Concurrent use of hormonal long‐acting reversible contraception by women of reproductive age dispensed teratogenic medications, Australia, 2013–2021

To the Editor:

We read with interest the study by Grzeskowiak and colleagues reviewing the concurrent prescription of teratogenic medications and Pharmaceutical Benefits Scheme subsidised long‐acting reversible contraception (LARC).1 The authors concluded that the rates of concurrent dispensation were “suboptimal”, with particular focus on dermatology practice in Australia. However, just because a LARC may not have been prescribed alongside a category X medication, it does not mean a patient was not appropriately counselled regarding the risk of teratogenicity and contraception. Most Australian dermatologists would recommend abstinence or two different forms of contraception while being treated with a category X medication but these need not be a LARC. Although LARC offer the lowest failure rates, there are many reasons why an alternative form of contraception might be recommended by a dermatologist. None of the LARC (the copper intrauterine device [IUD], the levonorgestrel IUD, and progestogen implant) offer protection against sexually transmitted infection. In the study,1 90% of cases related to isotretinoin prescription, and for these patients, the combined oral contraceptive pill may provide contraception and help treat acne concomitantly. For patients who have not reached coitarche, are sexually abstinent, do not have sperm producing partners, or otherwise unable to fall pregnant, contraception may not be indicated. As the authors highlight, the incidence of category X prescription is increasing, and we concur entirely regarding the importance of ongoing surveillance of unintended pregnancies and their outcomes. This should be the outcome measure evaluated, before raising questions about effectiveness of current measures or advocating for changes to prescribing guidelines in Australia.2,3