Ulipristal (Monograph)
Brand name: ella
Drug class: Contraceptives
VA class: HS200
Chemical name: 19-Norpregna-4,9-diene-3,20-dione, 17-(acetyloxy)-11-[4-(dimethylamino)phenyl]-, (11β)-
Molecular formula: C30H37NO4
CAS number: 126784-99-4
Introduction
Postcoital contraceptive; synthetic selective progesterone receptor modulator.
Uses for Ulipristal
Postcoital Contraception
Prevention of unintended pregnancy after unprotected intercourse or known or suspected contraceptive failure as an emergency contraceptive. Postcoital (emergency) contraceptive regimens are not as effective as most other methods of long-term contraception;not intended for routine use as a contraceptive.
Levonorgestrel currently is the preferred postcoital contraceptive when the drug is initiated within 72 hours of unprotected intercourse. Ulipristal is an effective alternative to levonorgestrel for postcoital contraception when used within 120 hours after unprotected intercourse.
Ulipristal Dosage and Administration
Administration
Administer orally without regard to meals.
Administer as soon as possible but within 120 hours following unprotected intercourse.
May be used at any time during the menstrual cycle.
If vomiting occurs within 3 hours after administration, consider repeating the dose.
Dosage
Available as ulipristal acetate; dosage expressed in terms of the salt.
Adults
Postcoital Contraception
Oral
Single 30-mg dose taken within 120 hours of unprotected intercourse or known or suspected contraceptive failure.
Special Populations
No special population dosage recommendations at this time.
Cautions for Ulipristal
Contraindications
-
Known or suspected pregnancy.
Warnings/Precautions
Warnings
Fetal/Neonatal Morbidity and Mortality
May cause fetal harm; exclude pregnancy before initiating treatment. Embryofetal death reported in animals, but no adequate and well-controlled studies to date in pregnant women. If inadvertently used during pregnancy, apprise of potential fetal hazard.
Existing Pregnancy
Not intended for termination of existing pregnancy; exclude possibility of pregnancy prior to administration. Perform pregnancy testing if pregnancy cannot be excluded on basis of history and/or physical examination.
Follow-up physical and/or pelvic examination recommended if there is concern regarding general health or pregnancy status of women receiving the drug.
Ectopic Pregnancy
Consider possibility of ectopic pregnancy in women who become pregnant or complain of severe lower abdominal pain. Manufacturer states that history of ectopic pregnancy is not considered a contraindication to use.
Repeated Use
Intended for occasional use as emergency contraceptive. Postcoital (emergency) contraceptive regimens are not as effective as most other methods of long-term contraception; not intended for routine use as a contraceptive. Repeated use within the same menstrual cycle not recommended; safety and efficacy of such repeated use not evaluated.
Fertility Following Use
Rapid return of fertility likely following treatment for emergency contraception; continue or initiate routine methods of contraception as soon as possible to prevent pregnancy.
Ulipristal may reduce the efficacy of other hormonal contraceptives. (See Drug Interactions.) Reliable barrier contraceptives (e.g., condom with spermicide) recommended in women for subsequent acts of intercourse within the same menstrual cycle after receiving ulipristal.
Effect on Menstrual Cycle
Onset of menstruation may occur a few days earlier or later than expected. If menstruation delayed by >1 week, rule out pregnancy. Intermenstrual bleeding also reported.
HIV and STDs
Does not protect against HIV infection or other sexually transmitted diseases (STDs).
Specific Populations
Pregnancy
Category X. (See Fetal/Neonatal Morbidity and Mortality and also see Contraindications under Cautions.)
Lactation
Distributed into milk in rats; not known whether distributed into human milk. Use not recommended.
Pediatric Use
Safety and efficacy established in women of reproductive age. Safety and efficacy expected to be identical for postpubertal adolescents <18 years of age and women ≥18 years of age. Not intended for use before menarche.
Geriatric Use
Not evaluated in women ≥65 years of age and not intended for use in postmenopausal women.
Hepatic Impairment
Not studied in patients with hepatic impairment.
Renal Impairment
Not studied in patients with renal impairment.
Common Adverse Effects
Headache, abdominal pain, nausea, dysmenorrhea, fatigue, dizziness.
