mifepristone (Mifeprex, RU-486, Mifegyne)

^[1]^[2]^[3]^[4]^[5]^[6]

Introduction

Controversial abortion pill. Available 11/2000;

3 office visits vs dispensed by mail^[6]
1st visit: 200 mg mifepristone tablet
- formerly 600 mg (3 tablets)^[4]
- not necessary to observe in a medical facility
2 days later, 400 ug of buccal misoprostol
- unclear with new labeling that this step required^[4]
- vaginal misoprostol 24 hours later^[5]
doxycline 100 mg PO BID
follow-up after 2 weeks to confirm termination of pregnancy

septic death (4 cases)
- Clostridium sordellii etiologic agent in 2 of 4 cases^[2] Mifeprex info: (877) 432-7596 or www.earlyoptionpill.com

anti-progestin; interrupts pregnancy
misoprostol stimulates uterine contractions
combination of mifepristone followed by misoprostol is 95% effective in terminating pregnancies during the 1st 7 weeks
RU486 also antagonizes glucocorticoid receptors

↑ Prescriber's Letter 7(10):56 2000
↑ ^2.0 ^2.1 FDA Medwatch http://www.fda.gov/medwatch/safety/2005/safety05.htm#Mifeprex http://www.fda.gov/medwatch/safety/2006/safety06.htm#Mifeprex
↑ FDA Drug Safety. March 30, 2016 Mifeprex (mifepristone) Information http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111323.htm
↑ ^4.0 ^4.1 ^4.2 Greene MF, Drazen JM A New Label for Mifepristone. N Engl J Med 2016; 374:2281-2282. June 9, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27276566 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1604462
↑ ^5.0 ^5.1 Schreiber CA, Creinin MD, Atrio J et al. Mifepristone pretreatment for the medical management of early pregnancy loss. N Engl J Med 2018 Jun 7; 378:2161. June 7, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29874535 https://www.nejm.org/doi/10.1056/NEJMoa1715726
Westhoff CL. A better medical regimen for the management of miscarriage. N Engl J Med 2018 Jun 7; 378:2232. June 7, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29874544 https://www.nejm.org/doi/10.1056/NEJMe1804945
↑ ^6.0 ^6.1 US Food & Drug Administration. Jan 24, 2023 Information about Mifepristone for Medical Termination of Pregnancy Through Ten Weeks Gestation. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-about-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation