LONDON (AP) — Taking an arthritis drug along with the morning-after Plan B pill may increase the effectiveness of birth control, according to new research published Wednesday.
Levonorgestrel, often called Plan B, is the most widely available type of emergency contraception. It works by preventing or delaying ovulation.
Scientists estimate that it’s about 95% effective when taken within a day of unprotected sex, dropping to 58% or lower within three days. The new study, published by the Lancet medical journal, suggests levonorgestrel can remain very effective up to three days after unprotected sex when taken with piroxicam, an anti-inflammatory pain medication usually prescribed for arthritis.
“It’s great and very timely that we can have more effective emergency contraceptive options,” said Kelly Cleland, executive director of the American Society for Emergency Contraception, who was not part of the Lancet study.
Scientists tracked 836 women in a Hong Kong clinic between 2018 and 2022 who had unprotected sex and requested emergency contraception within three days. Half of the women received a dose of levonorgestrel and piroxicam while the other half received the contraceptive pill plus a placebo.
Doctors calculated that 95% of pregnancies among women who received the combination with piroxicam were prevented, compared to 63% of those who received the placebo combination.
The most common side effects in both groups were fatigue, nausea, stomach pain, dizziness and headache. No funding is provided for research. The researchers used Hong Kong brands of contraceptives that are sold over the counter in the US under several names, including Plan B One-Step.
The authors acknowledge that because the study was conducted in mostly Asian women weighing less than 70 kilograms (154 pounds), it is unclear whether the results can be extrapolated to other populations. There is some evidence that levonorgestrel does not work as well in heavier women.
Piroxicam is in the same anti-inflammatory class as ibuprofen and paracetamol. It requires a prescription in many countries, including the US and UK
“It’s exciting that they found these existing drugs actually increase the efficacy of Plan B,” said Dr. Beverly Gray, a Duke University professor of obstetrics and gynecology who was not part of the new study. “But any drug that requires a prescription is going to be one more barrier, so what we really need is an over-the-counter drug that people can take along with Plan B.”
Dr. Kristina Gemzell Danielsson, head of Women and Children’s Health at Sweden’s Karolinska Institute and one of the authors of the Lancet study, said similar anti-inflammatory drugs could have a similar effect. She said there would be no risk to women taking over-the-counter ibuprofen on a Plan B, though it may not prove as effective as the longer-acting piroxicam.
Piroxicam can cause stomach bleeding or a severe skin reaction and increase the risk of heart or kidney disease in people who are prone to these conditions. However, experts say using the drug once is less likely to cause harm, especially for the large number of young women who are most likely to use emergency contraception.
Gemzell-Danielsson said further studies could examine whether anti-inflammatories increase the effectiveness of the other main emergency contraceptive pill, ellaOne.
She recommends that women keep some form of emergency contraception at home, especially in places with very strict abortion policies.
“This is a simple, effective and very smart solution to have,” says Gemzell-Danielsson. “You don’t buy (Band-Aids) because you plan to cut yourself, but you have them because you think it might happen.”
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The Associated Press Department of Health and Science receives support from the Howard Hughes Medical Institute Science and Education Media Group. AP is fully responsible for all content.
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