TABLE 7

Immunosuppressant Adverse Effects and Interactions With Hormonal Contraception

Type of MedicationDrug InteractionsAdverse Effects Influencing ContraceptionContraceptive Considerations
Corticosteroids (prednisone)COCs may increase plasma concentrations of corticosteroids; monitor for increased corticosteroid effectsHypertensionSevere and uncontrolled hypertension is a contraindication to COC use.
DiabetesLow-dose pills have minimal impact on glucose metabolism.
Weight gain, osteoporosisMonitor weight and BMD carefully if DMPA is used.
Azathioprine (Imurana)Liver toxicityLiver dysfunction interferes with estrogen metabolism.
Mycophenolate mofetil (CellCeptb)Diarrhea, vomitingSevere gastrointestinal disturbance could decrease COC absorption.
Cyclosporine, tacrolimus (Prograf,c FK506)COCs may increase levels; monitor blood levels closelyHypertensionSevere hypertension is a contraindication to COC use.
HyperlipidemiaCOCs have minimal effect on lipids.
HyperkalemiaDrospirenone (a progestin with spironolactonelike activity) is contraindicated with hyperkalemia.
DiabetesLow-dose pills have minimal impact on glucose metabolism.
HeadacheHeadache can be an adverse effect of steroid hormones: monitor headache frequency.d
Sirolimus (Rapamunee)COCs may increase levels; monitor blood levels closelyHyperlipidemiaCOCs have minimal effect on lipids.
  • Reproduced with permission from Sucato GS, Murray PJ. Gynecologic issues of the adolescent female solid organ transplant recipient. Pediatr Clin North Am. 2003;50(6):1521–1542.

  • a Triton Pharma Inc, Concord, Ontario.

  • b Genentech USA Inc, South San Francisco, CA.

  • c Astellas Ireland Co Ltd, Kerry, Ireland.

  • d If headaches increase after initiation of contraceptive method or neurologic symptoms accompany migraine headache, consider changing method.

  • e Pfizer, Philadelphia, PA.