Management of contraception in women post organ transplant on tacrolimus
– case report and literature review
A. Brockmeyer (1), J. Williams (2), A. Webb (1)
Abacus Clinics for Contraception and Reproductive Health Care, Liverpool,
UK (1); Pharmacy Department, University Hospital Aintree, Liverpool, UK (2)
Introduction: An increasing number of women of reproductive age now
undergo successful organ transplants. They are advised to use effective
contraception post organ transplant but they are usually also taking a number of
other potent prescribed medications. Tacrolimus is one such drug commonly used
post organ transplant because it acts as an immunosuppressant. It is
contraindicated in pregnancy but the pharmaceutical company gives conflicting
advice about its concomitant with any form of hormonal contraception.
Aims and methods: We present a case report of a 36 year old woman with
multiple health problems and on many drugs including tacrolimus post kidney
transplant. She also had numerous fibroids, two premature classical Caesarean
sections and had been advised to use effective contraception. Her partner did
not wish a vasectomy. To investigate the feasibility of concomitant use of
hormonal contraception and tacrolimus we contacted the pharmacy department of
our local hospital and undertook a subsequent extensive literature search.
Results: There is only limited information about tacrolimus and the
concomitant use of hormonal contraception in the literature. Tacrolimus is
metabolised by cytochrome P-450 3A4 in the liver, the same cytochrome that
metabolises ethinyloestradiol and progesterone. Some of the studies presented
give conflicting results about the potential interactions between tacrolimus and
steroid hormones. Overall, however, it would appear that, at therapeutic levels,
tacrolimus does not interfere with the efficacy of hormonal contraception. In
the light of this evidence and following full discussion of all options, the
woman in our case report opted for a subdermal implant. Her physician has been
contacted to ensure regular monitoring of her tacrolimus levels.
Conclusion: Women post organ transplant on tacrolimus need effective
contraception. There appears to be no evidence to date to suggest that hormonal
contraception is any less effective in these women therefore they may use this
form of contraception. It is important to check the tacrolimus levels regularly.
