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Letter to editor| Volume 95, ISSUE 4, P435-436, April 2017

Revisiting contraceptive steroid hormone pharmacokinetics in obese women

Published:January 27, 2017DOI:https://doi.org/10.1016/j.contraception.2017.01.008
Revisiting contraceptive steroid hormone pharmacokinetics in obese women
Previous ArticleVaginal misoprostol prior to intrauterine device insertion in women delivered only by elective cesarean section — reply to letter to the editor
      A recent commentary by Dr. William Jusko [
      • Jusko W.J.
      Clarification of contraceptive drug pharmacokinetics in obesity.
      Contraception. 2016; ([in press])
      ] supports the findings of our prior studies, and those by Westhoff et al., that demonstrate obesity changes the pharmacokinetics of contraceptive steroid hormones, namely levonorgestrel Cmax, half-life, and time to steady state [
      • Edelman A.B.
      • Carlson N.E.
      • Cherala G.
      • Munar M.Y.
      • Stouffer R.L.
      • Cameron J.L.
      • et al.
      Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic–pituitary-ovarian activity.
      Contraception. 2009; 80: 119-127
      ,
      • Edelman A.
      • Cherala G.
      • Munar M.Y.
      • Dubois B.
      • McInnis M.
      • Stanczyk F.Z.
      • et al.
      Prolonged monitoring of ethinyl estradiol and levonorgestrel levels confirms an alterered pharmacokinetic profile in obese oral contraceptive users.
      Contraception. 2013; 87: 220-226
      ,
      • Edelman A.
      • Cherala G.
      • Munar M.Y.
      • McInnis M.
      • Stanczyk F.Z.
      • Jensen J.T.
      Correcting oral contraceptive pharmacokinetic alterations due to obesity. A randomized controlled trial.
      Contraception. 2014; 90: 550-556
      ,
      • Westhoff C.L.
      • Torgal A.H.
      • Mayeda E.R.
      • Pike M.C.
      • Stanczyk F.Z.
      Pharmacokinetics of a combined oral contraceptive in obese and normal weight women.
      Contraception. 2010; 81: 474-480
      ]. However, his commentary highlights potential weaknesses in our efforts to understand what might be driving these changes (clearance or volume of distribution or both). Thus, we have re-analyzed our data [
      • Edelman A.
      • Cherala G.
      • Munar M.Y.
      • Dubois B.
      • McInnis M.
      • Stanczyk F.Z.
      • et al.
      Prolonged monitoring of ethinyl estradiol and levonorgestrel levels confirms an alterered pharmacokinetic profile in obese oral contraceptive users.
      Contraception. 2013; 87: 220-226
      ] (analysis performed with WinNonLin software).
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      References

        • Jusko W.J.
        Clarification of contraceptive drug pharmacokinetics in obesity.
        Contraception. 2016; ([in press])
        View in Article
        • Edelman A.B.
        • Carlson N.E.
        • Cherala G.
        • Munar M.Y.
        • Stouffer R.L.
        • Cameron J.L.
        • et al.
        Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic–pituitary-ovarian activity.
        Contraception. 2009; 80: 119-127
        View in Article
        • Edelman A.
        • Cherala G.
        • Munar M.Y.
        • Dubois B.
        • McInnis M.
        • Stanczyk F.Z.
        • et al.
        Prolonged monitoring of ethinyl estradiol and levonorgestrel levels confirms an alterered pharmacokinetic profile in obese oral contraceptive users.
        Contraception. 2013; 87: 220-226
        View in Article
        • Edelman A.
        • Cherala G.
        • Munar M.Y.
        • McInnis M.
        • Stanczyk F.Z.
        • Jensen J.T.
        Correcting oral contraceptive pharmacokinetic alterations due to obesity. A randomized controlled trial.
        Contraception. 2014; 90: 550-556
        View in Article
        • Westhoff C.L.
        • Torgal A.H.
        • Mayeda E.R.
        • Pike M.C.
        • Stanczyk F.Z.
        Pharmacokinetics of a combined oral contraceptive in obese and normal weight women.
        Contraception. 2010; 81: 474-480
        View in Article
        • Cherala G.
        • Edelman A.
        • Thornburg K.L.
        Traditional assay methodology, drug species, and perinatal growth: a perfect storm for oral contraceptive failure among obese women.
        J Womens Health. 2014; 23: 855
        View in Article
        • Edelman A.B.
        • Cherala G.
        • Blue S.W.
        • Erikson D.W.
        • Jensen J.T.
        Impact of obesity on the pharmacokinetics of levonorgestrel-based emergency contraception: single and double dosing.
        Contraception. 2016; 94: 52-57
        View in Article

      Article info

      Publication history

      Published online: January 27, 2017
      Accepted: January 21, 2017
      Received in revised form: January 18, 2017
      Received: December 20, 2016

      Footnotes

      ☆Authors Disclosures: These potential conflicts of interest have been reviewed and managed by OHSU for Drs. Edelman and Jensen. A. Edelman is a consultant for World Health Organization, Gynuity Health Projects, Genzyme, Merck and Agile Therapuetics. Nexplanon trainer for Merck and receives grant funding from Merck. Author for UptoDate (Royalties received). J. Jensen has received payments for consulting from Agile Pharmaceuticals, Abbvie Pharmaceuticals, Bayer Healthcare, ContraMed, Evofem Inc, HRA Pharma, Merck Pharmaceuticals, Microchips, Teva Pharmaceuticals and the Population Council. He has also received research funding from Abbvie, Bayer, Merck, FHI360, Medicines 360, the Population Council, and the Bill & Melinda Gates Foundation. These companies and organizations may have a commercial or financial interest in the results of this research and technology. G. Cherala is currently employed by Novo Nordisk Inc.

      ☆☆Financial Support: No direct support was provided for this letter to the editor. Original grant support for reference 3: HD 01243-03 Women's Reproductive Health Research Fellow (NICHD K-12), PHS Grant 5 M01 RR000334 and 1 R03 HD 053611-01, reference 4: NICHD 1R01HD089957-01.

      Identification

      DOI: https://doi.org/10.1016/j.contraception.2017.01.008

      Copyright

      © 2017 Elsevier Inc. All rights reserved.

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