Contraceptives currently marketed

Meanwhile, the currently marketed CYP3A4 inducers can profoundly affect the pharmacokinetics of coadministered CYP3A4 substrates, e.g., rifampin on midazolam (139) or triazolam (140). Clearly, the most frequent outcome is a loss of efficacy, which is perhaps less serious than inhibition interactions, although the consequences of coadministering rifampin with the oral contraceptive pill can lead to contraceptive failure (141-143). 

This section describes the early history leading to creation of the steroid industry, provides an account of key processes used in the manufacture of the oral contraceptives and anti-inflammatories currently marketed in the United States and highlights the creation of diverse biological activities by molecular manipulation of the steroid molecule. The section concludes with an outline of a few of the synthesis challenges faced and overcome in the manufacture of betamethasone anti-inflammatories. 

Ortho Pharmaceuticals, a subsidiary of Johnson Johnson, has had an ongoing contraceptive R D program. Eight companies that have discontinued Such R D are Syntex, Searle, Parke-Davis, Merck, Upjohn, Mead Johnson, Wyeth-Ayerst, and Eli Lilly (207). Wyeth-Ayerst, a subsidiary of American Home products, has renewed its contraceptive R D program in recent years, focusing on new forms of oral contraceptives (8,25 1). In addition, a relatively new, small firm, Gynco-Pharma, currently markets a copper IUD. Non-U.S. firms as well as universities and nonprofit foundations also carry on R D on new forms of birth control (207). 

It is obvious that these commonalties can be tailored to achieve successful contraceptive formulations with varying degrees of efficacy, user friendliness, and aesthetics. U.S. marketed contraceptive products all contain N9 as the spermicide at various concentrations. These products rely only on the mechanism of sperm destruction by the nondiscriminating surfactant effects of the spermicide, as effects of the carrier system on sperm motility are generally minimal. No claim of activity against STDs and HIV are made by current contraceptive products, with the exception of full barrier methods such as condoms. 

Currently one must ask why the particular risk of the third-generation contraceptives was identified so late. These third-generation products had been in development since the late 1970s and the first had been marketed in 1981-82, some 14 years before the Committee on Safety of Medicines issued its statement. Could society not have done better and thereby reduced the risks to which women were exposed There are two principal answers, both of them at least partly in the affirmative. 

A number of pharmaceutical microencapsulated products are currently on the market, such as aspirin, theophylline and its derivatives, vitamins, pancrelipase, antihypertensives, potassium chloride, progesterone, and contraceptive hormone combinations. ° ... 

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