A patient who is taking a combination oral contraceptive begins taking carbamazepine. After several weeks, the patient tells the nurse she has begun experiencing spotting during her cycle. What will the nurse tell her to do?
a. Change to condoms instead of oral con-traceptives.
b. Discuss an oral contraceptive with in-creased estrogen.
c. Request a decreased dose of carbamaze-pine.
d. Stop taking the oral contraceptive imme-diately.
B
Carbamazepine induces hepatic cytochrome P450 and thus accelerates the metabolism of oral contraceptives. Spotting is a sign of reduced OC blood levels; patients experiencing this symp-tom may need an increased estrogen dose. If the dose of OC is not changed, the woman may use condoms along with the OC. Reducing the dose of carbamazepine is not correct. Discontinuing the OC immediately is not correct.
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