ulipristal acetate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
ulipristal acetate: clinical details
Prescribing considerations
- Exclude existing pregnancy when the period is late or pregnancy symptoms are present; ulipristal does not terminate pregnancy.
- Review recent and current enzyme-inducing medicines, hormonal contraception and previous emergency contraception.
- Explain that effectiveness is not guaranteed and that no protection is provided for later intercourse.
- Limited and inconclusive evidence suggests effectiveness may decline with increasing weight or BMI, but oral emergency contraception remains suitable regardless of weight; discuss the copper IUD as the most effective emergency option.
- Not recommended in severe asthma controlled with oral glucocorticoids or in severe hepatic impairment.
Contraindications and cautions
- Hypersensitivity to ulipristal acetate or any product excipient.
- Selected formulations contain lactose and should not be used in specified rare hereditary disorders of galactose metabolism or absorption.
Monitoring
- Routine laboratory monitoring is not required for emergency-contraception use.
- Advise pregnancy testing and clinical review if the next period is more than seven days late, unusually light or heavy, or accompanied by pregnancy symptoms.
- Consider ectopic pregnancy if pregnancy occurs, including when uterine bleeding is present.
Clinical pharmacology
A selective progesterone receptor modulator that delays ovulation by suppressing the luteinising-hormone surge. It is highly protein-bound, primarily metabolised through CYP3A4 and has an active mono-demethylated metabolite.
Formulation and product differences
- Both selected products are white, round, film-coated tablets marked “U30” and contain lactose.
- Ulipristal Sandoz contains 228 mg lactose per tablet; the selected Zentiva product contains 240 mg lactose monohydrate and 1.35 mg sodium per tablet.
- Both are supplied in light-protective blister packaging and are essentially sodium-free by the usual labelling threshold.
ulipristal acetate preparations and strengths
Tablet
Route: Oral
Strengths: 5 mg, 30 mg
ulipristal acetate interactions
Check all prescribed, non-prescribed and herbal products before supply because some can reduce contraceptive effectiveness.
CYP3A4 enzyme inducers, including carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, rifampicin, rifabutin, griseofulvin, efavirenz, nevirapine and St John’s wort
These can substantially reduce ulipristal exposure and effectiveness; a non-hormonal emergency-contraception option should be considered.
Long-term ritonavir
Its enzyme-inducing effect may reduce ulipristal concentrations and effectiveness.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.