Mifepristone

 Action Competes with progesterone at progesterone-receptor sites.

 Indications Termination of pregnancy through day 49 of pregnancy. Unlabeled use(s): Postcoital contraception; intrauterine fetal death/nonviable early pregnancy; unresectable meningioma; endometriosis; Cushing syndrome.

 Contraindications Confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass; UD in place; chronic adrenal failure; concurrent long-term corticosteroid therapy; history of allergy to mifepristone, misoprostol, or other prostaglandin; emorrhagic disorders or concurrent anticoagulant therapy; inherited porphyrias.

 Route/Dosage

ADULT: PO Day 1: Patient takes 600 mg mifepristone in a single dose. Day 3: Unless a confirmed abortion has occurred, patient takes 400 mcg misoprostol. Day 14: Follow-up visit to confirm by clinical examination or ultrasonographic scan that a complete termination of pregnancy has occurred.

 Interactions

Erythromycin, grapefruit juice, itraconazole, ketoconazole: May increase mifepristone plasma levels. Carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin, St. John's wort: May decrease mifepristone plasma levels.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Headache; dizziness; insomnia; anxiety; syncope; fainting. EENT: Sinusitis. GI: Abdominal pain and cramping; nausea; vomiting; diarrhea; dyspepsia. GU: Uterine cramping and hemorrhage; vaginitis; pelvic pain. HEMA: Anemia; decreased hemoglobin. OTHER: Fatigue; back pain; fever; viral infections; rigors; chills; shaking; sthenia; leg pain; leukorrhea.

 Precautions

Pregnancy: Indicated for termination of pregnancy. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly: Safety and efficacy not established. Monitoring: Qualified physician must supervise administration. Surgical intervention: Facilities for transfusions and resuscitation may be necessary in incomplete abortion. Vaginal bleeding: Occurs in almost all patients. Availability: Available only through selected physician offices.

 Administration/Storage

 Assessment/Interventions

 Patient/Family Education