The truth about antibiotics and birth control!

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Q: I heard that antibiotics interfere with birth control pills, but I’m on the birth control that gets implanted under my skin – will antibiotics interfere with that too?

A: I’m so glad you asked this question!  This is one of the biggest medical myths of all time; one that gets propagated in doctors’ offices, health clinics, hospitals, blogs, magazines – and OK fine, student health centers – every day.  So now, for the first time ever… in print… online… on this blog… the TRUTH!

The only antibiotic that has ever been shown to interfere with birth control levels and effectiveness is a medicine called rifampin which is used to treat tuberculosis.  Rifampin may also interfere with the birth control patch and vaginal ring so if you are taking it, be sure to use a back-up, non-hormonal (i.e. condom) form of birth control.

There are some other medications that can interfere with your birth control, however, and if you are taking any of them you should always use back-up contraception.

  • Griseofulvin
  • Phenytoin (Dilantin)
  • Carbamazepine (Tegretol)
  • Phenobarbital
  • Topirimate (Topamax)
  • St. John’s Wort (herbal supplement)

But in general, your birth control will not be affected by any run-of-the-mill antibiotic that you might be taking for things like sinus infections, strep throat, urinary tract infections, skin infections, acne, etc.  Some people believe that because antibiotics disrupt the normal bacteria in the gastrointestinal tract, they will interfere with the absorption of the birth control pills from your stomach.  But this is not an issue, and even if it were, it wouldn’t apply to birth control methods that don’t involve swallowing pills like the skin patch or the vaginal ring or Implanon.

Now, there are enough women out there who swear that they have little antibiotic babies running around the house that your health care provider will probably still tell you to use back-up just in case.  And birth control doesn’t do anything to protect you against sexually transmitted infections, so using a condom is a good idea no matter what medications you’re taking.  But you can rest assured that your birth control is just as effective when you’re taking antibiotics as when you’re not. 

John A. Vaughn, MD (OSU SHS)

Is “All Natural” Really “All Good”?

photo: wikimedia commons

I’m a little uncomfortable with alternative and complimentary medicine. 

Before you plot my death by alfalfa sprout poisoning, let me just say that I’m not against any treatment per se – I’m just a stickler for a little thing called “evidence.”

Is saw palmetto good for the aging prostate? No. Fish oil for elevated trigylcerides? Sometimes. Riboflavin, magnesium, and butterbur for migraines? Worth a try. I will, however, not recommend a treatment simply because the words “alternative”, “natural”, “ancient” or “complimentary” are on the label.  It’s all medicine.

A technical point: “alternative,” “herbal” and “natural” supplements aren’t considered drugs by the Food & Drug Administration (FDA). Supplements are considered food, and are therefore not subject to the rigorous approval process or quality control surveillance that prescription drugs are. Providers and consumers have to rely on manufacturers to tell us about their products, often without a wealth of evidence. Suppositions without proof are advertisements, not facts.

I’m not comfortable prescribing a medication on the basis of advertisements. I’m sure there are wonderful treatments lurking out there in fields and rainforests, but I want proof of efficacy and safety before I recommend it. Let me give you a good example.

Many patients have asked me for a natural remedy for high cholesterol, a serious problem for which there’s not a “one size fits all” treatment. I consider a lot of variables: age, other health problems, family history, etc. Once you and I decide on a treatment, I check and recheck to see if it’s working and if there are any problems.

I’m asked over and over about red rice yeast, a so-called natural alternative to a category of prescription medications called statins. In fact, red rice yeast does work… because it is a statin.  It’s identical to a prescription drug called lovastatin, which means it comes with identical risks: hepatitis (liver inflammation), rhabdomyolysis (breakdown of muscle tissue), and myositis (painful inflammation in the muscles). Some commercially available preparations of red rice yeast have bonus chemicals, including citrinin, which can cause kidney failure. 1

Now, who is watching your liver, kidneys, and muscle while you’re taking red rice yeast? Not me. And Google tells me it costs between $14-30 a month. Prescription lovastatin costs $4 a month. So this treatment isn’t safer, cheaper, or more effective. So what is the advantage? Sure, you don’t need to see your doctor to get a prescription, but is saving the cost of a co-pay really worth risking liver or kidney failure?

Before you take any medication – prescription, “all-natural” or genetically engineered from mutated space alien zombie death rays – check out the evidence. There’s pharmacologic gold in them there hills, but like my mama always says, there’s no free lunch. Drugs are drugs, no matter who is selling them to you.

Victoria Rentel, MD (Student Health Services)

1. The Medical Letter, read all about it: Vol 51, Issue 1320, P 71-2, Sept 7, 2009.

Is it OK to share ADD medicine?

Don't end up like this guy!

ADD medicine

Q:  Is it OK to give my friend one of my ADD pills to help him study for a test?

A:  Before we answer that question, let me ask you another one.  Would you sell that pill to a stranger for $50?  I’m guessing – hoping – your answer is an emphatic “NO.”  Well, from a legal point of view, these two questions are identical.

Most ADD medications (such as Concerta, Ritalin, Adderall, Focalin, Metadate, Methylin, and Daytrana) are Schedule II controlled substances because of their serious side effects and potential for addiction.  They are monitored very closely by doctors, pharmacists, and the Drug Enforcement Agency (DEA).  We’re not lawyers here at Student Health, but we do know that… 

It is a violation of Section 2925.03 of the Ohio Revised Code (Ohio law) to sell another person a controlled substance.  The important thing to remember here is that the legal definition of “sell” includes “delivery, barter, exchange, transfer, or gift…”  

So even if you are just trying to help out your friend – and getting nothing in exchange for it – you are breaking the law.  And we’re not talking about a speeding ticket here.  You are committing a 4th degree felony, which is punishable by 6-18 months in prison and/or a $5,000 fine.  And assuming you are anywhere on or near campus, the felony gets bumped up to 3rd degree and you’re looking at 1-5 years in prison and/or a $10,000 fine.  Not to mention the fact that you could lose your financial aid and/or get kicked out of school.  

Now granted, the odds of someone busting into your dorm room and catching you in the act are very slim.  And unless you really don’t get along with your roommates or neighbors, odds are no one is going to turn you in.  But forget about the legal stuff for a minute.

  1. These medications are addictive and there’s a real chance your friend could get hooked on this stuff.  You don’t want to risk sending someone down that dark road.
  2. While these medications have a calming effect on people with ADD, they are actually central nervous system stimulants so in addition to things like headache, insomnia, anorexia, agitation, anxiety, tremors, vertigo, depression, and nervousness, they can cause life-threatening problems like heart attacks, increased heart rate, increased blood pressure, and heart arrhythmias.  Doctors evaluate people for these conditions prior to starting these medications and monitor them closely while they’re taking them.  Without knowing your friend’s health history, you could literally be putting his life at risk – and no test is worth that much. 

Managing your health is a serious responsibility and that’s especially true if you have ADD.  If you’re taking one of these medications, the best thing to do is keep it to yourself – if no one knows you have the pills, they won’t be able to ask you for one.  And if you have a friend who is taking these medicines, don’t pressure them into giving you one.  It’s more likely to hurt you than help you, and it’ll just put everyone at risk for serious trouble. 

If you have any questions about these or other medications you may be taking, the staff of Student Health Services pharmacy is always available to help!

Jason Goodman, PharmD, RPh (OSU SHS)