Can oral contraceptive pills (OCPs) be less effective when taking Mounjaro (tirzepatide)?

From the Guidelines

Oral contraceptive pills (OCPs) may be less effective when taking Mounjaro (tirzepatide) due to potential interactions affecting absorption, and it is recommended to consider alternative contraceptive methods or add a barrier method for additional protection. When considering the use of OCPs with Mounjaro, it's essential to weigh the potential risks and benefits, prioritizing morbidity, mortality, and quality of life as outcomes. The evidence from the U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1, although not directly addressing Mounjaro, highlights concerns about the effectiveness of hormonal contraceptives when used with certain medications that may affect their absorption or mechanism of action.

Key Considerations

• Mounjaro's effect on gastric emptying and potential impact on OCP absorption
• The importance of alternative contraceptive methods, such as intrauterine devices (IUDs), implants, or injections, which are not affected by gastrointestinal absorption
• The need for patients to discuss their contraceptive options with their healthcare provider, especially if they experience gastrointestinal side effects from Mounjaro

Recommendations

• Consider adding a barrier method like condoms for additional protection when using OCPs with Mounjaro
• Discuss alternative birth control options with your healthcare provider, such as IUDs, implants, or injections
• Be aware of the potential for reduced OCP effectiveness and take steps to mitigate this risk, such as switching to a non-oral contraceptive method or adding a barrier method for 4 weeks after starting Mounjaro and after each dose escalation, as recommended by the manufacturer. The guidance provided by the manufacturer of Mounjaro and the principles outlined in the U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1, support the recommendation to prioritize alternative contraceptive methods or add a barrier method when using OCPs with Mounjaro, to minimize the risk of reduced contraceptive effectiveness and ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

Contraception Use of MOUNJARO may reduce the efficacy of oral hormonal contraceptives. Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation and for 4 weeks after each dose escalation with MOUNJARO [see Drug Interactions (7.2), Use in Specific Populations (8. 3), and Clinical Pharmacology (12.3)].

1. 2 Oral Medications MOUNJARO delays gastric emptying, and thereby has the potential to impact the absorption of concomitantly administered oral medications. ... Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation and for 4 weeks after each dose escalation with MOUNJARO.

Yes, oral contraceptive pills (OCPs) can be less effective when taking Mounjaro (tirzepatide) because Mounjaro delays gastric emptying, which may impact the absorption of oral medications, including oral hormonal contraceptives 2. It is recommended that patients using oral hormonal contraceptives switch to a non-oral contraceptive method or add a barrier method of contraception for 4 weeks after initiation and for 4 weeks after each dose escalation with Mounjaro.

From the Research

Effectiveness of Oral Contraceptive Pills (OCPs)

• The effectiveness of OCPs can be influenced by various factors, including drug interactions 3
• Certain medications, such as rifampin, anticonvulsants, and certain antibiotics, can decrease the efficacy of OCPs 3
• However, there is no direct evidence to suggest that Mounjaro (tirzepatide) interacts with OCPs, as none of the provided studies mention this specific medication

Contraception and Medical Conditions

• Women with certain medical conditions, such as diabetes, hypertension, and depression, can safely use OCPs, but require careful consideration and monitoring 4, 5
• Progestin-only contraceptives are recommended for women with contraindications to estrogen, such as those with a history of venous thromboembolism or cardiovascular disease 5

Contraceptive Options and Effectiveness

• OCPs are a commonly used reversible method of contraception, with a failure rate of 4-7% per year 6
• Other contraceptive options, such as intrauterine devices and subdermal implants, have higher effectiveness and lower failure rates 6
• The choice of contraceptive method depends on individual factors, including medical history, personal preferences, and lifestyle 6, 5