Mifepristone (Mifeprex, Mifegyne)

Dose:

• Day One: 200 mg mifepristone orally as a single dose.
• Day Two or Three: 800 mcg misoprostol buccally 24 to 48 hours after the first dose of mifepristone (Two 200 mcg misoprostol tablets should be placed in each cheek pouch [the area between the cheek and gums] for 30 minutes and then swallow any remnants with water or another liquid).
• Post-treatment Assessment Day 7 to 14:A follow-up visit approximately 7 to 14 days after the administration of mifepristone is necessary to confirm complete termination of pregnancy and to evaluate the degree of bleeding.
• Termination of pregnancy can be confirmed by medical history, clinical examination, human Chorionic Gonadotropin (HCG) testing, or ultra-sonographic scan. Lack of bleeding following treatment usually indicates failure; however, prolonged or heavy bleeding is not proof of a complete abortion.
• The existence of debris in the uterus (e.g., if seen on ultrasonography) following the treatment procedure will not necessarily require surgery for its removal.Patients should expect to experience vaginal bleeding or spotting for an average of 9 to 16 days. Heavy bleeding for a median duration of 2 days has been reported. Some women may experience some type of bleeding for more than 30 days. Persistence of heavy or moderate vaginal bleeding at the time of follow-up, however, could indicate an incomplete abortion.
• If complete expulsion has not occurred, but the pregnancy is not ongoing, another dose of misoprostol 800 mcg buccally may be administered. A follow-up visit in approximately 7 days to assess for complete termination is recommended.Surgical evacuation is recommended to manage ongoing pregnancies after medical abortion. 

  Comments

• Medication for cramps or gastrointestinal symptoms may be needed during the period immediately following the administration of misoprostol.
• The effectiveness of the regimen may be lower if misoprostol is administered less than 24 hours or more than 48 hours after mifepristone administration.
• Most women will expel the pregnancy within 2 to 24 hours of taking misoprostol; select appropriate location for the patient to be when misoprostol is administered, taking into account that expulsion could begin within 2 hours of administration.
• For purposes of this treatment (pregnancy termination), pregnancy is dated from the first day of the last menstrual period.
• The duration of pregnancy may be determined from menstrual history and clinical examination.
• Assess the pregnancy by ultra-sonographic scan if the duration of pregnancy is uncertain or if ectopic pregnancy is suspected.
• Remove any intrauterine device (IUD) before beginning treatment with this drug.Use: Medical termination of intrauterine pregnancy through 70 days gestation

Effects:

Applies to Misoprostol: oral tablet.

• Misoprostol administration to women who are pregnant can cause birth defects, abortion, premature birth, or uterine rupture. Uterine rupture has been reported when misoprostol was administered in pregnant women to induce labor or to induce abortion.
• The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery.
• Misoprostol should not be taken by pregnant women to reduce the risk of ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs).
• Patients must be advised of the abortifacient property and warned not to give the drug to others.
• Misoprostol should not be used for reducing the risk of NSAID-induced ulcers in women of childbearing potential unless the patient is at high risk of complications from gastric ulcers associated with use of the NSAID, or is at high risk of developing gastric ulceration.
• In such patients, misoprostol may be prescribed if the patient: has had a negative serum pregnancy test within 2 weeks prior to beginning therapy; is capable of complying with effective contraceptive measures; has received both oral and written warnings of the hazards of misoprostol, the risk of possible contraception failure, and the danger to other women of childbearing potential should the drug be taken by mistake; will begin misoprostol only on the second or third day of the next normal menstrual period.