Pristil

Indications

• Emergency contraception (30 mg tablet): to lower the chance of pregnancy after unprotected sex or when a contraceptive method has failed, taken within 120 hours (5 days).
• Uterine fibroids (5 mg tablet): used by specialists for moderate to severe symptoms of fibroids in selected women. This use is now restricted because of rare but serious liver injury.

How It Works

Ulipristal acetate blocks the effect of the hormone progesterone. As an emergency contraceptive it delays or stops the release of an egg. In fibroids it reduces heavy bleeding and can shrink the fibroids.

Dosage and Administration

Emergency contraception: one 30 mg tablet by mouth as soon as possible, and no later than 120 hours after unprotected sex, with or without food. If you vomit within 3 hours, take another tablet. Fibroids: 5 mg tablets only as prescribed by a specialist, in limited treatment courses with liver blood tests.

Interactions

• Rifampicin, Carbamazepine, Phenytoin, Phenobarbital, Efavirenz and St John's wort can make it less effective, including if taken in the past 4 weeks. A copper IUD is the better emergency option for these women.
• Hormonal contraceptives (pills, patch, ring, injection, implant): they may reduce each other's effect. Wait 5 days after ulipristal before starting or restarting hormonal contraception, and use condoms until it is effective.
• Do not take the Levonorgestrel emergency pill within 5 days of ulipristal.
• Medicines that reduce stomach acid, such as Omeprazole, may lower its absorption.

Contraindications

Allergy to ulipristal, and a known pregnancy (it is not an abortion pill and will not end a pregnancy that has already started). For the 5 mg tablet also: liver disease, unexplained vaginal bleeding, and cancer of the womb, cervix, ovary or breast.

Side Effects

Headache, nausea, stomach pain, period coming earlier or later than usual, spotting, breast tenderness, dizziness and tiredness.

Get urgent medical help for severe pain low in the stomach (it can be a sign of pregnancy outside the womb), swelling of the face or difficulty breathing, or, with the 5 mg tablet, yellow skin or eyes, dark urine, severe tiredness or pain in the upper right stomach.

Pregnancy and Lactation

Not for use during pregnancy. If you become pregnant despite taking it, tell your doctor. After a dose, breastfeeding is not recommended for 1 week; express and throw away the milk during this time.

Precautions and Warnings

• It is not a regular method of contraception and does not protect against sexually transmitted infections.
• It may be less effective in women with a high body weight; a copper IUD can be discussed.
• Use condoms until your next period. Do a pregnancy test if your period is more than 7 days late or unusual.
• Not recommended in severe asthma treated with steroid tablets.

Overdose

Serious effects are not expected. Seek medical advice if you have taken more than prescribed.

Therapeutic Class

Selective progesterone receptor modulator (emergency contraceptive).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.