Retrospective Analysis of Sugammadex Use in Adolescent Females on Progestin-Containing Contraceptives

Abstract

Sugammadex, a novel neuromuscular blockade reversal agent, functions as a steroid binder postulated to decrease hormone exposure used within progestin-containing contraceptive medications. Thus, alternative non-medication contraceptive methods are recommended to prevent unplanned pregnancies. The study aims were to evaluate sugammadex use in adolescent females prescribed a progestin-containing contraceptive and positive pregnancy screening frequency. We hypothesized sugammadex use is infrequent in this population and no pregnancy screens would be positive. This is a retrospective observational cohort study utilizing the TriNetX ® Electronic Health Record (EHR) database of female subjects aged 12 to 21 years reported to be prescribed sugammadex. The data collected was analyzed for demographics, International Classification of Diseases, 9th and 10th edition diagnostic, medication, procedural codes, progestin-containing medication timing, and timing of pregnancy screening. We included 18686 subjects [contraceptive group, 2017 (10.8%) and no contraceptive group, 16669 (89.2%)]. Both groups had similar frequencies of pregnancy screening [contraceptive group, 54 (2.7%) versus no contraceptive group, 366 (2.2%)]. Of the contraceptive group, 1 (0.05%) subject, 17 years of age, was confirmed to have a positive pregnancy screen 35 days after surgery. We found that sugammadex may be administered to adolescent females prescribed progestin-containing contraceptives, but positive pregnancy screens are rare. Effective counseling, use of nonhormonal contraceptives 7 days after sugammadex administration, and the theoretical reproductive risks of this agent may have contributed to these findings. Continued counseling after sugammadex use in the adolescent population is recommended to avoid the occurrence of unplanned pregnancies.