Enhanced Efficacy of Morning-After Pill With Anti-Inflammatory Painkiller

The research team conducted the world's first randomized, placebo-controlled trial involving piroxicam, a long-acting nonsteroidal anti-inflammatory drug (NSAID) used for arthritis pain. This medication inhibits prostaglandin production. They //combined it with the levonorgestrel emergency contraceptive pill (1^✔ ✔Trusted Source
Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial

Go to source). The results demonstrated that, with the new combination, only one out of 418 women became pregnant, while seven out of another 418 women who received levonorgestrel and a placebo became pregnant.

Enhanced Pregnancy Prevention: Piroxicam-Levonorgestrel Co-Treatment Outperforms Levonorgestrel Alone

The findings indicated that the piroxicam-levonorgestrel co-treatment prevented a significantly higher percentage of pregnancies (94.7%) compared to levonorgestrel alone (63.4%). There were no notable differences in adverse effects, including changes in menstrual bleeding patterns and stomach discomfort between the two regimens. The study was published in a recent issue of The Lancet.

Emergency contraception is a contraceptive method that can be used to prevent an unintended pregnancy when a regular contraceptive method fails or is not used. It can be in the form of an oral emergency contraceptive pill or the insertion of a copper intrauterine contraceptive device (Cu-IUD).

The oral levonorgestrel emergency contraceptive pill is one of the most popular choices of emergency contraception and is widely used in most countries. It was pioneered by a clinical trial in Hong Kong led by HKUMed’s Professor Ho Pak-chung, published in 1993. However, all contraceptive methods have a failure rate. Hence, the research team is continuing its efforts to explore more effective options.

Prostaglandins are substances produced by most body tissues in humans and mediate a number of biological processes, including inflammatory responses. In the reproductive system, prostaglandin is an important mediator of processes like ovulation, fertilization and embryo implantation. The research team postulated that adding a medication that blocks prostaglandin synthesis may have an additional complimentary effect in achieving contraception.

Chief-investigator Dr Raymond Li Hang-wun, from HKUMed, said, ‘Our study is the first to find that piroxicam, a readily available medication, taken at the same time as the levonorgestrel pill can prevent more pregnancies than levonorgestrel alone. We hope these findings will lead to further research and ultimately changes in clinical guidelines to enable women around the world to access more effective emergency contraception.’

Co-investigator Dr Sue Lo Seen-tsing, from FPAHK, said, ‘The levonorgestrel pill was registered in Hong Kong in 2002 and has been used safely since then. Locally, emergency contraceptives must be prescribed by healthcare providers, who assess which emergency contraceptive method is the most suitable in each case.

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Contraceptive counselling should be provided to help women seeking emergency contraception understand that it cannot replace regular contraceptives and to motivate them to use the latter. Since there is still a small failure rate, a follow-up visit is important. The levonorgestrel emergency contraception pill should be taken within 72 hours after unprotected sex; the earlier it is taken, the more effective it is.’

Reference:

1. Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial - (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01240-0/fulltext)

Source-Eurekalert