Ulipristal acetate in emergency contraception: mechanism of action

2013 ◽  
Vol 34 (4) ◽  
pp. 195-196 ◽  
Author(s):  
Bruno Mozzanega ◽  
Erich Cosmi ◽  
Giovanni Battista Nardelli
Keyword(s):  
Mechanism Of Action ◽  
Emergency Contraception ◽  
Ulipristal Acetate

scholarly journals Mechanism of Action, Efficacy and Safety of Emergency Hormonal Contraception (levonorgestrel and ulipristal acetate) and Attitudes of Pharmacists

2014 ◽  
Vol 31 (3) ◽  
pp. 155-161 ◽  
Author(s):  
Jelena Milosavljević ◽  
Katarina Ilić ◽  
Dušanka Krajnović
Keyword(s):  
Clinical Trials ◽  
Mechanism Of Action ◽  
Emergency Contraception ◽  
Hormonal Contraception ◽  
Published Data ◽  
Ulipristal Acetate ◽  
Attitudes And Practices ◽  
History Of ◽  
Emergency Contraceptive ◽  
History Of Use

Summary Emergency hormonal contraception is used to prevent unintended pregnancy postcoitally. The mechanism of action of the most frequently used hormonal preparations for emergency contraception, levonorgestrel (LNG) and ulipristal acetate (UPA), is still not fully known, but clinical trials indicate that they act by inhibiting or delaying ovulation. LNG has a long history of use for emergency contraception, proven safety and high efficacy if administered in the preovulation period. The newest emergency contraceptive, UPA, available only with a prescription, is indicated within this period of 120 hours after sexual intercourse and the data indicate that UPA does not lose efficacy within this period. Clinical trials showed its noninferiority versus LNG and its effect on the potentially occurring pregnancy is being additionally monitored. However, many misconceptions and controversial opinions about emergency contraception are still present, even among pharmacists. A search of Medline database identified 20 papers published from January 1993 to December 2012, on pharmacists’ knowledge, attitudes and practices related to emergency contraception. In these papers, the attitudes of pharmacists pertaining to the dispensing regime of emergency contraception were different. Research in Australia has shown that personal attitudes and religious convictions influence the practice of dispensing emergency contraception. In the research conducted in New Mexico, 30% of pharmacists were against prescribing emergency contraception for religious or moral reasons. There were no published data in regards to pharmacists’ knowledge, attitudes and dispensing practice in Serbia and such research is highly recommended.

scholarly journals Ulipristal acetate. A new emergency contraceptive. Ethical aspects of its use

2010 ◽  
Vol 59 (1) ◽  
Author(s):  
Justo Aznar
Keyword(s):  
Sexual Intercourse ◽  
Mechanism Of Action ◽  
Emergency Contraception ◽  
Ethical Aspects ◽  
Unprotected Sexual Intercourse ◽  
Ethical Assessment ◽  
Ulipristal Acetate ◽  
Unwanted Pregnancies ◽  
Emergency Contraceptive ◽  
First Time

Così come si presenta la pillola del giorno dopo può essere utilizzata in modo efficace fino a 72 ore dopo il rapporto sessuale non protetto. Tuttavia, in alcuni casi, questo periodo può essere troppo breve. Per tale motivo, è stata commercializzata per la prima volta una pillola, l’acetato ulipristal (Ellaone), per la contraccezione d’emergenza post-coitale fino a 120 ore (5 giorni) dopo i rapporti sessuali non protetti o nel caso di insuccesso del contraccettivo. Un aspetto importante da considerare nella valutazione etica di un farmaco usato per la contraccezione d’emergenza è il suo meccanismo d’azione, in quanto tale valutazione sarà molto diversa se il farmaco agisce inibendo o ritardando l’ovulazione o impedendo l’impianto della blastocisti nell’utero materno, dal momento che in quest’ultimo caso eserciterebbe la sua azione portando a termine la vita di un embrione in vita, secondo dunque un meccanismo abortivo. In relazione al meccanismo d’azione dell’Ellaone, quando la pillola è assunta cinque giorni prima dell’ovulazione la sua azione sarà fondamentalmente anticoncezionale, e lo stesso se è assunta quattro giorni prima. Se assunta tre giorni prima dell’ovulazione, può essere anticoncezionale o anti-impiantatorio, ma da allora in poi, il meccanismo attraverso cui l’Ellaone è in grado di prevenire le gravidanze indesiderate sarà anti-impiantatorio o, in altre parole, abortivo. In sintesi, tra il 50% e il 70% del tempo, Ellaone agirà secondo un meccanismo abortivo. Ci sembra che questa sia la realtà oggettiva circa il meccanismo d’azione dell’acetato ulipristal (Ellaone), e quindi il suo effetto anti-impiantatorio dovrà essere preso in considerazione per l’elaborazione di un giudizio etico sul suo uso. ---------- Current presentations of the morning-after pill can be used effectively for up to 72 hours after unprotected sexual intercourse. However in some cases, this period can be short. For that reason, a pill, ulipristal acetate (Ellaone), which is licensed for post-coital emergency contraception up to 120 hours (5 days) following unprotected sexual intercourse or contraceptive failure, has now been marketed for the first time. An important aspect to consider in the ethical assessment of any drug used in emergency contraception is its mechanism of action, as this assessment will be very different if the drug acts by inhibition or delaying the ovulation or by preventing the implantation of the blastocyst in the maternal uterus, since in the latter case it would exert its action by terminating the life of an already living embryo, i.e. by an abortive mechanism. In relation to the Ellaone’s mechanism of action, when the pill is taken five days before ovulation its action will be basically anticonceptive, and the same if it is taken four days beforehand. When it is taken three days before ovulation, it may be anticonceptive or by prenventing implantation, but from then on, the mechanism by which Ellaone may prevent unwanted pregnancies will be by an anti-implantation mechanism, in other words, abortive. In summary, between 50% and 70% of the time, Ellaone will act by an abortive mechanism. It seems to us that this is the objective reality about the mechanism of action of ulipristal acetate (Ellaone), and therefore its anti-implantation effect will have to be taken into consideration when issuing an ethical judgement on its use.

Current dispensing and practice use patterns of ulipristal acetate 30mg (Ella®), as emergency contraception in British Columbia, Canada

2020 ◽  
Vol 42 (5) ◽  
pp. 671
Author(s):  
Michelle Chan ◽  
Judith Soon ◽  
Laura Schummers ◽  
Sarah Munro ◽  
Parkash Ragsdale ◽  
...  
Keyword(s):  
British Columbia ◽  
Emergency Contraception ◽  
Ulipristal Acetate ◽  
Use Patterns

Can We Identify Women at Risk of Pregnancy Despite Using Emergency Contraception? Data From Randomized Trials of Ulipristal Acetate and Levonorgestrel

2013 ◽  
Vol 68 (3) ◽  
pp. 208-210 ◽  
Author(s):  
Anna Glasier ◽  
Sharon T. Cameron ◽  
Diana Blithe ◽  
Bruno Scherrer ◽  
Henri Mathe ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Contraception ◽  
Randomized Trials ◽  
Ulipristal Acetate
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