Introduction
Mifepristone and Misoprostol are two medicines commonly used in combination to terminate a pregnancy. Mifepristone is an anti-progestin, which blocks the action of progesterone and prevents the pregnancy from progressing. Misoprostol is a prostaglandin, which causes uterine contractions to expel the contents of the uterus.
Uses for
Mifepristone and Misoprostol can be used to terminate a pregnancy up to 10 weeks of gestational age. It is a safe and effective way for a woman to end a pregnancy in the privacy of her own home.
Mechanism of Action
Mifepristone is an anti-progesterone, which blocks the action of progesterone. Progesterone helps maintain the lining of the uterus, but when it is blocked, it can cause the uterus to shed its lining, which leads to the expulsion of the pregnancy. Misoprostol is a prostaglandin, which causes the uterus to contract and helps expel the pregnancy.
How Long Does It Take to Work?
Mifepristone and Misoprostol usually take about two to four hours to work. Most women will experience bleeding and cramping, which may last a few hours or up to a few days. In some cases, a second dose of Misoprostol may be necessary.
Absorption
Mifepristone and Misoprostol are both rapidly absorbed after oral administration. Mifepristone is rapidly metabolized to its active metabolites, which can be detected in the blood within 2-3 hours.
Route of Elimination
Mifepristone and Misoprostol are both primarily eliminated in the feces. The metabolites of mifepristone can also be found in the urine.
Dosage
This can only be prescribed by qualified medical professionals who are able to assess the gestational age of an embryo and to diagnose ectopic pregnancies. The qualified medical professionals must also be able to provide surgical Intervention/MVA (Manual Vaccum Aspiration) in cases of incomplete abortion or severe bleeding or have made plans to provide such care through others and be able to assure patient access to medical facilities equipped to provide blood transfusions and resuscitation, if necessary.Day 1 (First visit): Mifepristone administration: One tablet of Mifepristone (200 mg) is taken in a single oral dose under the supervision of a qualified medical professional in a clinic, medical office or hospital.
Day 2 (Second visit): Misoprostol administration: 24-48 hours after ingesting the Mifepristone tablet, the patient takes four 200 microgram tablets (800 micrograms) of Misoprostol buccally or sublingually. Misoprostol tablets can be administered by the patient herself (place two tablets on each side of cheeck & gum or under the tongue). She should wait for 30 minutes. During the period immediately following the administration of Misoprostol, the patient may need medication for cramps or gastrointestinal symptoms. The patient should be given instructions on what to do if significant discomfort, excessive bleeding or other adverse reactions occur and should be given a phone number to call if she has questions following the administration of Misoprostol.
Day 10 to 14 (Third visit): Post-treatment examination: Patients must return to the clinic, medical office or hospital within 10 to 14 days after the administration of mifepristone. This visit is very important to confirm by clinical examination or ultrasonographic scan that a complete termination of pregnancy has occurred.
Patients who have an ongoing pregnancy at this visit have a risk of fetal malformation resulting from the treatment. Surgical termination/MVA is recommended to manage Menstrual Regulation (MR)/termination of pregnancy failures.
The recommended dose of mifepristone and misoprostol to terminate a pregnancy up to 10 weeks of gestation is as follows:
- Mifepristone: 600 mg orally
- Misoprostol: 800 mcg orally
Administration
Mifepristone and Misoprostol should be taken orally with water or juice. The medicines can be taken together or separately, but it is preferred to take them together for the most effective results.
Side Effects
The most common side effects associated with mifepristone and misoprostol include nausea, vomiting, diarrhea, cramping, and vaginal bleeding. Other side effects may include headache, dizziness, and fatigue.
Toxicity
Mifepristone and misoprostol are generally well-tolerated, but an overdose can cause serious complications, including seizures, coma, and death. If an overdose is suspected, it is important to seek medical attention immediately.
Precaution
Mifepristone and misoprostol should not be used in women with an ectopic pregnancy or who have an allergy to mifepristone or misoprostol. It should also not be used in women who are taking other medications, including anticoagulants, corticosteroids, or nonsteroidal anti-inflammatory drugs.
Interaction
Mifepristone and misoprostol can interact with other medications. Before beginning any new medications, women should tell their healthcare provider if they are taking mifepristone or misoprostol.
Disease Interaction
Mifepristone and misoprostol should not be used in women with certain conditions, including heart disease, uncontrolled high blood pressure, anemia, or history of blood clots.
Drug Interaction
Mifepristone and misoprostol can interact with other medications, including anticoagulants, corticosteroids, and other nonsteroidal anti-inflammatories, and can cause serious side effects. Women should inform their healthcare provider if they are currently taking any medications before taking mifepristone or misoprostol.
Food Interactions
Mifepristone and misoprostol should be taken with food to reduce the risk of side effects. Women should not take mifepristone and misoprostol with grapefruit juice or other grapefruit containing products.
Pregnancy Use
Mifepristone and misoprostol should not be used in women who are pregnant. Women should not take this medication if they think they may be pregnant.
Lactation Use
Mifepristone and misoprostol should not be used in women who are breastfeeding. Women should not take this medication if they think they may be breastfeeding.
Acute Overdose
Overdose of mifepristone and misoprostol can be life-threatening and should be immediately treated by a medical professional. Symptoms of an overdose include seizures, pulmonary edema, coma, and death.
Contraindication
Mifepristone and misoprostol should not be used in women with certain medical conditions, including an ectopic pregnancy, allergy to mifepristone or misoprostol, history of blood clots, heart disease, uncontrolled high blood pressure, or anemia.
Use Direction
Mifepristone and misoprostol should be taken orally with food and water. The tablets should not be chewed or crushed before taking them. Women should take the medicines as soon as possible, following the instructions provided by their healthcare provider.
Storage Condition
Mifepristone and misoprostol should be stored in a cool, dry place away from light and moisture. The tablets should not be frozen, and should be kept out of the reach of children.
Volume of Distribution
Mifepristone and misoprostol are rapidly distributed throughout the body. Mifepristone is metabolized in the liver and its active metabolites are distributed to target tissues.
Half Life
The half-life of mifepristone is approximately two hours, and the half-life of misoprostol is approximately three hours.
Clearance
Mifepristone is metabolized in the liver and its active metabolites are rapidly cleared from the body. Misoprostol is rapidly eliminated in the feces.
