The Use of Alcohol Pharmacotherapies and Prescription Contraceptives among Females of Reproductive Age in Australia

Abstract There is no clear clinical guidance on the use of alcohol pharmacotherapies in pregnancy due to insufficient safety information. Contraception should therefore be considered for reproductive-aged females receiving alcohol pharmacotherapies not wishing to become pregnant. This study evaluated the concurrent use of alcohol pharmacotherapies with prescription contraception and other medications in Australian females of reproductive age compared to those not receiving an alcohol pharmacotherapy. A 10% representative sample of prescription medications subsidised by the Australian Pharmaceutical Benefits Scheme (PBS) was used to identify females aged 18 to 44 years who were dispensed naltrexone or acamprosate between 2013 and 2023 (‘exposed’ cohort). A ‘non-exposed’ comparison cohort consisted of females of the same age with no history of alcohol pharmacotherapy dispensings. The exposed cohort included 2845 females. Of these, 32.1% were established on prescription contraception compared with 23.2% in the unexposed cohort (OR: 1.56, 95% CI: 1.44–1.69). However, dispensing of medications used for pregnancy termination was higher in the exposed cohort compared to those unexposed (0.25% vs 0.16%; OR: 1.53, 95% CI: 0.61–3.17). Co-dispensing of psychiatric, cardiovascular, analgesic, nicotine dependence, and peptic ulcer and gastro-oesophageal reflux disease medications were also significantly higher in the exposed cohort compared with those unexposed. In Australia, alcohol pharmacotherapies are commonly dispensed to females of reproductive age not also dispensed prescription contraception on the PBS. This may result in unintended pregnancies and prenatal exposure to medications with limited safety information. The use of multiple medications was also common, which may also negatively impact pregnancy, further highlighting the importance of contraception.