Emergency contraception (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

FSRH CEU Guidance: Drug Interactions with Hormonal Contraception (May 2022).
SPS article: Using contraception with enzyme-inducing medicines (June 2023).

Refer to Emergency Contraception algorithm. Further information is available at https://www.fsrh.org/standards-and-guidance/

Insertion of an intra-uterine device is more effective than hormonal methods of emergency contraception, preventing 99% of expected pregnancies:

  • a device such as the TT 380 SlimLine® or Nova-T® 380 can be inserted up to 120 hours (5 days) after unprotected sexual intercourse.
  • if intercourse has occurred more than 5 days previously, the device can still be inserted up to 5 days after the earliest likely calculated ovulation (ie within the minimum period before implantation).
  • Mirena® is unsuitable for emergency contraception. Hormonal emergency contraception may be used if the IUCD is unsuitable or an oral preparation is preferred (also refer to Emergency Contraception algorithm).
  •  trial data has shown that the pregnancy rate is significantly lower with ulipristal than with levonorgestrel.
  • for further information contact Highland Sexual Health, tel: 01463 704000 (for Argyll and Bute, contact Helensburgh SRH clinic tel: 01436 655000 or Dunoon SRH clinic tel: 01369 708359, or clinicians and patients can contact the Sandyford Initiative, tel: 0141 2118130).
  • for missed pill advice see Emergency Contraception algorithm.

INTRA-UTERINE CONTRACEPTIVE DEVICE (COPPER) - (First line)

Therapy notes

  • Fertility declines with age and therefore any copper IUCD fitted in a woman over 40 remains effective for contraception until 2 years after the menopause.

Formulation and dosage details

Formulation:

T-Safe 380A, TT 380® SlimLine and Copper T 380A

Dosage:

These are banded devices and are the preferred choice due to its 10 year use.

Formulation and dosage details

Formulation:

Nova-T® 380 (non banded) 

Dosage:

With its 5 year use is a suitable alternative.

ULIPRISTAL - (Second line)

Therapy notes


Hormonal emergency contraception may be used if the IUCD is unsuitable or an oral preparation is preferred (also refer to Emergency Contraception algorithm):

  • trial data has shown that the pregnancy rate is significantly lower with ulipristal than with levonorgestrel.
  • for missed pill advice see guidance.
  • if vomiting occurs within 3 hours of taking the ulipristal tablet, take another tablet.
  • do not use ulipristal more than once in a cycle or concomitantly with levonorgestrel.
  • women taking liver enzyme-inducing medicines should be advised not to use ulipristal during or within 28 days of stopping treatment.
  • advise women not to use ulipristal if they are currently taking drugs that increase gastric pH (eg antacids, histamine H2 receptor antagonists and proton pump inhibitors).
  • avoid breast-feeding for at least 1 week after taking ulipristal.
  • avoid hormonal contraception for 5 days after Ulipristal as studies have shown that this reduces the efficacy of Ulipristal – refer to https://www.fsrh.org/documents/ceustatementquickstartingafterupa/.

Formulation and dosage details

Formulation:

Tablets (EllaOne®) 30mg

Dosage:

30mg between 0 and 120 hours (5 days) after intercourse

Notes:

For further information contact Highland Sexual Health, tel: 01463 704000 (for Argyll and Bute, contact Helensburgh SRH clinic tel: 01436 655000 or Dunoon SRH clinic tel: 01369 708359, or clinicians and patients can contact the Sandyford Initiative, tel: 0141 2118130).

LEVONORGESTREL

Therapy notes

Formulation and dosage details

Formulation:

TabletsOTC 1·5mg

Dosage:

1·5mg as soon as possible after unprotected sexual intercourse, preferably within 12 hours but no later than after 72 hours (may also be used between 72 to 96 hours after coitus but efficacy decreases with time), alternatively 3mg for 1 dose, taken as soon as possible after intercourse, preferably within 12 hours and no later than after 72 hours (may also be used between 72 to 96 hours after coitus but efficacy decreases with time). Higher dose should be considered for patients with body-weight over 70kg or BMI over 26kg/m2.

  • repeat if patient vomits within 2 hours.
  • if on enzyme inducing drugs and certain antiretroviral drugs, take 2 tablets as a single dose if IUD is unacceptable. off-label.

Editorial Information

Document Id: F369