Can medroxyprogesterone (Depo-Provera) cause increases in serum bilirubin?/nThe question concerns a

Fråga: Can medroxyprogesterone (Depo-Provera) cause increases in serum bilirubin? The question concerns a 39-year-old woman on Depo-Provera in unknown dosage as a contraceptive given for several months or years (?). Now serum bilirubin is elevated (48-33) and conjugated bilirubin increased (8). ALAT, ASAT and GT are all normal. Is this an adverse drug reaction?

Sammanfattning: In an extensive literature search, no reports were found on elevated bilirubin serum levels. However, two such cases have been reported to SADRAC.

Svar: An extensive literature search including Medline, Drugline and the reference hand-books has not revealed any references on bilirubin elevation. Rather, in a few studies, lowered bilirubin levels have been reported (1,2). However, the Swedish Adverse Drug Reactions Advisory Committee (SADRAC) has two reports of increases of bilirubin in women aged 36 and 27 years of age on Depo-Provera used as contraceptive. These reports were both from mid 80´s and the reactions were regarded as moderately severe. Both women recovered without sequele.

In this case, it may be advisable to withdraw the drug. If bilirubin levels return to normal, it is suggested that this case be reported to the regional centre at Huddinge Hospital of SADRAC (3).