Contraindications of Birth Control Pills and Zepound (Tirzepatide)
Combined oral contraceptives (COCs) are absolutely contraindicated in patients with a history of thromboembolism, cardiovascular disease, uncontrolled hypertension, smoking ≥15 cigarettes daily in women ≥35 years, and should not be used concurrently with Zepound (tirzepatide) in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2. 1
Absolute Contraindications for Combined Oral Contraceptives
Cardiovascular Conditions
- History of deep vein thrombosis or pulmonary embolism
- Current thrombophlebitis or thromboembolic disorders
- Cerebrovascular disease or coronary artery disease
- Severe hypertension (SBP ≥160 mmHg or DBP ≥100 mmHg)
- Vascular disease
- Known thrombogenic mutations
- Valvular heart disease with complications
- Multiple risk factors for atherosclerosis 1
Age and Smoking Status
Postpartum Status
- ≤21 days postpartum, regardless of breastfeeding status 1
Reproductive System and Breast Conditions
- Current or history of breast cancer
- Undiagnosed abnormal genital bleeding 1
Liver Conditions
- Acute or flare of viral hepatitis
- Severe or decompensated cirrhosis
- Liver tumors (benign or malignant) 1
Migraine
- Migraine with aura at any age 1
Relative Contraindications for Combined Oral Contraceptives
- Age ≥35 years and smoking <15 cigarettes daily
- Breastfeeding patient 21-29 days postpartum
- Moderately elevated blood pressure (SBP 140-159 mmHg or DBP 90-99 mmHg)
- Adequately controlled hypertension
- VTE with no risk factors for recurrence
- Superficial venous thrombosis 1, 2
Drug Interactions with Birth Control Pills
Medications That May Decrease COC Effectiveness
- Anticonvulsants: phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine
- Antimicrobials: rifampin (Note: other antibiotics do not reduce COC effectiveness)
- Antidepressants: St. John's wort 1
Special Considerations for HIV Medications
- Certain antiretroviral medications may interact with hormonal contraceptives
- Refer to current HIV treatment guidelines for specific recommendations 1
Contraindications Specific to Zepound (Tirzepatide)
Zepound (tirzepatide) is a GLP-1 receptor agonist similar to semaglutide and liraglutide, approved for weight management. Key contraindications include:
- Personal or family history of medullary thyroid carcinoma
- Multiple Endocrine Neoplasia syndrome type 2
- Pregnancy or women planning pregnancy
- History of pancreatitis
- History of severe gastrointestinal disease 1
Important Considerations for Combined Use
When considering both birth control pills and Zepound:
Pregnancy prevention is critical: Zepound is contraindicated in pregnancy, making reliable contraception essential for women of reproductive potential 1
Weight considerations: While COCs typically cause minimal weight changes, Zepound is specifically designed for weight loss
Monitoring requirements:
- Blood pressure should be measured before initiating COCs and monitored regularly
- Patients on Zepound should be monitored for gastrointestinal side effects and potential gallstone formation 1
Risk assessment: The combined cardiovascular risk profile should be carefully evaluated, especially in patients with multiple risk factors 1
Clinical Pearls and Pitfalls
Common pitfall: Failing to recognize that smoking dramatically increases cardiovascular risks with COCs, especially in women over 35 3, 4
Important caveat: The absolute risk of venous thromboembolism with modern low-dose COCs is relatively small (7-10 events per 10,000 women-years) compared to the risk during pregnancy (5-20 per 10,000 person-years) 1, 3
Often overlooked: Blood pressure measurement is essential before initiating COCs, as approximately 10% of reproductive-aged women have elevated blood pressure 2
Key consideration: For women with contraindications to estrogen-containing contraceptives, progestin-only methods (pills, injections, implants, or levonorgestrel IUDs) may be safer alternatives 5