Ulipristal acetate
ELLA
What it isA selective progesterone-receptor modulator taken as single-dose emergency contraception effective up to five days after intercourse.
Why this oneIt outperforms levonorgestrel in the fourth and fifth days and in higher-BMI patients because it still delays ovulation after the LH surge begins.
What limits itCYP3A4 inducers reduce efficacy; progestin-containing contraception started immediately afterward can blunt its effect, so delay restarting it.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Emergency contraception (after unprotected intercourse or contraceptive failure) | Females of reproductive potential | One 30 mg tablet PO as soon as possible within 120 h (5 days) | Single dose | 30 mg single dose |
Renal Undefined
Hepatic Undefined
For occasional use; repeat use within the same cycle not recommended
Instructions
- Take one tablet as soon as possible within 120 h (5 days) of unprotected intercourse
- Take with or without food, at any time in the cycle
- If vomiting occurs within 3 h, consider repeating the dose
- Initiate/resume hormonal contraception no sooner than 5 days after; use a barrier method until next menses
- Do not administer with CYP3A4 inducers (e.g., rifampin)
Available strengths
- tab 30 mg
Contraindications
- Known or suspected pregnancy
Cautions
- Not indicated for termination of an existing pregnancy
- Consider ectopic pregnancy if lower abdominal pain
- Repeated use within the same cycle not recommended
- CYP3A4 inducers reduce plasma concentration/efficacy
- Rapid return of fertility — use barrier method after use
- May alter menstrual cycle; rule out pregnancy if menses delayed >1 week
- Does not protect against STIs/HIV
Adverse reactions
- Headache
- Abdominal and upper abdominal pain
- Nausea
- Dysmenorrhea
- Fatigue
- Dizziness
Pregnancy Contraindicated in existing or suspected pregnancy; not indicated for pregnancy termination
Lactation Present in human milk in small amounts (~1% of maternal dose over 5 days)
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 30 mg | tab | per unit | — | $37.10/ea | not offered |
NO BOXED WARNINGS
Principal riskEctopic pregnancy if it fails; CYP3A4 inducers reduce efficacy
Classes and tags
Clinical profile
Legacy pregnancy categoryX
Defining liabilityOvulation/contraception interactions and altered menstrual timing