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.
Ulipristal acetate prescription history
Animated chart of estimated U.S. prescriptions per year, Hormonal contraceptives (1960–2026). Ulipristal acetate enters in 2010 (estimated).
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
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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 |
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Self-check
- How long after intercourse can ulipristal emergency contraception be effective?
Up to five days. - Why delay restarting progestin contraception after ulipristal?
Immediate restarting can blunt its effect.