinyl estradiol in healthy
female volunteers [Abstract 348]. 5th Conference on Retroviruses and
Opportunistic Infections, Chicago, IL, February 1–5, 1998.
4. Sevinsky H, Eley T, He B, et al. Effect of efavirenz on the pharacokinetics
of ethinyl estradiol and norgestimate in healthy female subjects [Abstract
A958]. In: Program and abstracts of the 48th Interscience Conference on
Antimicrobial Agents and Chemotherapy, Washington, DC, October
25–28, 2008. Washington, DC: American Society for Microbiology;
2008.
5. Danel C, Moh R, Anzian A, et al. Tolerance and acceptability of an
efavirenz-based regimen in 740 adults (predominantly women) in West
Africa. J Acquir Immune Defic Syndr 2006;42:29–35.
6. Scholler-Gyure M, Debroye C, Aharchi F, et al. No clinically relevant
effect of TMC125 on the pharmacokinetics of oral contraceptives. 8th
International Congress on Drug Therapy in HIV Infection, Glasgow,
UK, November 12–16, 2006..
7. Mildvan D, Yarrish R, Marshak A, et al. Pharmacokinetic interaction
between nevirapine and ethinyl estradiol/norethindrone when administered
concurrently to HIV-infected women. J Acquir Immune Defic
Syndr 2002;29:471–7.
8. Zhang J, Chung E, Eley T et al. Effect of atazanavir/ritonavir on the
pharmacokinetics of ethinyl estradiol and 17-deactyl-norgestimate in
healthy female subjects [Abstract A-1415]. In: Program and abstracts
of the 47th Interscience Conference on Antimicrobial Agents and
Chemotherapy, Chicago, IL, September 17–20, 2007. Washington,
DC: American Society for Microbiology; 2009.
9. Sekar V, Lefebvre E S-GSeal. Pharacokinetic interaction between
nevirapine and ethinyl estradiol, norethindrone, and TMC114, a new
protease inhibitor [Abstract A-368]. In: Program and abstracts of the 46th
Interscience Conference on Antimicrobial Agents and Chemotherapy,
San Francisco, CA, September 27–30, 2006. Washington, DC: American
Society for Microbiology; 2009.
10. Glaxo Smith Kline. Prescription medicines. Lexiva (fosamprenavir
calcium). Glaxo Smith Kline 2009. Available from http://us.gsk.com/
products/assets/us_lexiva.pdf. Accessed March 15, 2010.
11. Glaxo Smith Kline. Study APV10020. A phase I, open label, two period,
single-sequence, drug-drug interaction study comparing steady-state
plasma ethinyl estradiol and norethisterone pharmacokinetics following
administration of brevinor for 21 days with and without fosamprenavir
700 mg twice daily (BID) and ritonavir 100 mg (BID) for 21 days in
healthy adult female subjects. Glaxo Smith Kline 2009. Available from
http://www.gsk-clinicalstudyregister.com/files/pdf/23138.pdf. Accessed
March 15, 2010.
12. Merck & Company. Indinavir patient prescribing information. Merck
& Company 2009. Available from http://www.merck.com/product/usa/
pi_circulars/c/crixivan/crixivan_pi.pdf. Accessed March 15, 2010.
13. Abbott Laboratories. Lopinavir and ritonavir prescribing information,
2009. Abbott Laboratories 2009. Available from http://www.rxabbott.
com/pdf/kaletratabpi.pdf. Accessed March 15, 2010.
14. Agouron Pharmaceuticals. Viracept (Nelfinavir mesylate) prescribing
information, 2008. Agouron Pharmaceuticals 2009. Available from
http://us.gsk.com/products/assets/us_viracept.pdf. Accessed March 15,
2010.