Mifepristone: Uses & Side Effects

Mifepristone (brand name: Mifeprex) is a prescription medication that is a progesterone blocker. It blocks the effect of progesterone, a hormone that is necessary to continue pregnancy. Mifepristone is used with misoprostol (Cytotec) for medical abortion or medical termination, which is the procedure where prescription medications are used to end a pregnancy. Please continue reading to learn about the uses and side effects of this medicine.

What is mifepristone used for?

Medical abortion (termination of pregnancy)

Mifepristone is approved by the FDA for medical abortion which is a termination of pregnancy using medication. Mifepristone is used, along with another drug called misoprostol (Cytotec), for medical termination of early pregnancy. Mifepristone can be used up to 10 weeks gestation (week 10 of pregnancy), or up to 70 days after the last menstrual period. Sometimes, mifepristone is prescribed to those who are up to 11 weeks pregnant.

Hyperglycemia

Mifepristone is available under the brand name Korlym to treat hyperglycemia (high blood sugar) in people who have too much cortisol hormone in their bodies due to a condition called Cushing’s syndrome.

What are other uses of mifepristone?

Besides the above FDA-approved indications, mifepristone is used as off-label in the following instances. Off-label use means using approved medications for unapproved indication when the healthcare provider deems it is medically necessary and appropriate for a specific patient.

Endometriosis
Refractory ovarian cancer
Dilation of the cervix
Induction of labor
Emergency contraception

Can mifepristone prevent pregnancy?

Although some studies show that prescribing mifepristone at a very low dose can be used as a method of emergency contraception. However, the use as emergency contraception or as the morning-after pills are not approved in the U.S.

How to take mifepristone?

Mifepristone tablets are taken by mouth to terminate an intrauterine pregnancy, meaning the fertilized egg implants and develops within the uterus. The usual dosing is as follows: You take a single dose of mifepristone 200 mg on day one. Then, 24 to 48 hours after the initial dose, you place four tablets of misoprostol 200 mcg (total 800 mcg) between your gum and cheek, two on each side, for 30 minutes, followed by drinking a little water to swallow the dissolved medicine. Do not take more than the maximum dose of this medication prescribed by your doctor.

Where to get mifepristone?

Mifepristone can cause serious and potentially life-threatening complications. Because of this risk, it is only available through a restricted program called the Mifeprex Risk Evaluation and Mitigation Strategies (REMS) Program. Prior to January 2023, you can only get this medicine from a health care professional in medical offices and hospitals rather than through retail pharmacies. However, with the modification to the Mifepristone REMS at the beginning of the year, mifepristone can be dispensed through retail pharmacies as long as the pharmacy meets the requirements of the Mifepristone REMS program. All patients prescribed mifepristone are given an information sheet (medication guide) and a patient agreement form to read and sign before starting mifepristone treatment.

What precautions should I take?

Mifepristone may not be right for people with certain medical conditions. Tell your doctor if you have ever had medical problems like an ectopic pregnancy (tubal pregnancy), adrenal failure, chronic steroid use, certain blood disorders, or current use of a blood thinner.

If you have an intrauterine device (IUD) for birth control, it will need to be removed before taking mifepristone as an IUD may interfere with pregnancy termination.

Tell your doctor if you cannot follow the guidelines in the patient agreement form. Make a plan with your doctor about the person you will call in case there is an emergency after you take mifepristone. You will need fast access to medical treatment in the first two weeks after taking mifepristone. If you need to go to the emergency room, take your mifepristone medication guide with you so that your treating doctors know that you are undergoing a medical termination of a pregnancy.

Make sure you attend the follow-up visit. This will ensure you get appropriate medical care and that your pregnancy ends without serious complications. Sometimes, mifepristone can result in incomplete abortion that may require further treatment.

What are the symptoms after taking Mifeprex?

Approximately 2 to 24 hours after taking misoprostol, you will develop symptoms such as stomach pain, vaginal bleeding, uterine cramping, nausea, and diarrhea. Make sure you are at an appropriate location, as the pregnancy will likely be expelled. The vaginal bleeding or spotting typically lasts for 9 to 16 days but can last for 30 days or more. You will need to go back to your doctor’s office for a physical examination or ultrasound after 7-14 days to confirm the termination of pregnancy and ensure you do not have heavy bleeding. Persistent bleeding at the time of follow-up can indicate an incomplete abortion.

What is a common side effect of mifepristone?

Common side effects of mifepristone include vaginal bleeding; burning, itching, or discharge from the vagina; abdominal pain; pelvic pain; cramps; headache. Call your doctor for medical advice about side effects if they are severe.

What are the risks of taking mifepristone?

Heavy vaginal bleeding

Be sure to tell your doctor if you have anemia, bleeding problems, or are on blood thinners (anticoagulants) that can increase bleeding risk.

Medical/surgical abortion can lead to serious and potentially fatal bleeding. Vaginal bleeding is expected during a medical abortion; however, if the heavy vaginal bleeding does not improve, you should get emergency medical care right away. Heavy bleeding typically means you go through two full-thickness sanitary pads every couple of hours. Mifepristone may not be safe for you to take if this is the case.

Fatal infections

A serious infection can develop after a miscarriage or medical or surgical abortion. There are reports of some patients who developed fatal infections (serious bacterial infections) after taking mifepristone for the medical termination of pregnancy.

Call your doctor immediately or seek medical attention if after taking mifepristone you develop a high fever (more than 100.4 °F or 38 °C) for more than 4 hours, chills, rapid heartbeat, severe pelvic or stomach pain; these can be signs of a serious medical problem. Also, seek immediate medical attention if you start feeling ill with nausea, vomiting, and diarrhea 24 hours after taking misoprostol, as these can be signs of a serious infection.

Allergic reactions

In very few cases, taking mifepristone can lead to an allergic reaction. Call your doctor immediately or seek immediate medical attention if you develop a skin rash, hives, itching, or swelling of the face, eyes, lips, tongue, throat, or hands or have trouble breathing or swallowing.

Drug interactions

Possible drug interactions between mifepristone and other drugs can lead to serious complications. Give your doctor and pharmacist a complete list of all your other medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal remedies like St. John’s Wort. Be sure to mention short- or long-term corticosteroid therapy—mifepristone may not be right for you if you are taking chronic steroid medicines.

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