Mifepristone
About Mifepristone
Mifepristone is an oral prescription medication used primarily for the medical termination of an early pregnancy (up to 70 days or 10 weeks of gestation) in combination with another medicine. It is also prescribed in specific cases to manage high blood sugar levels in adults with a condition called endogenous Cushing's syndrome who also have type 2 diabetes or glucose intolerance.
For ending an early pregnancy, this medication is typically taken as a single dose under clinical supervision, followed by a second medication a day or two later. When used for managing high blood sugar in Cushing's syndrome, it must be taken once daily with food at the exact same time every day to maintain consistent levels in your body. Making specific dietary adjustments, such as limiting sodium and eating potassium-rich foods, can help manage side effects during long-term treatment.
Common side effects include vaginal bleeding, cramping, nausea, headache, and physical weakness. While bleeding and cramping are expected parts of the pregnancy termination process, you must seek immediate medical attention if you experience extremely heavy bleeding, severe abdominal pain, or a fever that lasts more than 24 hours.
Do not take this if you have an intrauterine device (IUD) in place, a suspected pregnancy outside the womb (ectopic pregnancy), chronic adrenal failure, or bleeding disorders. It is crucial to discuss your complete medical history with your doctor before starting this medicine, especially if you have liver damage or kidney issues or are taking long-term steroid medications.
This medicine can interact with certain blood thinners, grapefruit juice, and medications processed by the liver, which can either increase your risk of severe side effects or make the treatment less effective. If you are breastfeeding, elderly, or have specific medical concerns, consult your healthcare provider to understand the unique risks and safety precautions required for your situation.
Uses of Mifepristone
• Medical Abortion: Mifepristone is used to terminate early pregnancies by blocking progesterone, typically up to 49 days from the last menstrual period.
• Combined Therapy: Mifepristone is often used in combination with misoprostol to complete the abortion process.
• Cushing’s Syndrome Treatment: Mifepristone is used to treat Cushing's Syndrome by helping to manage excess cortisol levels.
• Regulation of the Menstrual Cycle: To regulate a delayed menstrual cycle, Mifepristone can be used, but medical supervision is necessary to reduce the risk of side effects.
• Preventing Ovulation: Mifepristone inhibits or delays ovulation which is necessary for making it an effective emergency contraceptive.
Medicinal Benefits
This medication provides critical therapeutic options for patients needing specialised endocrine or gynaecological care:
- Non-surgical pregnancy option: It offers a highly effective, non-surgical alternative for ending an early pregnancy, allowing patients to complete the process in a familiar and private environment.
- Targeted hormone blocking: By directly blocking progesterone, it reliably halts the supportive environment of the pregnancy, preparing the uterine lining for the final step of the medical regimen.
- Blood sugar management: For those with Cushing's syndrome, it successfully lowers and stabilises blood sugar levels, helping to reduce the severe, long-term complications of high cortisol without requiring immediate invasive surgeries.
Directions for Use
To ensure the medication is safe and effective, always follow these administration guidelines:
- Swallow the tablet whole with a full glass of water. Do not crush, chew, or break the tablet, as this can affect how the medicine is absorbed in your body.
- If you are taking this medication to end an early pregnancy, you will take the tablet as a single oral dose. Your doctor will provide you with a second, different medication to take 24 to 48 hours later.
- If you are taking this daily for blood sugar control, take it with food at the same time each day to help prevent stomach upset and ensure a steady level of the medicine in your blood.
- Always follow your doctor's exact instructions regarding the schedule and clinical follow-up appointments.
Storage
Side Effects of Mifepristone
Common Side Effects (Usually mild):
- Vaginal bleeding and spotting (which may be heavy and contain clots)
- Abdominal cramping or pelvic pain
- Nausea, vomiting, diarrhea, or stomach upset
- Headache, dizziness, or a general feeling of weakness and fatigue
- Mild fever, chills, or hot flashes
Serious Side Effects (Call a doctor right away):
- Extremely heavy vaginal bleeding (soaking through two or more thick sanitary pads per hour for two consecutive hours)
- Severe, worsening pelvic pain or abdominal tenderness
- A fever of 100.4°F (38°C) or higher that lasts for more than 4 hours, or starts several days after taking the medicine
- Signs of a severe allergic reaction, such as hives, swelling of the face, lips, tongue, or throat, and difficulty breathing or swallowing
- Severe dizziness, fainting, or rapid heartbeat
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Drug Warnings
- Ensure a follow-up appointment is scheduled with your doctor 7 to 14 days after taking this medicine to confirm the pregnancy has been completely terminated.
