In this episode, I’ll discuss the drug interaction between sugammadex and oral contraceptives.
Sugammadex is a γ-cyclodextrin that was designed to bind rocuronium and vecuronium for the purpose of reversing paralysis from these neuromuscular blocking medications. It has been on the European market since 2008 and has been recently approved for use in the US.
In vitro studies suggest that sugammadex may bind to progesterone, and therefore lower the free plasma concentrations. The effect of this interaction is considered the same as missing a dose of the oral contraceptive and carries the recommendation that an additional, non-hormonal contraceptive method should be used for the next 7 days.
Because of this interaction, patient counseling and discharge instructions are being more frequently used as a way to inform patients of childbearing age who have received sugammadex in the OR or PACU.
Interestingly, this interaction could be predicted by considering the mechanism of action of rocuronium, vecuronium, sugammadex and progesterone. Both rocuronium and vecuronium are steroid-based neuromuscular blockers. Progesterone is also a steroid-based structure. Therefore it makes sense that sugammadex would bind progesterone the same way it binds rocuronium or vecuronium and cause this interaction.
To get more information on how mechanism of action can be used to predict indications and contraindications for new drugs, sign up to my free download area at pharmacyjoe.com/free and grab download # 7 on the list.