Contraception Guidelines for Women Taking Topiramate

Introduction to Topiramate and Contraception

The Journal of Neurology, Neurosurgery and Psychiatry guidelines warn that women must be informed that topiramate can reduce the efficacy of the contraceptive pill/oral contraceptives and other hormonal contraceptives 1

According to contraception guidelines, levels of DMPA (medroxyprogesterone acetate) do not appear to be reduced by the use of antiretroviral agents, and this agent is largely free of antiretroviral interactions 2
Progestin-only injectables like Depo-Provera are a preferred option for women taking topiramate due to their low failure rate and lack of significant pharmacokinetic interactions with topiramate, although the specific strength of evidence is not provided 1

Combined hormonal contraceptives containing estrogen should be avoided or used with caution in women taking topiramate, as topiramate's enzyme-inducing activity can reduce plasma steroid concentrations, according to the Journal of Neurology, Neurosurgery and Psychiatry guidelines 1

For women with idiopathic intracranial hypertension, topiramate's appetite-suppressing effects may be beneficial, with a moderate strength of evidence supporting this claim 1