- Do not start any new medications, herbal supplements, or over-the-counter drugs without checking with your doctor or pharmacist first.
- Avoid drinking alcohol during treatment, as it can worsen dizziness, drowsiness, and stomach discomfort and can mask signs of severe complications.
- Be aware that vaginal bleeding is normal during this treatment, but it does not guarantee that the pregnancy has been fully terminated; only a medical exam can confirm this.
- If you have a negative blood type (such as Rh-negative), ask your doctor if you need an injection of Rh immunoglobulin to protect future pregnancies.
Drug Interactions
Drug-Drug Interactions
- Corticosteroids: Mifepristone blocks the action of steroids, making medications like prednisone or dexamethasone less effective.
- Blood Thinners: Taking this medicine with anticoagulants (like warfarin) or antiplatelet drugs can significantly increase the risk of severe, life-threatening uterine bleeding.
- CYP3A4 Inhibitors and Inducers: Medications like ketoconazole, erythromycin, and rifampin can alter how your liver breaks down this drug, either causing dangerous toxicity or reducing its effectiveness.
Drug-Food Interactions
- Grapefruit and Grapefruit Juice: Can slow down the breakdown of this medication in the body, leading to higher drug levels and a greater risk of side effects.
Drug-Disease Interactions
- Adrenal Insufficiency: Do not take this medication if you have chronic adrenal gland failure, as it can worsen this life-threatening condition.
- Ectopic Pregnancy: This medicine is not effective for treating pregnancies outside the uterus and should not be used if an ectopic pregnancy is suspected.
- Severe Anaemia: Use with extreme caution, as the expected blood loss during pregnancy termination can worsen severe anaemia.
Drug-Drug Interactions Checker List:
Safety Advice
Alcohol
unsafeAlcohol is known to cause excessive drowsiness if taken along with Mifepristone and increase uterine bleeding.
Pregnancy
unsafeMifepristone is used for medical abortion. If taken in pregnancy, it can lead to abortion.
Breast Feeding
cautionLet your doctor know if you are a nursing mother before prescribing Mifepristone; your doctor will decide whether Mifepristone can be taken by breastfeeding mothers or not.
Driving
unsafeMifepristone may reduce alertness or induce sleep and dizziness. If you experience these symptoms, don't drive or operate machinery.
Liver
cautionMifepristone to be taken with caution, especially if you have a history of Liver diseases/conditions. The dose may have to be adjusted by your doctor.
Kidney
cautionMifepristone to be taken with caution, especially if you have a history of Kidney diseases/conditions. The dose may have to be adjusted by your doctor.
Children
unsafeMifepristone is not recommended for children below the age of 12. The safety and effectiveness of Mifepristone have not been established in children due to limited testing of this drug on children by competent authorities worldwide. If necessary, your doctor will decide whether to give Mifepristone or not.
Habit Forming
Diet & Lifestyle Advise
For pregnancy termination care:
- Plan to rest in a comfortable environment for at least 24 to 48 hours after taking the second medication, as cramping and bleeding can be intense.
- Use sanitary pads instead of tampons or menstrual cups during the bleeding process to monitor the amount of blood loss and lower the risk of uterine infection.
- Stay hydrated by drinking plenty of water, clear broths, or electrolyte solutions to replace fluids lost through bleeding, vomiting, or diarrhoea.
For blood sugar management (Cushing's syndrome):
- Limit your intake of grapefruit and grapefruit juice, as they can significantly alter how your body processes this medication, increasing the risk of side effects.
- Eat potassium-rich foods like bananas, leafy greens, and potatoes, as long-term use of this medication can lower potassium levels in your blood.
- Monitor your blood sugar levels regularly at home and keep a log to share with your healthcare provider at each visit.
Special Advise
Mifepristone should not be used to end the pregnancy after ten weeks.
Contact your doctor immediately if you experience heavy vaginal bleeding after taking this medicine.
