Does Sugammadex (Bridion) interfere with hormonal contraceptives?

From the Guidelines

Sugammadex (Bridion) can decrease the efficacy of hormonal contraceptives, particularly for transmasculine and nonbinary patients on oral contraceptives, and cisgender women, leading to an increased risk of pregnancy for 1 week following administration. This is based on the most recent evidence from a 2024 study published in the Mayo Clinic Proceedings 1. The study highlights the importance of counseling patients on the potential interaction between sugammadex and hormonal contraceptives to prevent unintended pregnancy. Key points to consider include:

• Sugammadex can bind to progestogen hormones in contraceptives, temporarily reducing their blood levels and potentially compromising their effectiveness
• Patients using hormonal contraceptives should be advised to follow the advice for missed doses that comes with their contraceptive and use an additional non-hormonal contraceptive method for 7 days after receiving sugammadex
• This interaction is not relevant for transfeminine patients taking estrogen for gender affirmation, as they are typically assigned male at birth and take estrogen for purposes other than birth control, as noted in the study 1
• Clinicians should be aware of this potential interaction to provide appropriate counseling and prevent unintended pregnancy, particularly in the context of day surgery where patients will be discharged shortly after receiving sugammadex.

From the FDA Drug Label

1. 3 Interaction Potentially Affecting the Efficacy of Hormonal Contraceptives In vitro binding studies indicate that BRIDION may bind to progestogen, thereby decreasing progestogen exposure. Therefore, the administration of a bolus dose of BRIDION is considered to be equivalent to missing dose(s) of oral contraceptives containing an estrogen or progestogen If an oral contraceptive is taken on the same day that BRIDION is administered, the patient must use an additional, non-hormonal contraceptive method or back-up method of contraception (such as condoms and spermicides) for the next 7 days In the case of non-oral hormonal contraceptives, the patient must use an additional, non-hormonal contraceptive method or back-up method of contraception (such as condoms and spermicides) for the next 7 days.

Sugammadex (Bridion) may interfere with hormonal contraceptives by binding to progestogen and decreasing progestogen exposure.

• To minimize the risk of reduced contraceptive efficacy, patients should use an additional, non-hormonal contraceptive method or back-up method of contraception for the next 7 days after administration of Sugammadex. 2

From the Research

Sugammadex and Hormonal Contraceptives

• Sugammadex is a steroid binder that can potentially bind to the estrogens and progestins contained within hormonal contraception, which may lead to decreased effectiveness of hormonal contraceptives 3.
• The FDA label for sugammadex contains a drug-drug interaction warning between this medication and hormonal contraception, advising that women taking hormonal contraception use a backup contraceptive method or abstinence for seven days after exposure to sugammadex 3.

Clinical Implications

• A study found that only 0.7% of women using hormonal contraception at the time of sugammadex exposure had documented counseling on this drug-drug interaction, highlighting the need for improved counseling processes to avoid unnecessary risk for unintended pregnancies 3.
• Another study found that most anesthesia providers recognized the potential for sugammadex interference with oral hormonal contraception, but fewer accurately identified potential interference with hormonal intrauterine devices and hormonal contraceptive implants 4.
• The study also found that most providers agreed that potential interference with contraceptive effectiveness should be discussed with patients preoperatively, but many reported rarely discussing this drug interaction with patients in actual clinical practice 4.

Knowledge Gaps and Practice Improvement

• A multisite survey found that while almost all respondents knew that sugammadex may interfere with oral contraceptive effectiveness, only 47% knew about aprepitant's potential contraceptive interference, highlighting the need for increased education and awareness among anesthesia providers regarding drug interactions with hormonal contraceptives 5.
• The survey also found that most providers considered the interference of these perioperative drugs with hormonal contraceptives to be clinically relevant, but many reported rarely engaging in shared decision-making with patients regarding the choice of medication and alternative contraceptive methods 5.

Special Populations

• A retrospective analysis of sugammadex use in adolescent females on progestin-containing contraceptives found that positive pregnancy screens were rare, but effective counseling and use of nonhormonal contraceptives 7 days after sugammadex administration may have contributed to these findings 6.
• The study highlights the importance of continued counseling after sugammadex use in the adolescent population to avoid the occurrence of unplanned pregnancies 6.