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Ginstman C, Kopp Kallner H, Fagerberg-Silwer J, Carlsson B, Ärlemalm A, Böttiger Y, Brynhildsen J. Pharmacokinetics of Oral Levonorgestrel in Women After Roux-en-Y Gastric Bypass Surgery and in BMI-Matched Controls. Obes Surg 2020; 30:2217-2224. [PMID: 32030619 PMCID: PMC7475059 DOI: 10.1007/s11695-020-04447-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women are advised to primarily use non-oral contraceptive alternatives after Roux-en-Y gastric bypass since it is not known if the surgery affects the pharmacokinetics of oral contraceptives. METHODS This is a multi-center, open label, phase 2 pharmacokinetic study performed at the University Hospital of Linköping and the Clinical Trials Center, Department of Obstetrics and Gynecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. Fifteen women aged 18-40 years who had previously undergone Roux-en-Y gastric bypass surgery and reached a BMI < 30 were included. Fifteen BMI-matched women with no previous history of Roux-en-Y gastric bypass surgery served as a control group. After administration of a single dose of a combined oral contraceptive containing 0.03 mg ethinylestradiol/0.15 mg levonorgestrel, serum levonorgestrel concentrations were determined during a 24-h period using ultra performance liquid chromatography/tandem mass spectrometry. The area under the plasma concentration time curve of levonorgestrel (AUC0-24h) was the main outcome measure. RESULTS There were no significant differences in the studied pharmacokinetic parameters, AUC0-24h, total AUC, peak serum concentration (Cmax), time to peak serum concentrations (Tmax), apparent oral clearances of levonorgestrel (CLoral), or terminal half-lives (t½) between the groups. CONCLUSION This is to our knowledge the first study to evaluate the pharmacokinetics of oral levonorgestrel in women with a BMI < 30 at least 1 year after RYGB compared with a BMI-matched group of women. We could not find any significant pharmacokinetic differences between the groups, suggesting that oral levonorgestrel may be used in non-obese women after Roux-en-Y gastric bypass once a stable body weight has been reached. CLINICAL TRIAL NUMBER EudraCT 2014-004677-17.
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Affiliation(s)
- Charlotte Ginstman
- Department of Obstetrics and Gynecology, Linköping University, University Hospital, 58185, Linköping, Sweden.
- Department of Clinical and Experimental Medicine, Linköping University, University Hospital, 58185, Linköping, Sweden.
| | - Helena Kopp Kallner
- Department of Obstetrics and Gynecology, Karolinska Institutet, 17177, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, 17177, Stockholm, Sweden
| | | | - Björn Carlsson
- Department of Clinical Pharmacology, Linköping University, 581 85, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Andreas Ärlemalm
- Department of Clinical Pharmacology, Linköping University, 581 85, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Ylva Böttiger
- Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden
- Division of Drug Research, Linköping University, 58185, Linköping, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynecology, Linköping University, University Hospital, 58185, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, University Hospital, 58185, Linköping, Sweden
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