Patients Concern
Disease/Condition Glossary
Medical abortion: It is a procedure in which medicine is used to end a pregnancy. It is effectively causing abortion if performed in the first 70 days of pregnancy. Vagina bleeding occurs, and if it does not stop, please inform your doctor as it might require medical supervision. Having a medical abortion is a very emotional decision. You should be mentally prepared for all the risks a surgical absorption could lead to, like incomplete abortion, heavy and prolonged bleeding (which may last up to 30 days), fever, and digestive system discomfort. Also, if the medication does not work, it can lead to an unwanted ongoing pregnancy, leading to fetal defects. So, to avoid any complications, keep in regular touch with your doctor and do as advised.
FAQs
Mifepristone is used in combination with Misoprostol to induce a medical abortion. Mifepristone is primarily used to end an early pregnancy (lasting up to 70 days or less than this) or an unwanted pregnancy with medication help.
If you miss a dose of Mifepristone, take the missed dose as soon as you remember it. However, if it's almost time for the next dose, do not take a double dose to make up for a missed one.
Some of the common side effects of Mifepristone are nausea, weakness, fever/chills, vomiting, headache, diarrhoea, and dizziness.
Mifepristone contains Mifepristone, which works by blocking the effect of progesterone (female hormone), which is needed to sustain a pregnancy. In the absence of progesterone, the lining of the uterus breaks down as it does every month during the menstrual cycle, and the development of the pregnancy is stopped.
No, taking more than the prescribed dose of Mifepristone will not make it more effective and could be dangerous. Please follow the dosage as prescribed by your doctor to avoid potential side effects or complications.
Please inform your doctor if you have a history of liver disease before using Mifepristone. The dosage may need to be adjusted by your doctor, as liver impairment can affect how the drug is metabolized.
Swallow Mifepristone as a whole with water; do not crush or chew it. The doctor will determine the dose based on your condition.
After taking Mifepristone, you may experience cramping or bleeding in the uterus as the medication works to block the hormone progesterone and prepare your body for the next step in the abortion process. Typically, bleeding begins within 24-48 hours after taking Mifepristone. It is common to experience other side effects such as nausea, vomiting, diarrhoea, dizziness, or infection following the abortion. Follow-up with your doctor is essential to ensure that the process is complete.
For pregnancy termination, the medicine starts blocking hormones within a few hours of taking it, though you may not experience significant bleeding or cramping until you take the second medication 24 to 48 hours later. If you are taking it daily for Cushing's syndrome, it may take several weeks to see a steady improvement in your blood sugar levels. Talk to your doctor if you have questions about what to expect.
This medicine can pass into breast milk, but the amount is typically low. However, because its effects on infants are not fully known, it is recommended to discuss breastfeeding with your healthcare provider. Some women choose to pump and discard breast milk for a few days after taking the medication. Talk to your doctor to make a safe plan for your baby.
If you vomit within 1 hour of taking the tablet, the medicine may not have been fully absorbed, and you may need to take another dose. Do not take an extra tablet on your own; instead, contact your healthcare provider or clinic immediately for instructions on what to do.
There is no medical evidence to suggest that a single, uncomplicated use of this medicine for medical abortion affects your future fertility or ability to have a healthy pregnancy. However, you can become pregnant again very quickly after the procedure, so you should discuss birth control options with your healthcare provider. Talk to your doctor for personalised advice.
This medicine can cause side effects like dizziness, fatigue, and physical weakness, especially when combined with cramping or blood loss. It is safest to avoid driving or operating machinery until you know how the medicine affects you and you feel physically strong enough. Talk to your doctor if you are unsure.
Heavy bleeding and the passage of tissue are signs that the medicine is working, but the only way to confirm a complete and successful termination is to have a follow-up medical examination, ultrasound, or blood test 7 to 14 days later. Skipping this follow-up can lead to serious health complications. Talk to your doctor to schedule this vital appointment.
No, it is highly recommended to use sanitary pads instead of tampons or menstrual cups during the entire bleeding process. Pads make it easier to monitor how much blood you are losing and significantly reduce the risk of introducing bacteria that could cause a uterine infection. Talk to your doctor or pharmacist if you need advice on post-treatment care.
It is highly recommended to avoid alcohol while taking this medicine. Alcohol can worsen side effects like dizziness, nausea, and dehydration, and it may mask important warning signs of complications, such as heavy bleeding or infection. Talk to your doctor before consuming any alcohol during your treatment.
