OBJECTIVES: Hormonal Contraceptive Agents (HCAs) may be used concomitantly with other medications that may perpetrate Drug-Drug Interactions (DDIs). We examined the prevalence of potential HCA-DDIs in a cohort of privately insured women.

METHODS: We assessed the annual prevalence of hormonal contraceptive use among commercially insured women in the IBM Truven MarketScan® Database. All women aged 12 to 48 years, with 1 year of continuous enrollment in medical and prescription benefits in 2016 were included. Prevalence of hormonal contraceptives was defined, depending on dosage form (oral, injectable, intrauterine devices, vaginal rings, and dermal implants and patches) as one prescription fill or presence of outpatient encounters with procedural or diagnosis codes indicating insertion. Potential HCA-DDIs were identified utilizing prescription fills for known inhibitors or inducers of relevant metabolizing enzymes of HCAs identified by Micromedex®. Prevalence of the interaction was defined as co-appearance of the HCA and potential interacting medication in the same calendar year. Drug Interactions were further categorized by potential cytochrome enzyme interaction pathways of CYP3A4, CYP2C9, and CYP2C19.

RESULTS: In 2016, we identified 5,466,660 women of child-bearing age with full enrollment. Of those, 1,548,698 (28.3%) had ≥1 claim indicating HCA use. Overall, 216,720 (13.99%) were concomitantly taking HCA-inducer combinations, whereas 645,427 (41.68%) were concomitantly taking HCA-inhibitor combinations. The five most common HCA-inhibitor combinations included: antibiotics 426,739 (27.55%), antifungals 207,703 (13.41%), antidepressants 124,203 (13.41%), antacids 73,670 (4.76%), and immunosuppressants 7,070 (0.46%). The five most common HCA-inducer combinations included: steroids 172,958 (11.17%), antiepileptics 33,285 (2.15%), migraine treatments 23,090 (1.49%), stimulants 2,513 (0.16%), and antibiotics 570 (0.04%).

CONCLUSIONS: Commercially insured women taking HCAs commonly use concomitant therapies including both inhibitors and inducers of HCA-metabolizing enzymes. Further formal pharmacoepidemiologic studies using real-world evidence is needed to better understand the clinical relevance of HCA-DDIs.