Is the Depo (medroxyprogesterone acetate) shot contraindicated in patients with seizures?

Depo-Provera (Medroxyprogesterone Acetate) Use in Patients with Seizures

Depo-Provera (medroxyprogesterone acetate) is not contraindicated in patients with seizures and may actually be a preferred contraceptive option for women with epilepsy.

Safety Profile in Epilepsy

Medroxyprogesterone acetate (MPA) injection is generally considered safe and appropriate for women with seizure disorders for several reasons:

• There is no evidence that Depo-Provera increases seizure risk or worsens seizure control in patients with epilepsy
• Unlike combined hormonal contraceptives, Depo-Provera is not affected by most enzyme-inducing antiseizure medications (AEDs)
• It provides a reliable contraceptive option for women taking medications that might interact with other hormonal contraceptives

Potential Benefits for Seizure Control

Some evidence suggests that progesterone may actually have beneficial effects on seizure control:

• A preliminary study found that medroxyprogesterone acetate added to antiepileptic regimens reduced seizure frequency by an average of 30% in women who developed amenorrhea 1
• Another study using progesterone as adjuvant therapy in women with catamenial epilepsy showed a decline in seizure frequency in the majority of patients 2

Considerations with Antiseizure Medications

While Depo-Provera is generally effective with antiseizure medications, there are some important considerations:

• A recent exploratory study found that some patients using enzyme-inducing antiseizure medications had lower MPA concentrations, suggesting a potential interaction that could reduce efficacy in some cases 3
• Injectable contraception (depot medroxyprogesterone acetate) appears effective with AED use, but monitoring may be appropriate 4

Administration and Follow-up

For women with seizures using Depo-Provera:

• The standard dosing is 150 mg administered by deep intramuscular injection every 3 months (13 weeks) 5
• Regular follow-up every 3 months is recommended to assess effectiveness and side effects 5
• For women taking enzyme-inducing AEDs, clinicians may consider monitoring for contraceptive effectiveness

Bone Health Considerations

Long-term use of Depo-Provera is associated with decreased bone mineral density:

• The American College of Obstetricians and Gynecologists recommends daily intake of 1300 mg calcium and 600 IU vitamin D, regular weight-bearing exercise, and smoking cessation to mitigate reductions in bone mineral density 5
• This is particularly important for women with epilepsy who may already have increased risk of bone health issues due to certain antiseizure medications

Alternative Contraceptive Options

If there are concerns about potential interactions between specific antiseizure medications and Depo-Provera:

• Intrauterine devices (IUDs) and barrier methods do not rely on hormonal components for contraceptive efficacy and are appropriate for women using enzyme-inducing medications 4
• The Mirena IUD (levonorgestrel) is also classified as Category 1 (no restrictions for use) for women with various medical conditions 5

In conclusion, Depo-Provera is not contraindicated in patients with seizures and may be a preferred contraceptive option for many women with epilepsy, especially those taking enzyme-inducing antiseizure medications that might reduce the effectiveness of combined hormonal contraceptives.