American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which medication is suitable for women with epilepsy who take oral contraceptives?

Phenytoin
Valproate
Levetiracetam
Carbamazepine

The correct answer is: Levetiracetam

Levetiracetam is a suitable medication for women with epilepsy who take oral contraceptives because it does not significantly interact with hormonal contraceptives. Unlike some antiepileptic drugs, it is not known to induce hepatic enzymes that would lower the effectiveness of oral contraceptives. This characteristic makes levetiracetam a preferable option in managing epilepsy for women who are concerned about maintaining effective contraception. In contrast, medications like phenytoin and carbamazepine can induce cytochrome P450 enzymes, which may decrease the efficacy of hormonal contraceptives, increasing the risk of unintended pregnancy. Valproate, while it does not interfere with contraceptive efficacy, poses significant risks during pregnancy, particularly related to fetal development, and is generally not favored as a primary treatment in women of childbearing age without adequate contraceptive measures. Therefore, levetiracetam stands out as a safer choice due to its minimal interaction with hormonal contraceptives and its established safety profile in women who are pregnant or may become pregnant. This ability to manage both epilepsy effectively and contraceptive needs makes levetiracetam the correct choice in this scenario.