A 27-year-old woman with epilepsy on phenytoin (an enzyme-inducing antiepileptic drug) requests combined oral contraceptive pills for birth control. What is the most appropriate recommendation?

• A Standard dose COCP is safe and effective with no interaction
• B She should take two COCP tablets daily to overcome the interaction
• C COCP is absolutely contraindicated with all antiepileptics
• D COCP efficacy is reduced; a pill containing at least 50 mcg ethinyl estradiol or an alternative method is recommended ✓

Explanation

Enzyme-inducing drugs like phenytoin accelerate hepatic metabolism of estrogen and progestin, reducing contraceptive efficacy. WHO MEC recommends either a higher-dose estrogen pill (at least 50 mcg ethinyl estradiol) or a non-hormonal method such as IUCD. Standard-dose COCPs carry an unacceptable failure risk.

Reference: WHO Medical Eligibility Criteria for Contraceptive Use, 5th ed.

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Written and medically reviewed by the StethoPrep medical team.