cautions/contraindications

Last edited 03/2021 and last reviewed 11/2022

Criteria for Exclusion:

• Informed consent not given
  
  
• Individuals under 16 years old and assessed as lacking capacity to consent using the Fraser Guidelines
  
  
• Individuals 16 years of age and over and assessed as lacking capacity to consent
  
  
• This episode of UPSI occurred more than 96 hours ago. N.B. A dose may be given if there have been previous untreated or treated episodes of UPSI within the current cycle if the most recent episode of UPSI is within 96 hours
  
  
• Known or suspected pregnancy (N.B. a previous episode of UPSI in this cycle is not an exclusion. Consider pregnancy test if more than three weeks after UPSI and no normal menstrual period since UPSI)
  
  
• Less than 21 days after childbirth
  
  
• Less than 5 days after miscarriage, abortion, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease (GTD)
  
  
• Known hypersensitivity to the active ingredient or to any component of the product - see Summary of Product Characteristics
  
  
• Use of ulipristal acetate emergency contraception in the previous 5 days
  
  
• Acute porphyria

Cautions:

• All individuals should be informed that insertion of a copper intrauterine device (Cu-IUD) within five days of UPSI or within five days from earliest estimated ovulation is the most effective method of emergency contraception. If a Cu-IUD is appropriate and acceptable supply oral EC and refer to the appropriate health service provider
  
  
• Ulipristal acetate can delay ovulation until closer to the time of ovulation than levonorgestrel.  Consider ulipristal if the individual presents in the five days leading up to estimated day of ovulation
  
  
• Levonorgestrel is ineffective if taken after ovulation
  
  
• If individual vomits within three hours from ingestion, a repeat dose may be given
  
  
• Individuals using enzyme-inducing drugs/herbal products or within 4 weeks of stopping them
  
  
• Body Mass Index (BMI) >26kg/m2 or weight >70kg - individuals should be advised that though oral EC methods may be safely used, a high BMI may reduce the effectiveness. A Cu-IUD should be recommended as the most effective method of EC. If levonorgestrel is to be given see dosage section
  
  
• Consideration should be given to the current disease status of those with severe malabsorption syndromes, such as acute/active inflammatory bowel disease or Crohn’s disease. Although the use of levonorgestrel is not contra-indicated it may be less effective and so these individuals should be advised that insertion of Cu-IUD would be the most effective emergency contraception for them and referred accordingly if agreed
  
  
• If the individual is less than 16 years of age an assessment based on Fraser guidelines must be made and documented
  
  
• If the individual is less than 13 years of age the healthcare professional should speak to local safeguarding lead and follow the local safeguarding policy
  
  
• If the individual has not yet reached menarche consider onward referral for further assessment or investigation

Reference:

1. BNF 7.3.1
2. Drug and Therapeutics Bulletin 2000; 38 (10): 75-77.
3. Patient Group Direction (PGD) (NHS Specialist Pharmacy Service). Supply and/or administration of levonorgestrel 1500micrograms tablet(s) for emergency contraception (Accessed 17th March 2021).