Published: May 1999


Update On Deaths With Third Generation Oral Contraceptives

Information on this subject has been updated. Read the most recent information.

Prescriber Update 18: 18-19
May 1999

Medsafe Editorial Team

Two more deaths from pulmonary embolism have been reported this year with the third generation oral contraceptives (OCs) bringing the total to nine. In each of the most recently reported cases the woman had a risk factor - one had a first degree relative who had died of pulmonary embolism and the other was obese.
Women with risk factors for venous thromboembolism should be advised against using a third generation OC.

Now nine deaths with third generation OCs

There have now been nine deaths from pulmonary embolism reported to the Centre for Adverse Reactions Monitoring in women taking third generation oral contraceptives (OCs) containing desogestrel or gestodene. The two most recently reported deaths occurred in October 1996 and March 1999. Both women had known risk factors. One woman was obese (BMI 33) and the mother of the other, and possibly her maternal grandfather, had died of pulmonary embolism.

There have also been further cases of thromboembolic events not leading to death, including three cases of pulmonary embolism with third generation pills and one with Diane 35. In addition, there have been two reports of deep vein thrombosis (DVT) with second generation OCs and one each of DVT and superficial thrombophlebitis with third generation pills.

Advise against third generation OCs for women with risk factors

The Medicines Adverse Reactions Committee (MARC) has been advised of the recently reported deaths. The MARC has confirmed that the prescribing advice issued in July 1996 continues to be appropriate. Women seeking a prescription for a combined OC should be assessed for risk factors for venous thromboembolism. Prescription of a low dose second generation pill should be considered in first-time users without contraindications. Women with a risk factor for venous thromboembolism who are already using a third generation pill should be advised to have their prescription changed.

Professor David Skegg, a member of the MARC and Head of the Department of Preventive and Social Medicine, University of Otago is conducting a case-control study of deaths from pulmonary embolism in New Zealand women of child-bearing age during the period 1986 to 1997. Medsafe is providing funding for the study.


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