EHC

• Ulipristal Acetate (ELLAONE)


  Emergency hormonal contraception (EHC) to be taken within 120 hours (5 days) of unprotected sexual intercourse (UPSI)
• Indications for Ulipristal Acetate


  • EHC within 120 hours (5 days) of UPSI
• Dose of Ulipristal Acetate


  One (30mg) tablet (including in patients >70kg or BMI >26)
• Administration of Ulipristal Acetate


  • With/without food
  • Any point in cycle
  • Vomiting within 3 hours, repeat dose
• Clinical conditions NOT recommended for use of Ulipristal Acetate


  • Severe liver impairment
  • Severe asthma (taking oral glucocorticoid)
• Interactions with Ulipristal Acetate

  • CYP3A4 enzyme inducers/herbal products <4 weeks
  • Carbamazepine
  • Fosphenytoine
  • Griseofulvin
  • Nevirapine
  • Oxycarbazepine
  • Phenobarbital
  • Phenytoin
  • Primidone
  • Rifabutin
  • Rifampicin
  • St John's Wort/Hypericum perforatum
  • Long term ritonavir use
• Breastfeeding advice for Ulipristal Acetate

  • Discontinue for 1 week
  • Express and discard to maintain lactation
• Contraceptive advice for Ulipristal Acetate

  • Reduced efficacy of COC and POP
  • Progestogen-containing drugs NOT to restart for 5 days
  • Reduce efficacy of EHC
  • Reliable barrier method until next period
• Levonorgestrel (LEVONELLE)


  Emergency hormonal contraception (EHC) to be taken within 72 hours (3 days) of unprotected sexual intercourse (UPSI)
• Indications for Levonorgestrel


  • >16 years
  • Within 72 hours (3 days) of UPSI
• Dose of Levonorgestrel


  • One (1500 mcg) tablet
  • Two (3000 mcg) tablet
• Administration of Levonorgestrel


  • Any point of cycle
  • Can take more than 1 dose per cycle (cycle disruption)
  • Vomiting within 3 hours, repeat dose
• Clinical conditions NOT recommended for use of Levonorgestrel


  • Severe liver dysfunction
  • Risk of ectopic pregnancy
  • Inflammation of fallopian tubes
  • Severe malabsorption syndrome (reduced efficacy)
• Interactions with Levonorgestrel


  • CYP3A4 enzyme inducers
  • Carbamazepine
  • Griseofulvin
  • Phenytoin
  • Primidone
  • Rifabutin
  • Rifampicin
  • Ritonavir
  • Efavirenz
  • Herbal medicines such as St John's Wort
• Breastfeeding advice for Levonorgestrel

  • Take EHC immediately after a feed (reduces amount potentially ingested in next feed)
  • Small amount in breast milk
• Contraceptive advice for Levonorgestrel


  • Continue regular contraceptives as normal
• Referral advice for Levonorgestrel

  • Eligible for copper IUD and patient choice
  • CYP3A4 enzyme inducers/herbal products <4 weeks and willing to have copper IUD
  • Clinical condition where not recommended
  • EHC reduced efficacy
  • Pregnancy/suspected
  • Period changes (late, lighter or heavier)
  • Allergies
  • UPSI or contraceptive failure over time limit
  • Severe lower abdominal pain post EHC (ectopic pregnancy risk)