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Indications

Mifepristone is used, together with Misoprostol, for medical termination of early pregnancy and for menstrual regulation, within the country's legal limits and only under the care of a qualified doctor or trained health provider. It is also used by doctors to soften and open the neck of the womb before some procedures, and to help labour start after the death of a baby in the womb.

How It Works

It blocks progesterone, the hormone needed to keep a pregnancy going. This loosens the lining of the womb and softens its neck, and makes the womb more responsive to Misoprostol, which then causes contractions.

Dosage and Administration

As prescribed, and only after a health provider has confirmed how far along the pregnancy is and that it is inside the womb. A common regimen is a single 200 mg tablet by mouth, followed 24 to 48 hours later by Misoprostol as directed by the provider. Do not take it on your own without medical supervision. A follow-up visit is needed to make sure the process is complete.

Interactions

• Rifampicin, Carbamazepine, Phenytoin, Phenobarbital and St John's wort can make it less effective.
• Ketoconazole, Itraconazole, Erythromycin and grapefruit juice can raise its levels.
• It blocks the effect of Corticosteroids (such as Prednisolone); people on long-term steroids should not use it.
• Blood thinners such as Warfarin increase the risk of heavy bleeding.

Contraindications

• Suspected or confirmed pregnancy outside the womb (ectopic pregnancy).
• Long-term adrenal failure, or long-term treatment with Corticosteroids.
• Severe asthma not controlled by treatment.
• Bleeding disorders or treatment with blood thinners.
• Inherited porphyria (a rare blood disorder).
• An intrauterine device (IUD) in place, which must be removed first.
• Pregnancy beyond the stage allowed for medical methods, or allergy to mifepristone.

Side Effects

Expected: vaginal bleeding and cramping, usually heavier than a period, mainly after Misoprostol. Also common: nausea, vomiting, diarrhoea, headache, dizziness, and fever or chills on the day Misoprostol is taken.

Get urgent medical help for:

• Very heavy bleeding, such as soaking two thick pads an hour for two hours in a row.
• Fever of 38°C or more lasting over 24 hours, or starting a day or more after Misoprostol.
• Severe abdominal pain, foul-smelling vaginal discharge, or feeling very unwell, weak or faint.
• No bleeding within 24 hours after Misoprostol, or pregnancy symptoms that continue.
• Swelling of the face or throat, or difficulty breathing.

Pregnancy and Lactation

It is used to end a pregnancy. If the pregnancy continues after treatment, there is a risk of harm to the baby, so a follow-up check is essential. Small amounts pass into breast milk; breastfeeding can usually continue, but ask the provider.

Precautions and Warnings

• Use only under medical supervision, with access to emergency care.
• Tell the provider about anaemia, heart disease, high blood pressure, asthma, kidney or liver disease, or if you smoke and are over 35.
• People with Rh-negative blood may need an anti-D injection.
• Fertility returns quickly; a contraceptive method can be started straight away.

Overdose

Large amounts may cause signs of adrenal insufficiency, such as weakness, low blood pressure and vomiting. Get medical help.

Therapeutic Class

Antiprogestogen (progesterone receptor blocker).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.