Ulipristal (u-li-pris′tal)
Ella
Classification: PROGESTERONE AGONIST/ANTAGONIST; POSTCOITAL CONTRACEPTIVE
Therapeutic: POSTCOITAL CONTRACEPTIVE
Pregnancy Category: X
AVAILABILITY
Tablet
ACTION & THERAPEUTIC EFFECT
A selective progesterone receptor modulator with
antagonistic and partial agonistic effects. It binds to the progesterone
receptor preventing the binding of progesterone. If taken
immediately before ovulation, it
delays follicular rupture and inhibits
ovulation. It may also alter the
endometrium and interfere with implantation
of a fertilized ovum.
USES
Postcoital contraception after unprotected
intercourse or a known or suspected contraceptive failure.
CONTRAINDICATIONS
Known or suspected pregnancy (category X); lactation.
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| Nursing Implications for Ulipristal Ella |
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ROUTE & DOSAGE
Postcoital Contraception
Adult: PO 30 mg within 120 h of unprotected intercourse or known or
suspected contraceptive failure; may repeat within 3 h if patient vomits
initial dose
ADMINISTRATION
Oral
- Give within 120 h of unprotected intercourse.
- Store at controlled room temperature 20°–25° C
(68°–77° F).
ADVERSE
EFFECTS (≥5%)
Body as a
Whole: Abdominal and upper abdominal
pain. CNS: Fatigue, dizziness, headache. GI: Nausea. Urogenital: Dysmenorrhea.
INTERACTIONS
Drug: Coadministration
of CYP3A4 inducers (e.g., carbamazepine,
phenobarbital, phenytoin, rifampin,
topiramate) can decrease the levels of ulipristal. Coadministration of
strong CYP3A INHIBITORS (e.g., itraconazole, ketoconazole) can
increase the levels of ulipristal. Food: Grapefruit juice can
increase the levels of ulipristal. Herbal: St. John’s
wort can decrease the levels of ulipristal.
PHARMACOKINETICS
Peak: 1 h. Distribution:
94% plasma protein bound. Metabolism: Hepatic
oxidation by CYP3A4
to active metabolite. Half-Life: 32.4 h.
NURSING
IMPLICATIONS
Assessment
& Drug Effects
- Monitor for vomiting. Drug may be re-administered
if patient vomits within 3 h of initial dose.
Patient
& Family Education
- Ulipristal is not intended for repeated use. It
should not replace conventional means of contraception.
- Certain concurrently taken drugs may interfere
with the contraceptive effects of ulipristal. Consult prescriber.
- Ulipristal may interfere with the length of the
next menstrual cycle (i.e., cycle may occur sooner or later than expected).
- Ulipristal does not protect against sexually
transmitted diseases.
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