title: Enhanced metabolism of levonorgestrel during phenytoin treatment in a woman with Norplant implants.
abstract: A 26-year-old woman, treated with phenytoin for 10 years because of epilepsy, had Norplant subdermal implants inserted after a legal abortion. She became pregnant again after nine months of Norplant use. Her plasma levonorgestrel (LNG) levels were followed during one month during phenytoin treatment and then later during one month after discontinuation of phenytoin. During phenytoin treatment, plasma LNG levels were markedly below the levels found in healthy women with Norplant. There was a pronounced, statistically significant increase in plasma LNG levels after discontinuation of phenytoin. The plasma levels of sex hormone binding globulin were markedly above those found in normal healthy women during treatment with phenytoin and decreased significantly after cessation of phenytoin. The effects on the pharmacokinetics of LNG were reflected by effects on the menstrual cycle. During phenytoin treatment, the woman had regular ovulatory menstrual cycles. After cessation of phenytoin, her cycles became irregular and during the study period of one month, no signs of ovulation were found. It is concluded that treatment with phenytoin during use of Norplant subdermal implants enhances the metabolism of LNG to an extent where the contraceptive efficacy is endangered.
mesh_terms: D000328:Adult; D004347:Drug Interactions; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006801:Humans; D007700:Kinetics; D016912:Levonorgestrel; D008598:Menstruation / Q000187:drug effects; D009644:Norgestrel / Q000097:blood* / Q000494:pharmacology; D010060:Ovulation / Q000187:drug effects; D010672:Phenytoin / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D011247:Pregnancy; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism
chemical_list: D012738:Sex Hormone-Binding Globulin; D009644:Norgestrel; D016912:Levonorgestrel; D010672:Phenytoin