title: Drug interactions between hormonal contraceptives and psychotropic drugs: a systematic review.
abstract: To examine whether the co-administration of hormonal contraceptives (HC) and psychotropic drugs commonly used to treat anxiety and/or depression results in safety or efficacy concerns for either drug.
  
  
  
  We searched PubMed and Cochrane libraries for clinical or pharmacokinetic (PK) studies that examined co-administration of any HC with psychotropic drugs [selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), oral benzodiazepines, bupropion, mirtazapine, trazadone, buspirone, hydroxyzine, monoamine oxidase inhibitors (MAOIs), or atypical antipsychotics] in reproductive aged women.
  
  
  
  Of 555 articles identified, 22 articles (18 studies) met inclusion criteria. We identified 5 studies on SSRIs, four on TCAs, one on bupropion, three on atypical antipsychotics and five on oral benzodiazepines. No articles met inclusion criteria for SNRIs, mirtazapine, trazadone, buspirone, hydroxyzine or MAOIs. Overall, clinical studies did not demonstrate differences in unintended pregnancy rates when HCs were administered with and without psychotropic drugs or in psychotropic drug treatment outcomes when psychotropic drugs were administered with and without HCs. PK studies did not demonstrate changes in drug exposure related to contraceptive safety, contraceptive effectiveness or psychotropic drug effectiveness for most classes of psychotropic drugs. However, limited PK data raise concern for HCs increasing systemic exposure of amitriptyline and imipramine (both TCAs), theoretically posing safety concerns.
  
  
  
  Limited quality and quantity evidence on use of psychotropic drugs and HCs suggests low concern for clinically significant interactions, though no data exist specifically for non-oral formulations of HC. Given the high frequency of use for both HCs and psychotropic drugs among reproductive-age women in the US, this review highlights a need for further research in this area.
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: wnw4@cdc.gov.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Berry-Bibee
authors.affiliation: Office of Clinical Pharmacology, U.S. Food and Drug Administration, Silver Spring, MD, USA.
authors.forename: Myong-Jin
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Katharine B
authors.initials: KB
authors.lastname: Simmons
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Naomi K
authors.initials: NK
authors.lastname: Tepper
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Halley E M
authors.initials: HE
authors.lastname: Riley
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: H Pamela
authors.initials: HP
authors.lastname: Pagano
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Curtis
mesh_terms: D001007:Anxiety / Q000188:drug therapy; D003278:Contraceptives, Oral, Hormonal / Q000493:pharmacokinetics*; D003863:Depression / Q000188:drug therapy; D004347:Drug Interactions; D005260:Female; D006801:Humans; D011619:Psychotropic Drugs / Q000145:classification / Q000493:pharmacokinetics*; D016032:Randomized Controlled Trials as Topic
chemical_list: D003278:Contraceptives, Oral, Hormonal; D011619:Psychotropic Drugs
keywords: Anxiety; Depression; Drug interactions; Hormonal contraception; Psychotropic drugs