Question

A patient who has been taking ethinyl estradiol/levonorgestrel for contraception and in no apparent distress has an elevated blood pressure in need of antihypertensive therapy.

• Which of the prototype drugs representing the JNC-8 first-line treatments for hypertension (i.e., CCBs, diuretics, ACEIs, and ARBs) have a potentially concerning drug-drug interaction with ethinyl estradiol/levonorgestrel?

• What is the most concerning consequence of the observed anti-HTN drug interaction with ethinyl estradiol/levonorgestrel?

Answer 1

Ethinyl estradiol and levonorgestrel is a combination birth control pill containing female hormones that prevent ovulation (the release of an egg from an ovary). ethinyl estradiol and levonorgestrel also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Ethinyl estradiol and levonorgestrel is used as contraception to prevent pregnancy. There are many brands and forms of this medicine available. Not all brands are listed on this leaflet.

Estrogens (and progestogens) may elevate blood pressure and worsen the hypertension, thus compounding the risk. Clinically significant blood pressure increases have been reported during estrogen therapy, particularly in patients receiving high dosages or treated with oral contraceptive combinations having high progestational activity. These effects also increase with duration of therapy and patient age. Therapy with estrogens should be administered cautiously in patients with preexisting hypertension. Patients should be monitored for changes in cardiovascular status, and their antihypertensive regimen adjusted or estrogen therapy withdrawn as necessary.