Learn about Ella drug interactions, including hormonal birth control, CYP3A4 inducers, and supplements. Know what to avoid and what to tell your doctor.
When you're taking Ella (Ulipristal Acetate) as emergency contraception, timing is critical — and so is knowing what other medications, supplements, or substances could interfere with how well it works.
Ella has a few important drug interactions that can either reduce its effectiveness or increase its levels in your body. This guide covers every interaction you should know about, in plain language.
A drug interaction happens when one substance affects how another medication works in your body. With Ella, interactions fall into two main categories:
Ella is processed in your liver by an enzyme called CYP3A4. Medications that speed up or slow down this enzyme can directly affect how much Ulipristal Acetate is active in your bloodstream.
These are the most important interactions to know about:
This is the interaction that catches most people off guard. Ella and hormonal birth control can reduce each other's effectiveness.
Here's why: both Ella and progestin-containing contraceptives act on the progesterone receptor. Ella blocks it; hormonal birth control activates it. When you take both, they essentially compete for the same receptor, and neither may work as well as it should.
This includes:
What to do: After taking Ella, do not restart hormonal contraception for at least 5 days. Use a barrier method (condoms, diaphragm) until your next menstrual period. Then resume your regular birth control.
These medications speed up the CYP3A4 enzyme, which breaks down Ella faster than normal. The result: lower blood levels of Ulipristal Acetate, which means Ella may not work as well.
Medications in this category include:
What to do: If you're taking any CYP3A4 inducer, tell your doctor before taking Ella. They may recommend a different form of emergency contraception, such as the Copper IUD (Paragard), which is not affected by these medications.
These medications slow down the CYP3A4 enzyme, which means Ella stays in your body longer and at higher concentrations. In clinical studies, the CYP3A4 inhibitor Ketoconazole increased Ulipristal Acetate levels by approximately 5.9-fold.
Medications in this category include:
What to do: While increased levels don't necessarily mean danger with a single-dose medication like Ella, you should still tell your doctor if you're taking any CYP3A4 inhibitor. They'll weigh the benefits and risks.
This herbal supplement, commonly taken for mild depression or anxiety, is a potent CYP3A4 inducer. St. John's Wort can significantly reduce Ella's effectiveness by speeding up how quickly your body breaks down Ulipristal Acetate.
If you're taking St. John's Wort, tell your healthcare provider before taking Ella. They may recommend the Copper IUD or a different emergency contraception approach.
While St. John's Wort is the most well-documented herbal interaction with Ella, be cautious with other supplements that may affect liver enzymes. Always mention any supplements you're taking when discussing emergency contraception with your provider.
Common OTC medications like Acetaminophen (Tylenol), Ibuprofen (Advil, Motrin), and Naproxen (Aleve) do not have known interactions with Ella. You can safely take these to manage common side effects like headache or cramping.
The good news: Ella has no significant food interactions. You can take it with or without food, at any time of day.
One minor note: grapefruit juice is a mild CYP3A4 inhibitor, which could theoretically increase Ulipristal Acetate levels. However, with a single-dose medication like Ella, this is unlikely to be clinically significant. There's no need to avoid grapefruit, but it's worth mentioning if your doctor asks about your diet.
Alcohol does not have a known interaction with Ella, but it can worsen side effects like nausea and dizziness.
When getting a prescription for Ella — whether in person or through telehealth — make sure to mention:
This information helps your provider determine whether Ella is the right choice or whether an alternative like the Copper IUD or a different emergency contraceptive would be more appropriate.
Ella has fewer drug interactions than many medications, but the ones it does have are important — especially the interaction with hormonal birth control. The key takeaway: tell your doctor about everything you're taking before using Ella, and use barrier contraception (not hormonal methods) for at least 5 days afterward.
For more about how Ella works in your body, read How Does Ella Work? Mechanism of Action Explained. And when you're ready to fill your prescription, use Medfinder to find a pharmacy with Ella in stock.
You focus on staying healthy. We'll handle the rest.
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