Adult: 30 mg taken as soon as possible within 120 hours (5 days) after unprotected intercourse or contraceptive failure. An additional dose should be taken if vomiting occurs within 3 hours. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Oral Uterine fibroids
Adult: For moderate to severe symptoms in patients who have not reached menopause when uterine fibroid embolisation and/or surgical treatment options are not suitable or have failed: 5 mg once daily for up to 3 months; initiate treatment during the 1st week of a menstrual cycle. Retreatment courses must start at the earliest during the 1st week of the 2nd menstruation after the previous treatment course completion. If a dose is missed by >12 hours, skip the dose and resume to usual dosing schedule. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
What are the brands available for Ulipristal in Singapore?
Pregnancy and lactation. When used for uterine fibroids: Genital bleeding of unknown cause or for reasons other than uterine fibroids; uterine, cervical, ovarian or breast cancer.
Special Precautions
Severe renal and hepatic impairment. Not intended for routine use as a contraceptive or for termination of existing pregnancy.
Adverse Reactions
Significant: Ectopic pregnancy; altered menstrual bleeding patterns; progesterone receptor modulator associated endometrial changes (PAEC), increase of endometrium thickness; liver injury, hepatic failure, some requiring liver transplantation (when used for uterine fibroids). Eye disorders: Visual disturbances. Gastrointestinal disorders: Nausea, vomiting, abdominal pain or discomfort, dyspepsia, flatulence, dry mouth, diarrhoea. General disorders and administration site conditions: Fatigue, pyrexia, malaise, chills. Infections and infestations: Influenza. Metabolism and nutrition disorders: Appetite disorders. Musculoskeletal and connective tissue disorders: Myalgia, back pain. Nervous system disorders: Headache, dizziness, migraine, somnolence. Psychiatric disorders: Mood disorders, emotional disorders, anxiety, insomnia, hyperactivity disorder, changes in libido. Reproductive system and breast disorders: Breast tenderness, dysmenorrhoea, pelvic pain, menorrhagia, vaginal discharge, metorrhagia, menstrual disorder, premenstrual syndrome, vaginitis. Skin and subcutaneous tissue disorders: Skin lesions, pruritus, acne, hot flush.
This drug may cause dizziness, somnolence or blurred vision, if affected, do not drive or operate machinery. Women of childbearing potential must use a reliable contraceptive method for subsequent acts of intercourse until the next menstrual period after using emergency contraception.
Monitoring Parameters
Evaluate pregnancy status before treatment. Monitor endometrium periodically, including annual ultrasound (in case of repeated intermittent treatment). When used for uterine fibroids: Obtain LFTs before and during treatment. When used for emergency contraception: Evaluate pregnancy status if menstruation is delayed for >7 days of the expected menstrual period following treatment.
Overdosage
Symptoms: Shortened menstrual cycle or prolonged duration of bleeding.
Management: Symptomatic treatment.
Drug Interactions
Decreased efficacy with CYP3A4 inducers (e.g. barbiturates, phenytoin, carbamazepine, rifampicin, rifabutin, griseofulvin, efavirenz, nevirapine, bosentan, felbamate, topiramate), combined hormonal contraceptives, progestogen-only contraception, levonorgestrel, drugs that increase gastric pH (e.g. antacids, H2-receptor antagonists, PPIs). May decrease the efficacy of oral glucocorticoid. Increased plasma concentration with moderate CYP3A4 inhibitors (e.g. erythromycin, verapamil) and potent CYP3A4 inhibitors (e.g. ketoconazole, itraconazole, ritonavir, telithromycin, clarithromycin).
Food Interaction
Decreased plasma concentration with St. John's wort. Increased plasma concentration with grapefruit juice.
Action
Description: Overview: Ulipristal is a synthetic selective progesterone receptor modulator with high affinity to human progesterone. Mechanism of Action: Ulipristal inhibits progestin from binding to the progesterone receptor. Its exact mechanism of action is unknown, but may involve prevention of cell proliferation and induction of apoptosis resulting in the reduction of fibroids size. Additionally, it also supresses the luteinising hormone surge thereby inhibiting or delaying ovulation and alterations to the endometrium that may affect implantation. Pharmacodynamics: In emergency contraception, administration of ulipristal in the mid-follicular phase results in inhibition of folliculogenesis and a decrease of estradiol concentration.
In uterine fibroids, ulipristal's direct action on endometrium results in the changes in histology of the endometrium called progesterone receptor modulator associated endometrial changes (PAEC). The histological appearance is an inactive and weakly proliferating epithelium associated with asymmetry of stromal and epithelial growth, leading to prominent cystically dilated glands with admixed estrogen (mitotic) and progestin (secretory) epithelial effects. These changes are reversible upon treatment cessation. Pharmacokinetics: Absorption: Rapidly absorbed from the gastrointestinal tract. Time to peak plasma concentration: 1 hour. Distribution: Enters breast milk (small amount). Plasma protein binding: >94% to albumin, α1-acid glycoprotein and high-density lipoprotein. Metabolism: Extensively metabolised in the liver by CYP3A4 and to a lesser extent by CYP1A2 and CYP2D6 enzymes into monodemethylated (active metabolite) and inactive metabolites. Excretion: Elimination half-life: Approx 32-38 hours.
Chemical Structure
Ulipristal Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 13559281, Ulipristal. https://pubchem.ncbi.nlm.nih.gov/compound/Ulipristal. Accessed Nov. 26, 2025.
G03AD02 - ulipristal ; Belongs to the class of emergency contraceptives. Used as systemic contraceptives. G03XB02 - ulipristal ; Belongs to the class of antiprogestogens.
References
Brayfield A, Cadart C (eds). Ulipristal Acetate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/11/2025.Ella 30 mg Tablet (Hyphens Pharma Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 03/11/2025.Ella Tablet (HRA Pharma America, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 03/11/2025.Joint Formulary Committee. Ulipristal Acetate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/11/2025.Ulipristal Acetate 30 mg Tablet (Laboratoire HRA Pharma). MHRA. https://products.mhra.gov.uk. Accessed 03/11/2025.Ulipristal Acetate 5 mg Tablets (Mercury Pharmaceuticals Limited). MHRA. https://products.mhra.gov.uk. Accessed 03/11/2025.Ulipristal Acetate. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 03/11/2025.Ulipristal. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 03/11/2025.
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