January 19, 2022
By Prachi Anshu, Drexel University College of Medicine
When people go into surgeries, they are typically aware of the common side effects of surgery and medications used for general anesthesia such as nausea, vomiting, sore throat, dry mouth, and muscle aches. These side effects are routinely discussed with patients prior to signing informed consent paperwork. In addition, these outcomes are often just a quick Google search away or may be relayed anecdotally by friends or family. Postoperative nausea and vomiting (PONV) is one such risk factor that is commonly known and has been extensively studied. The Apfel score that anesthesiologists use to calculate risk of developing PONV notes that female sex is a risk factor. With the well-known association of general anesthesia with nausea and vomiting, there are many ways anesthesiologists have been able to cater to patients who have an increased risk of PONV, for example by avoiding emetogenic stimuli, minimizing opioid use, and using various antiemetic agents.
Many patients, however, do not go into their surgeries anticipating that their hormonal contraceptives will become ineffective after their surgeries. As new medications are being introduced in the field of anesthesiology, new side effects are also emerging that may not be as well-known publicly as other common side effects of surgery and anesthesia. Sugammadex is a relatively new medication that was FDA approved in 2015 and has grown increasingly popular due to its ability to predictability and effectively reverse almost any degree of neuromuscular blockade induced by rocuronium or vecuronium within a few minutes. These neuromuscular blocking agents act as muscle relaxants that are used to relax your muscles completely and are used in almost all surgeries requiring general anesthesia. This makes medications that are used for the reversal of neuromuscular blocking drugs, such as neostigmine and Sugammadex, essential for any operation requiring neuromuscular blocking drugs.
Suggamadex’s interaction with hormonal contraceptives occurs through two main mechanisms:
- First, it lowers the amount of hormonal contraceptives in the patient’s blood (free plasma concentration).
- Second, it binds progesterone, a reproductive hormone commonly found in hormonal contraceptives.1
Common progesterone-containing contraceptives include combined oral contraceptive pills, combined dermal patch, vaginal rings, progestin-only (“mini- pill” or “morning-after pill,”) progestin-only implants, contraceptive Depo injections, and progestin-only IUD. Lab studies indicated a dose of Sugammadex may be equivalent to missing a few doses of estrogen- or progesterone-containing oral contraceptives. Its website recommends the use of additional non-hormonal contraceptive or backup contraceptive methods (such as spermicide or condoms) for seven days following the use of Sugammadex.
If you or someone you know is undergoing general anesthesia and uses hormonal contraceptives, knowing the risks of contraceptive failure and discussing it with your anesthesiologist before your surgery may better prepare you for your surgery and prevent undesirable outcomes. The use of other neuromuscular blockade reversing agents such as neostigmine may also be used without risk of hormonal contraceptive failure. However, in some situations, the risk of using neostigmine may outweigh the side effects of Sugammadex.