Precautions and warnings

Mifepristone should not be given if you are unsure about whether a woman is pregnant, how far along the pregnancy is, or if there is a chance of an ectopic (outside the uterus) pregnancy. Before giving Mifepristone, a doctor must do an ultrasound or check Beta-hCG levels. For abortions in the first trimester, Mifepristone should not be used with Misoprostol if the pregnancy is more than 49 days since the last period.

Mifepristone must not be given to people with chronic adrenal failure, those allergic to Mifepristone or any of its ingredients, anyone with severe asthma not controlled by steroids, people with porphyria, kidney or liver failure, malnutrition, or women who are breastfeeding.

Mifepristone is a fatty (lipophilic) drug, so it might pass into breast milk, but there is no solid data on this.

Drug Interactions

Aspirin and NSAIDs may make this medication less effective. Corticosteroids (even inhaled ones) may also work less well when taken together, so patients should be watched closely during and for a few days after using them both. This drug may increase the effects of oxytocin. The risk of diarrhoea from misoprostol is higher if it is taken with antacids that contain magnesium.

Contraindications

Do not use if you have or may have an ectopic pregnancy, chronic adrenal gland problems, are taking long-term corticosteroids, or are allergic to mifepristone, misoprostol, or other prostaglandins. Avoid if you have bleeding disorders, are taking blood thinners, have porphyria, liver or kidney problems, are pregnant or breastfeeding, have an IUD in place, or have an unexplained mass near the ovaries.

Mode of actions

Mifepristone works by blocking the effects of progesterone, a hormone needed for pregnancy. It attaches to progesterone receptors in the body and prevents progesterone from working. It can also partially mimic the effects of progesterone.

Misoprostol is a man-made version of prostaglandin E1. It helps protect the stomach lining by acting on certain receptors in the stomach lining cells. Misoprostol replaces natural prostaglandins that are reduced when someone takes medications like NSAIDs, helping to prevent stomach damage.

Dosage & Administration

Day 1: 1 tablet of mifepristone (200mg) is taken in a single oral dose.

Day 2: 24-48 hours after ingesting the mifepristone tablet, patient takes 4, 200 mcg (800 mcg) tablets of misoprostol buccally or sublingually. Place 2 tablets on each side of cheeck & gum or under the tongue.

Day 10-14: Patient must return to the doctor office or hospital within 10-14 days after the administration of mifepristone.

The visit is important to confirm by clinical examination or usg that a complete termination of pregnancy has occured.

Pregnancy & Lactation

This medicine must not be used during pregnancy. It can be absorbed through the skin and lungs caused can damage your unborn child’s organs and cause congenital disabilities. Strict two effective types of birth control starting one month before and during treatment and for three years after stopping this medicine. Discuss with your doctors if you are not sure which types of birth control are effective for you. You must need to take pregnancy tests regularly during your treatment with this medicine and for at least three years after taking this medicine. If it seems that you do become pregnant stop taking this medicine and call your doctor immediately. If you really become pregnant, miss a menstrual period, or have sex without using two forms of birth control. In some cases, your doctor can prescribe emergency contraception to prevent pregnancy. People on this medicine should not donate blood during the treatment and for three years afterward.

This medicine is also contraindicated breast milk. Breastfeeding is not recommended while using this medication and for three years afterward.

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