Drug Interactions
Appears to be principally metabolized by CYP3A4. No evidence of induction or inhibition of CYP isoenzymes from in vitro studies.
Specific Drugs
Drug |
Interaction |
Comments |
---|---|---|
Anticonvulsants (carbamazepine, felbamate, oxcarbazepine, phenytoin, topiramate) |
Possible decrease in plasma concentrations and efficacy of ulipristal |
|
Antifungal agents, azole (itraconazole, ketoconazole) |
Possible increase in plasma concentrations of ulipristal |
|
Barbiturates (e.g., phenobarbital) |
Possible decrease in plasma concentrations and efficacy of ulipristal |
|
Bosentan |
Possible decrease in plasma concentrations and efficacy of ulipristal |
|
Griseofulvin |
Possible decrease in plasma concentrations and efficacy of ulipristal |
|
Hormonal contraceptives |
May reduce efficacy of other hormonal contraceptives as a result of high-affinity binding to progesterone receptors |
Recommend reliable barrier contraceptives (e.g., condom with spermicide) for subsequent acts of intercourse within the same menstrual cycle |
Rifampin |
Possible decrease in plasma concentrations and efficacy of ulipristal |
|
St. John's wort (Hypericum perforatum) |
Possible decrease in plasma concentrations and efficacy of ulipristal |
Ulipristal Pharmacokinetics
Absorption
Bioavailability
Rapidly absorbed following oral administration with peak plasma concentrations attained within 60–90 minutes.
Food
High-fat meal reduces peak plasma concentrations by 40–45% and delays time to peak plasma concentrations from median of 0.75 to 3 hours. However, food not expected to result in clinically important effects on efficacy or safety.
Distribution
Plasma Protein Binding
>94% (mainly HDL-cholesterol, alpha-1-acid glycoprotein, albumin).
Elimination
Metabolism
In vitro data indicate metabolism is predominantly mediated by CYP3A4 in the liver to mono-demethylated (active) and di-demethylated (inactive) metabolites.
Half-life
About 32 hours.
Stability
Storage
Oral
Tablets
20–25°C. Protect from light.
Actions
-
Exhibits antagonist activity at progesterone receptors and inhibits progesterone from binding to its receptors; also possesses partial agonist activity at progesterone receptors.
-
Contraceptive effects may involve inhibition or delay of ovulation, inhibition of follicular growth or rupture, and/or alteration of the endometrium possibly affecting implantation. At recommended doses for postcoital contraception, no clinically important effects on the endometrium.
Advice to Patients
-
Importance of reading the patient information (medication guide) provided by the manufacturer before initiating therapy.
-
Importance of administering as soon as possible and not >120 hours after unprotected intercourse or known or suspected contraceptive failure.
-
Importance of women informing a clinician if pregnancy is known or suspected. Do not use for termination of existing pregnancy.
-
Importance of women informing a clinician if vomiting occurs within 3 hours of administration and to discuss the need for a repeat dose.
-
Importance of advising women to seek medical attention if severe lower abdominal pain occurs 3–5 weeks after administration to rule out possibility of ectopic pregnancy.
-
Importance of women contacting a clinician if menstruation delayed >1 week beyond the expected date to rule out possibility of pregnancy.
-
Importance of advising women not to use the drug routinely for contraception and not to repeat use within the same menstrual cycle.
-
Importance of informing women that ulipristal may reduce the efficacy of other hormonal contraceptives and to use reliable barrier contraceptives (e.g., condom with spermicide) for subsequent acts of intercourse within the same menstrual cycle.
-
Importance of advising women not to use the drug while breast-feeding.
-
Importance of advising women that ulipristal is not effective in all cases; drug may be less effective in women with body mass index >30 kg/m2.
-
Importance of informing women that ulipristal does not protect against HIV-infection (AIDS) or other STDs.
-
Importance of women informing a clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs and herbal supplements, as well as any concomitant illnesses.
-
Importance of informing patients of other important precautionary information. (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes |
Dosage Forms |
Strengths |
Brand Names |
Manufacturer |
---|---|---|---|---|
Oral |
Tablets |
30 mg |
ella |
Watson |
AHFS DI Essentials™. © Copyright 2025, Selected Revisions June 21, 2011. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
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