Ursodeoxycholic acid does not affect ethinylestradiol bioavailability in women taking oral contraceptives

Abstract

Objective

Contraception is recommended for female patients during ursodeoxycholic acid (UDCA) treatment for the potential teratogenic effect of this bile acid, and the aim of our study was to determine whether this treatment affects the bioavailability of ethinylestradiol (EE2).

Methods

In this double-blind, randomised study, we measured EE2 pharmacokinetics in eight healthy volunteers randomly allocated to receive oral contraceptive (30 μg EE2 and 75 μg gestodene) plus either UDCA (8–10 mg/kg per day) or placebo for 21 days during the first of three consecutive menstrual cycles. After a washout period during the second cycle, the subjects received the alternative treatment during the third menstrual cycle. Serum EE2 and UDCA were measured using radioimmunoassay and gas chromatography–mass spectrometry, respectively.

Results

The profile for serum EE2 concentration was similar during UDCA (mean maximum serum concentration 177 pg/ml, SEM 59) and during placebo treatment (153 pg/ml, SEM 62), and mean area under the curve (AUC) was 1374 pg/h per ml (SEM 580) and 1320 pg/h per ml (SEM 551) during the two regimens, respectively. The point estimates and 90% confidence intervals of UDCA/placebo ratios for EE2 AUC and for maximum serum concentration were 1.1 (0.8–1.5) and 1.2 (1.0–1.4), respectively. Mean serum triglycerides concentration increased from 58.3 mg/dl (SEM 6.8) at enrolment to 91.4 mg/dl (SEM 10.7) during placebo (P<0.01) and to 88.6 mg/dl (SEM 13.7) during UDCA treatment (P<0.05). During UDCA treatment, serum enrichment with this bile acid and with the metabolite iso-UDCA was 29% (16%) and 3% (2%), respectively.

Conclusion

Co-administration with UDCA does not affect the bioavailability of EE2 in healthy volunteers, indicating that contraceptive efficacy is not affected.

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Acknowledgements

The study was supported by a grant from Dr. Falk Pharma GmbH, Freiburg, Germany. Serum EE2 was measured free of charge at the Department of Pharmacokinetic, Schering AG, Berlin, Germany. This study complies with the current Italian laws.

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Correspondence to Alberto Lanzini.

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Baisini, O., Benini, F., Petraglia, F. et al. Ursodeoxycholic acid does not affect ethinylestradiol bioavailability in women taking oral contraceptives. Eur J Clin Pharmacol 60, 481–487 (2004). https://doi.org/10.1007/s00228-004-0796-2

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Keywords

  • Ursodeoxycholic acid
  • Ethinylestradiol
  • Oral contraceptives