Mifeston

Introduction
Mifeston is an anti progestational steroids class of drug used for medical termination of pregnancy. It works by blocking the action of progesterone, essential hormone for the growth of pregnancy. Mifeston is given alone or in combination with some other medicine to attain the maximum benefit. It should be taken with food or as your doctor’s advice. It should be taken orally, by swallow the tablets whole with a drink of water. If you experience vomiting within 45 minutes of tablet intake, inform your doctor or take another tablet. The medicine may take 24- 48 hours to show its action and you experience bleeding. The most common side effects of this medicine include nausea, vomiting, uterine cramps, diarrhea, infection following abortion, and uterine bleeding. If these bother you, or appear serious, let your doctor know. There may be ways of reducing or preventing them. Some side effects may mean you should inform your doctor immediately include heavy vaginal bleeding or abdominal pain. Before taking this medicine, tell your doctor if you have ever had an ectopic pregnancy, or you are breastfeeding or using an intrauterine device. Your doctor should also know about all other medicines you are taking as many of these may make this medicine less effective or change the way it works. You must avoid strenuous activity like heavy exercise, running and driving while abortion as it can affect the bleeding. Your doctor may perform an ultrasound or pelvic examination to check for abortion completion.

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Uses of Mifeston
Medical abortion
Side effects of Mifeston
Common
Nausea
Vomiting
Uterine cramps
Diarrhea
Infection following abortion
Uterine bleeding
How to use Mifeston
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Mifeston is to be taken with food.
How Mifeston works
Mifeston blocks the effects of progesterone, a natural female hormone which is needed for the pregnancy to sustain. Without this hormone, the lining of the uterus (womb) breaks down as it does during a menstrual period and stops the growth of the pregnancy.
What if you forget to take Mifeston?
If you miss a dose of Mifeston, please consult your doctor.
Quick Tips
Mifeston helps in medical termination of pregnancy.
If you vomit within 45 minutes of taking the tablet, talk to your doctor immediately. You will need to take another tablet.
Take it only as prescribed by the doctor. Miscarriages, if incomplete, may result in serious medical complications leading to hospitalization, surgery and possible infertility.
Be cautious while driving or doing anything that requires concentration as it can cause dizziness and sleepiness.
It does not affect fertility. Use contraception to avoid pregnancy.
Take it no later than 63 days after the first day of your last menstrual period.
Vaginal bleeding may or may not occur after taking this medicine. Inform your doctor immediately if excessive bleeding occurs or if you suffer from severe abdominal pain.
Brief Description
Indication
Termination of pregnancy, Labour induction, Cervical softening and dilatation, Postcoital contraception.
Administration
May be taken with or without food. 200 mg PO once given by a healthcare provider in a clinic, medical office, or hospital followed 24-48 hr later by misoprostol buccal administration Buccal administration (misoprostol) Because most women will expel the pregnancy within 2-24 hr of taking misoprostol, discuss with the patient an appropriate location for her to be when she takes the misoprostol, taking into account that expulsion could begin within 2 hr of administration Administer misoprostol 800 mcg buccally within 24-48 hr after taking Mifeprex The effectiveness of the regimen may be lower if misoprostol is administered <24 hr or >48 hr after mifepristone administration Tell the patient to place two 200 mcg misoprostol tablets in each cheek pouch (the area between the cheek and gums) for 30 minutes and then swallow any remnants with water or another liquid During the period immediately following the administration of misoprostol, the patient may need medication for cramps or GI symptoms

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Adult Dose
Pregnancy Termination Mifepristone: Indicated for the medical termination of intrauterine pregnancy through 70 days gestation in combination with misoprostol Day 1: 200 mg of mifepristone PO as a single dose under physician supervision Days 2-3: 800 mcg of MISOPROSTOL buccally once as a single dose; must be administered a minimum of 24-hr and a maximum of 48-hr following mifeprostone dose on day 1 Days 7-14 Must return for follow-up visit to confirm complete termination has occurred by medical history, clinical examination, hCG testing, or ultrasonographic scan If complete expulsion has not occurred, but the pregnancy is not ongoing, women may be treated with another dose of misoprostol 800 mcg buccally with follow-up in ~7 days Lack of bleeding following treatment usually indicates failure; however, prolonged or heavy bleeding is not proof of a complete abortion Surgical evacuation is recommended to manage ongoing pregnancies after medical abortion

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Contraindication
Confirmed or suspected ectopic pregnancy, chronic adrenal failure, concurrent long-term corticosteroid therapy, history of allergy to mifepristone, misoprostol or other prostaglandin, haemorrhagic disorders or concurrent anticoagulant therapy, porphyria, hepatic or renal impairment; pregnancy and lactation; IUD in place; undiagnosed adnexal mass.
Mode of Action
Mifepristone is a progesterone antagonist with antiglucocorticoid activity. It binds to the intracellular progesterone receptor where it competitively inhibits progesterone attachment. It is also a partial progesterone agonist.
Precaution
Patient w/ haemostatic disorders or anaemia; malnutrition. Patients taking strong CYP3A4 inhibitors (when used in the treatment of Cushing’s syndrome). Hepatic and renal impairment. Lactation. Monitoring Parameters Termination of pregnancy: Monitor Hb, haematocrit and RBC count in cases of heavy bleeding; CBC in patients who show signs of infection. Conduct clinical exam and/or ultrasound to confirm complete termination of pregnancy. Cushing’s syndrome: Monitor thyroid function, serum glucose, psychiatric symptoms, signs/symptoms of adrenal insufficiency; cushingoid appearance. Lactation Distributed in human milk; because of the potential for serious adverse reactions in nursing infants from mifepristone, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother

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Side Effect
>10% Abdominal pain, cramping (96%),Uterine cramping (83%),Nausea (43-61%),Headache (2-31%),Vomiting (1-26%),Diarrhea (12-20%),Dizziness (1-12%) 1-10% (Mifeprex) Fatigue (10%),Back pain (9%),Decreased hemoglobin >2 g/dL (6%),Uterine hemorrhage (5%),Viral infection (4%).Dyspepsia (3%),Insomnia (3%),Rigors (3%),Vaginitis (3%),Anemia (2%),Anxiety (2%),Fainting (2%),Leg pain (2%),Leukorrhea (2%),Pelvic pain (2%),Sinusitis (2%),Weakness (2%)

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Interaction
Increased serum levels w/ CYP3A4 inhibitors (e.g. ketoconazole, itraconazole, erythromycin). Decreased serum levels w/ CYP3A4 inducers (e.g. dexamethasone, rifampicin, phenytoin). Potentially Fatal: Increased risk of adverse effects w/ simvastatin, lovastatin and CYP3A4 substrates w/ narrow therapeutic range (e.g. ciclosporin, pimozide, ergotamine). Antagonises the effect of glucocorticoids. Increased risk of vag bleeding w/ anticoagulants.

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