Researchers at the University of Hong Kong (HKU) found that the anti-inflammatory drug piroxicam can increase the effectiveness of the emergency contraceptive drug levonorgestrel from 63% to 95%. The research was published in the journal Lancet.
The trial included 836 women who took the emergency contraceptive pill within 72 hours of having unprotected sex. They are randomly divided into two groups. Half were given a placebo and levonorgestrel, a synthetic version of the hormone progesterone that delays egg release. Others took levonorgestrel along with 40 mg of piroxicam, an arthritis medicine.
Only one of the 418 women in the piroxicam group and seven of the women who took the placebo conceived. No serious side effects were recorded.
The researchers calculated that about 4.5% of women (19 out of 418) would become pregnant without emergency contraception. Taking piroxicam with levonorgestrel could prevent 18 of 19 pregnancies (95%), and taking levonorgestrel alone could prevent 12 (63%) of 19 pregnancies.
Levonorgestrel prevents pregnancy by blocking or delaying the release of luteinizing hormone, thereby disrupting the ovulation process. Piroxicam may affect another type of hormone called prostaglandins. They facilitate many reproductive processes, including ovulation, fertilization, and embryo implantation. Therefore, we hypothesize that piroxicam may have a contraceptive effect both before ovulation, by blocking the ovulation process, and by preventing embryo implantation after ovulation,” explained study co-author Christina Gemtsell-Danielsson, a professor at the Karolinska Institute in Sweden.
The authors cautioned about the limitations of the study: it mostly included women of Asian descent and weighing less than 70 kg. Other trials have shown that levonorgestrel tablets may not work when taken by overweight women.
“Overall, this study suggests that anyone taking levonorgestrel as emergency contraception should consider adding 40mg of piroxicam orally, as it increases efficacy with few side effects,” said University of Hong Kong study author Dr Raymond Lee.
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