- Sugammadex and aprepitant are increasingly used in the perioperative setting, but may decrease the effectiveness of hormonal contraception (HC).
- This article presents the results of a survey sent to all anesthesia providers at a single hospital system (Mayo Clinic and affiliated institutions) regarding anesthesia providers’ awareness of the potential interactions between sugammadex, aprepitant, and HC.
- Respondents were queried regarding their use of these drugs, awareness of potential interactions, and counselling practices including approaches that employ shared decision-making (SDM).
- 337 of 1092 (31%) providers responded to the survey, including attending anesthesiologists, CRNAs, residents, fellows, and SRNAs.
Key Findings:
- Knowledge of Drug Interactions:While most providers (96%) recognized that sugammadex could interfere with oral contraceptives, only 47% were aware that aprepitant may have similar effects. Awareness of interactions with other contraceptive methods, such as IUDs and implants, was even lower.
- Counseling Practices:Despite acknowledging the clinical relevance of these drug-HC interactions, 36% of respondents rarely or never preoperatively discussed sugammadex’s effects with their patients, and 73% rarely or never discussed aprepitant’s effects.
- Recommended Alternative Contraception:Only 52% correctly identified the 7-day period for using alternative contraception after sugammadex exposure, and just 38.5% identified the 28–31 day recommendation for aprepitant.
- Training Deficiencies:Many respondents believed these topics were inadequately covered during training programs, with only 49% and 11% rating their education on sugammadex and aprepitant, respectively, as satisfactory.
- Shared Decision-Making (SDM):Most providers supported SDM, yet 79% rarely or never engaged patients in choosing between sugammadex and neostigmine, or discussed alternative antiemetics to aprepitant.
- The authors conclude that the results of this survey underscore a significant need for improved education and standardized guidelines addressing drug interactions with hormonal contraception. Providers should ensure preoperative counseling employs principles of SDM and includes discussion of alternative contraceptive options when appropriate.
