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Cautions relating use of combined oral contraceptive pill

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Cautions including any relevant action to be taken (1)

  • If the individual is less than 16 years of age an assessment based on Fraser guidelines must be made and documented.
  • If the individual is less than 13 years of age the healthcare professional should speak to local safeguarding lead and follow the local safeguarding policy.
  • Discuss with appropriate medical/independent non-medical prescriber any medical condition or medication of which the healthcare professional is unsure or uncertain.
  • Individuals taking lamotrigine should be advised that COC may interact with lamotrigine; this could result in reduced seizure control or lamotrigine toxicity.
  • Consideration should be given to the current disease status of those with severe malabsorption syndromes, such as acute/active inflammatory bowel disease or Crohn’s disease. Although the use of COC is not contra-indicated it may be less effective and so these individuals should be advised offered Long Acting Reversible Contraception (LARC).
  • Women should be advised that it is possible that medications that induce diarrhoea and/or vomiting (e.g. orlistat, laxatives) could reduce the effectiveness COC.
  • Offer Long Acting Reversible Contraception (LARC) to all individuals in particular those with medical conditions for whom pregnancy presents an unacceptable risk and those on a pregnancy prevention plan.

If an individual is known to be taking a medication which is known to be harmful to pregnancy a highly effective form of contraception is recommended. Highly effective methods include the LARC methods: IUD, IUS and implant. If a LARC method is unacceptable/unsuitable and a COC is chosen then an additional barrier method of contraception is advised. See FSRH advice.


  • Patient Group Direction (PGD) (NHS Specialist Pharmacy Service). Supply of a combined oral hormonal contraceptive (COC) . (Accessed 17th March 2021).

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