Dubin-Johnson syndrome and the combined contraceptive (COC) pill

• Dubin-Johnson syndrome and the contraceptive pill
  • rare autosomal recessive disorder manifested by chronic conjugated hyerbilirubinaemia
  • associated with mutations in the multidrug resistance protein 2 (MRP2)
    • MRP2 - a glycoprotein in the apical membrane of hepatocytes and it transports anion conjugates from hepatocytes to bile
    • this protein also transports oestrogen and progesterone metabolites - this is why the jaundice of Dubin-Johnson syndrome increases when a woman takes the combined contraceptive pill
      • however there are many other bile acid transporters and the presence of metabolites of progesterone and oestrogen should not cause cholestasis or liver damage. Also there will be urinary excretion of the oestrogen and progesterone metabolites and so there will not be a failure of excretion. Also the contraceptive effect of the combined pill will not be impaired
  • in consideration of a question regarding a woman with Dubin-Johnson syndrome, normal liver function tests and considering the use of the combined contraceptive pill, it has been stated that (1) "...patient might notice an increase in jaundice while taking the pill, but that this will not have any deleterious effects. It is not clear whether would be any real benefit for your patient from using a progestogen-only-pill...might be worth switching to progesterone-only preparation if she developed unacceptable jaundice on the combined pill.."

Reference:

1. GP (January 28th 2005), 42.