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Effects of Rifabutin and Rifampicin on the Pharmacokinetics of Ethinylestradiol and Norethindrone

Eric Masson, PharmD

Anapharm, Inc., Ste-Foy, Quebec, Canada; Faculte de Pharmacie, Universite Laval, Quebec, Canada

Edith Guilbert, MD

Clinique de planification des naissances, Pavillon CHUL-CHUQ, and Centre de Sante Publique de Quebec, Quebec, Canada

Dave Colborn, BS

Francois Paquet, MD

Sylvie Allard, MSc

Franyois Vallee, MSc

Anapharm, Inc., Ste-Foy, Quebec, Canada

Prem K. Narang, PhD, FCP

Department of Clinical Pharmacology and Pharmacokinetics, Pharmacia, Inc., Columbus, Ohio; Pharmacia & Upjohn, Kalamazoo, Michigan

This open-label, randomized, three-way crossover study of 28 healthy premenopausal women was conducted to copare the impact of concomitant rifabutin and rifampicin on the safety, pharmacokinetics, and pharmacodynamics of the oral contraceptives ethinylestradiol and norethindrone (Otho-Novum 1/35; Ortho Pharmaceutical, Raritan, NJ). Each participant received oral contraceptives dailyfor 21 days for the first control cycle, then was randomized to one of two sequences to receive oral contraceptives with concomitant rifampicin and rifabutin at equal doses of 300 mg/dayfor 10 days. Ethinylestradiol, norethindrone, follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone, rfampicin, and rifabutin (and metabolite) were measured in plasma over the same time frames in all three cycles. Safety was assessed from before the beginning to the end of each cycle. Twenty-two subjects completed all three cycles. Copared with the control cycle, rifabutin and rifampicin signiicantly altered the disposition of the oral contraceptive. Area under the concentration-time curve from 0 to 24 hours (AUCO_24) and maximum plasma concentration (cmax) of ethinylestradiol decreased by 64% and 42%, respectively, after coadministration with rifampicin and by 35% and 20%, respectively, after coadministration with rifabutin. The AUCOQ24 of norethindrone decreased by 60% and 20% after coadministration with rifampicin and rifabutin, respectively. Unlike progesterone levels, FSH and LH levels increased during coadministration with rifampicin and rifabutin. The incidence of spotting was significantly higher after coadmiistration with rifampicin (36.4%) and rifabutin (21.7%) than during the control cycle (3.7%). Although both rifampicin and rifabutin affected the pharmacokinetics of ethinylestrdiol and norethindrone, the magnitude of this effect was more pronounced with rifampicin. Likewise, the fact that the highest incidence of spotting occurred with rifampicin was consistent with higher metabolic induction by rifampicin. Despite the fact that there was no change in progesterone levels, it is recommended that patients be advised to use additional contraceptive methods while receiving rifabutin or rifampicin with oral contraceptives to prevent inadvertent pregnancy.

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