What is the recommended dosage and usage of ulipristal (generic name) for emergency contraception in a female patient of reproductive age?

Ulipristal Acetate for Emergency Contraception

Administer ulipristal acetate as a single 30 mg oral dose as soon as possible within 120 hours (5 days) of unprotected sexual intercourse. 1

Dosing and Administration

• The recommended dose is 30 mg taken as a single oral tablet 1
• Take as soon as possible within 5 days (120 hours) of unprotected intercourse 1, 2
• Earlier administration is preferable, though efficacy remains consistent throughout the entire 120-hour window 2, 3

Why Ulipristal Acetate is Preferred

Ulipristal acetate maintains superior effectiveness compared to levonorgestrel, particularly when taken 3-5 days after unprotected intercourse. 1, 2

Comparative Effectiveness:

• Within 72 hours: Ulipristal acetate is at least as effective as levonorgestrel, with some evidence suggesting greater efficacy even in this early window (0.9% vs 2.5% pregnancy rate at <24 hours) 4, 3
• Between 72-120 hours: Ulipristal acetate is significantly more effective than levonorgestrel, which shows markedly decreased efficacy after 72 hours 1, 2
• Observed pregnancy rate: 1.3% when taken between 96-120 hours after intercourse 5, 3

Special Populations:

• Ulipristal acetate may be more effective than levonorgestrel in women who are overweight or obese (BMI >25 kg/m² or weight >75 kg), as levonorgestrel shows reduced effectiveness in this population 2, 5, 6, 7

Mechanism of Action

• Ulipristal acetate works by inhibiting or delaying ovulation 2, 8
• It delays the luteinizing hormone (LH) surge or postpones LH peak if surge has already started 8
• May directly inhibit follicular rupture when administered just before ovulation 8
• Does not cause abortion or harm an established pregnancy 6

Critical Post-Administration Instructions

After taking ulipristal acetate, any regular contraceptive method can be started immediately, but barrier contraception or abstinence is required for 14 consecutive days or until the next menstrual period, whichever comes first. 2, 5

Contraceptive Restart Protocol:

• Start or resume hormonal contraception immediately after ulipristal acetate use 2, 5
• Use barrier method (condoms) or abstain from intercourse for 14 days after ulipristal acetate 2, 5
• This 14-day backup period is longer than the 7-day period required after levonorgestrel 5

Common Pitfall to Avoid:

The extended 14-day backup contraception requirement after ulipristal acetate is frequently overlooked. This is critical because ulipristal acetate's progesterone receptor modulator activity may theoretically reduce the effectiveness of progestin-containing contraceptives if started immediately without backup 2, 5.

Follow-Up Recommendations

• Perform a pregnancy test if withdrawal bleeding does not occur within 3 weeks after taking ulipristal acetate 2
• Menstrual onset is typically delayed by 2-3 days following treatment 8, 3

Tolerability Profile

• Generally well tolerated with a similar safety profile to levonorgestrel 8, 3
• Most common adverse effects (>10%): headache, nausea, and abdominal pain 3
• Side effects are mild and self-limiting 4

Advance Provision

• An advance supply of ulipristal acetate may be provided to ensure availability and enable prompt use when needed 1, 5
• Advance provision increases likelihood of timely use after unprotected intercourse 5

Prescription Status

• Ulipristal acetate requires a prescription in the United States, unlike levonorgestrel which is available over-the-counter 6, 7
• This prescription requirement may delay access, making advance provision particularly valuable 6