Ella (Ulipristal Acetate)

[SFLactation]

Our institution wants to start using Ella as emergency contraception since Plan B has such a high failure rate among women with a higher BMI. The plans are to give Ella to women who have a BMI greater than 25. The Infant Risk Center has minimal information on this drug, but states that "since it is a steroid, it is unlikely to enter milk readily." However, according to the NIH LactMed "European authorities recommend withholding breastfeeding for at least 36 hours after a dose of ulipristal acetate."

Is there any other evidence out there regarding Ella and its compatibility with breastfeeding? How should we advise our breastfeeding mothers with higher BMIs who need emergency contraception?

[admin]

SFLactation:

Ulipristal is an interesting product. It is a progesterone receptor blocker, with few other side effects. I actually think it could "increase" milk production in some women, but I haven't done this study yet.

Its levels over this period of time (single dose) would be minuscule and I don't think it would have any effect on a breastfeeding infant. It is a 'steroid' structure, and therefore would be largely prohibited from entry into human milk, just like most of the other steroids.

As to why they would recommend withholding breastfeeding for 36 hours is probably just a knee jerk response and is not really justified. I'll check some more and see if there is any justification for such a recommendation.


Tom

[smartinelli]

Any new information about using Ella when breastfeeding? Some sources are still recommending waiting to breastfeed after taking Ella.

[Nathalie Gagnon]

Hi, really interested for an update on this subject, since elactancia and CRAT are not in favor on withholding breastfeeding... Do you have something to add or something new on this topic Dr Hale? Thank you.
Nathalie Gagnon, hospital pharmacist

[kaytlin]

Nathalie,
Dr. Hale and I will discuss and get back to you. From a literature review, not much has changed. The CDC still recommends waiting 24 hours, but as was mentioned above isn't well justified.
What I can report it that the RID has been calculated at 0.8% in the first 24 hours--well below our conventional cutpoint of 10%.
Kaytlin