Morning-After Pill for Contraception

Products

The so-called “morning-after pill” is commercially available in many countries in the form of tablets and film-coated tablets. It is also available in pharmacies under medical treatment or after a structured consultation with dispensing documentation. An alternative is the copper IUD (“morning-after coil”). The name “pill” is not correct from a pharmaceutical point of view, as pills are no longer manufactured today – what is meant are tablets.

Structure and properties

Currently, two different active ingredients are on the market, which are contained in the drugs individually. One is the progestogen levonorgestrel (1.5 mg) and the other is the progesterone receptor modulator ulipristal acetate (30 mg). Both are structurally related to progesterone.

Effects

The morning-after pill (ATC G03AD) primarily inhibits or delays ovulation, making fertilization impossible. This prevents an unintended pregnancy. The active ingredients have no effect on an already existing pregnancy. If it is unclear whether a pregnancy exists, an appropriate test should be carried out before taking the medication. This method is not an abortion. Unlike levonorgestrel, ulipristal acetate is effective even immediately before ovulation, when the LH surge has already occurred. However, it can no longer exert its effect after the onset. Ulipristal acetate is more effective than levonorgestrel in a direct comparison, meaning that its use results in fewer unwanted pregnancies. Ulipristal acetate also has a longer duration of action (see below).

Indications

For emergency contraception after unprotected intercourse or contraceptive failure.

Dosage

According to the SmPC. The morning-after pill is taken as a single dose as soon as possible after unprotected intercourse. Levonorgestrel can be used up to 72 hours (3 days) and ulipristal acetate up to 120 hours (5 days) after intercourse. The sooner the medication is taken, the more effective it is. If vomiting occurs within 3 hours after taking the pill, another tablet should be given. The morning-after pill is intended for emergency use only and not as a regular method like hormonal contraceptives. Until the next menstrual period, a local and safe contraceptive should be used (e.g. condom). It should be noted that the method is not successful in every case. If the next menstrual period does not occur, a medical checkup or a pregnancy test is required.

Active substances

Medicinal products with marketing authorization:

  • Levonorgestrel (NorLevo, generic).
  • Ulipristal acetate (ellaOne).

Not approved in many countries:

  • Mifepristone is not approved as a morning after pill in many countries. This also applies to the Yuzpe method.

Contraindications

  • Hypersensitivity
  • Severe liver dysfunction
  • Pregnancy

Full precautions can be found in the drug label.

Interactions

CYP450 isozymes are involved in the metabolism of the active substances (especially CYP3A4) and corresponding interactions are possible. If interactions occur, copper IUDs offer an alternative.

Adverse effects

The most common potential adverse effects include: