Mifepristone (RU 486)
Article Abstract:
Mifepristone is a newly developed drug that can block the effects of progesterone, and is apparently a safe and effective method of inducing abortion. Mifepristone is available in France and China, and licensing is being sought in the UK. The drug has been used in the US for research, and for treating Cushing's disease (a disease in which excessive steroids are secreted from the adrenal gland) and breast cancer. Marketing approval for mifepristone has not yet been sought in the US, presumably due to fear of public reaction. Besides acting to block progesterone receptors, mifepristone also blocks receptors for other steroids, including androgens (male sex hormone) and also increases production of prostaglandins by the uterine lining during pregnancy. The blockade of progesterone effects and the stimulation of prostaglandins increase uterine contractility; during early pregnancy, this results in loss of the conceptus. Blood levels of mifepristone peak within two hours after oral dosage, decrease by half over 20 hours, and are excreted mainly in bile. Mifepristone is up to 89 percent effective in inducing abortion if amenorrhea (lack of menstruation) has occurred for less than 42 days. The effectiveness can increase to 95 percent in women with amenorrhea for up to 63 days if prostaglandin treatment is given with mifepristone. Bleeding starts within 10 to 58 hours after mifepristone administration, with or without prostaglandin, and lasts one to two weeks. Blood loss tends to exceed that of normal menstruation, with further treatment needed in about 1 percent of patients. Adverse effects have included abdominal cramps, transient nausea, vomiting, diarrhea, and headache. Prostaglandins can cause cardiovascular effects, but only two cases (out of 20,000 treatments) have been reported. No fetal deformities have occurred. The studies indicate that mifepristone given with prostaglandin can induce abortion in 95 percent of women in early pregnancy, and the only side effect that may require further treatment is excessive bleeding. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Medical Letter on Drugs and Therapeutics
Subject: Health
ISSN: 0025-732X
Year: 1990
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Methotrexate and misoprostol for abortion
Article Abstract:
A combination of methotrexate (Folex) and misoprostol (Cytotec) may induce abortion early in the pregnancy without surgery or serious complications. Intramuscular injections of the folic acid antagonist methotrexate destroy embryonic cells and misoprostol causes the uterus to contract and forces out its contents. Misoprostol is administered orally or vaginally a few days after the methotrexate injection. Research shows that the majority of women abort after the first or second dose of misoprostol, and that vaginal dosing is more effective than oral administration. Side effects include heavy bleeding and cramping, headache, nausea, vomiting, and diarrhea. Methotrexate reportedly has not caused major damage to lungs, bone marrow, and the liver. Being teratogenic, methotrexate can cause malformations in the fetus if the pregnancy continues.
Publication Name: Medical Letter on Drugs and Therapeutics
Subject: Health
ISSN: 0025-732X
Year: 1996
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Labor induction with misoprostol
Article Abstract:
Misoprostol should be used infrequently to induce labor in pregnant women. Although it can relax the cervix and allow labor to progress, it also has complications. Studies have also shown that the use of misoprostol does not substantially reduce the cesarean delivery rate.
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1999
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