Are there any interactions between Keppra (levetiracetam), lisinopril, Adderall (amphetamine and dextroamphetamine), and birth control?

Drug Interactions Between Keppra, Lisinopril, Adderall, and Birth Control

No significant drug interactions exist between Keppra (levetiracetam), lisinopril, Adderall (amphetamine and dextroamphetamine), and hormonal birth control that would reduce contraceptive effectiveness or require dosage adjustments.

Keppra (Levetiracetam) and Birth Control

Levetiracetam has a favorable drug interaction profile compared to many other antiepileptic drugs:

• Levetiracetam does not induce hepatic enzymes that metabolize hormonal contraceptives 1
• Unlike enzyme-inducing antiepileptic drugs (such as phenobarbital, phenytoin, carbamazepine), levetiracetam does not reduce the effectiveness of hormonal contraceptives 2
• FDA labeling specifically states that "levetiracetam (500 mg twice daily) did not influence the pharmacokinetics of an oral contraceptive containing 0.03 mg ethinyl estradiol and 0.15 mg levonorgestrel" 1
• No dose adjustments of hormonal contraceptives are required when taking levetiracetam 2

Lisinopril and Birth Control

• No clinically significant interactions have been documented between lisinopril (an ACE inhibitor) and hormonal contraceptives
• Lisinopril does not induce or inhibit hepatic enzymes that metabolize hormonal contraceptives
• No dose adjustments are necessary when using these medications concurrently

Adderall and Birth Control

• No documented significant pharmacokinetic interactions exist between Adderall (amphetamine and dextroamphetamine) and hormonal contraceptives
• Adderall is not known to reduce the effectiveness of hormonal contraception
• No dose adjustments are necessary when using these medications concurrently

Birth Control Considerations

When selecting a birth control method while on these medications:

• All hormonal contraceptive methods (including combined hormonal contraceptives, progestin-only pills, implants, and DMPA injections) can be used without restrictions 3
• IUDs (both hormonal and copper) are also appropriate options 3
• For women at high risk for STIs, appropriate STI screening should be conducted before IUD insertion 4

Important Clinical Considerations

Monitoring

• While no significant interactions are expected, be alert for:
  • Any unusual breakthrough bleeding with hormonal contraceptives (potential sign of reduced effectiveness)
  • Changes in seizure control with Keppra
  • Changes in blood pressure control with lisinopril

Common Pitfalls to Avoid

1. Assuming all antiepileptic drugs interact with hormonal contraceptives: Unlike enzyme-inducing antiepileptic drugs, levetiracetam does not reduce contraceptive effectiveness 2

2. Overlooking the importance of adherence: Even without drug interactions, inconsistent use of hormonal contraceptives remains a common cause of contraceptive failure

3. Confusing levetiracetam with enzyme-inducing antiepileptic drugs: Levetiracetam has a different metabolic pathway and does not induce liver enzymes that metabolize contraceptive hormones 1

4. Failing to consider individual factors: While no significant interactions exist between these medications, individual factors such as renal function, hepatic function, and comorbidities should always be considered when prescribing multiple medications

By understanding these medication interactions (or lack thereof), healthcare providers can confidently manage patients taking this combination of medications without concerns about reduced contraceptive effectiveness or the need for dosage adjustments.