Tirzepatide is a newer medication that is likely to get significant use in Type 2 diabetes and weight management. With the help of a wonderful pharmacy student, we previously did a tirzepatide clinical breakdown which you can find here. Tirzepatide avoids many drug interactions because it does not get broken down by CYP enzymes. This is a great thing. However, I did want to breakdown the tirzepatide birth control interaction as this may impact some of your female patients who are looking to use the medication for weight loss or diabetes control.
One of the key characteristics of tirzepatide is that it slows down the GI tract. While this can be a good thing for diabetes and weight management control, it has the potential to alter the absorption patterns of certain medications. The tirzepatide birth control interaction is one situation where we may create an undesired outcome.
The package insert for tirzepatide recommends the following to patients using oral contraceptives: “Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation and for 4 weeks after each dose escalation with MOUNJARO. Hormonal contraceptives that are not administered orally should not be affected.”
The evidence comes from a study listed in the package insert. Here’s what was reported. “Following administration of a combined oral contraceptive (0.035 mg ethinyl estradiol and 0.25 mg norgestimate) in the presence of a single dose of tirzepatide 5 mg, mean Cmax of ethinyl estradiol, norgestimate, and norelgestromin was reduced by 59%,66%, and 55%, while mean AUC was reduced by 20%, 21%, and 23%, respectively. A delay in tmax of 2.5
to 4.5 hours was observed.”
In my opinion, the tirzepatide birth control interaction is significant enough to be addressed when encountered. Interestingly, semaglutide which has a lot of overlapping similarities did not affect concentrations of hormonal agents. Here’s the study on this finding. It should be noted that this was in post-menopausal women.
Options to Consider When Addressing The Tirzepatide Birth Control Interaction
- Add a barrier method of contraception (i.e. backup methods) as specified in the package insert
- Reassess the risk versus benefit of tirzepatide and consider alternatives
- Change birth control methods altogether
What’s your opinion on this interaction?
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