Mifeprex is an antiprogestin. This medication works by preventing progesterone (a naturally occurring sex hormone) from attaching to progesterone receptors (binding sites). Blocking progesterone activity leads to uterine and cervix effects that will end your pregnancy—when Mifeprex is combined with another medication called misoprostol.
What Is Mifeprex Used For?
Mifeprex is used with misoprostol to end a pregnancy.
Brand Name(s): Mifeprex
Drug Availability: Prescription
Therapeutic Classification: Antiprogestin
Available Generically: Yes
Controlled Substance: No
Administration Route: Oral (by mouth)
Active Ingredient: Mifepristone
Dosage Form(s): Tablet
In 2011, there were over 6 million pregnancies in the United States (U.S.). Approximately half of these pregnancies were unintended. Compared to 2008, the rate of unintended pregnancies is trending down. When compared to other developed countries, however, the U.S. has more unintended pregnancies—particularly in people being female at birth with low incomes or within the 15 to 19-year-old age group.
Some of these individuals with unintended pregnancies will seek an abortion. In fact, based on a 2019 national survey, around 70% of obstetrician-gynecologists (OB-GYNs) reported having patients who wanted or needed an abortion in the past year. Only 24% of OB-GYNs, however, offered this health care service.
With more restrictions or bans on abortions, there will be a higher likelihood of people with unintended pregnancies seeking unsafe abortion practices. In fact, before the 1973 U.S. Supreme Court decision in Roe v Wade, hundreds of thousands of people sought illegal abortions that resulted in complications and deaths. After the Supreme Court ruling, preventable death rates of people with unintended pregnancies drastically decreased.
How to Take Mifeprex
Mifeprex is available from certified prescribers in a clinic or certified pharmacies in-store or through mail order, with a prescription from a certified prescriber. The following are additional details on what to expect.
Day one
Take one tablet of Mifeprex 200 milligrams (mg) by mouth. If your healthcare provider didn’t give you four tablets of misoprostol 200 micrograms (mcg), they will give you a prescription to fill this medication at the pharmacy. You will take misoprostol 24 to 48 hours after your initial Mifeprex dose.
Between 24 to 48 hours after your initial Mifeprex dose
Place two misoprostol 200-microgram tablets on the inside of your left cheek. Place another two misoprostol 200-microgram tablets on the inside of your right cheek. Let the tablets dissolve on the side of your cheeks for 30 minutes. Then, drink some water or another beverage to swallow any remaining pieces of medication in your mouth.
Seven to 14 days after taking your initial Mifeprex dose
Follow up with your healthcare provider to assess your health status. Your healthcare provider will also determine whether you bled and your pregnancy passed through your uterus. If your pregnancy hasn’t ended or passed through your uterus, your healthcare provider will advise you on next steps.
Storage
You can only receive Mifeprex during an office visit with your healthcare provider. Therefore, you don’t need to worry about how to store this medication or travel with it.
As for misoprostol, on the other hand, you can store it at room temperature away from a moist environment. Do not store medications in the bathroom.
To be safe, you can use a locked cabinet or closet to keep your medication out of the reach of children and pets.
Off-Label Uses
Healthcare providers may use Mifeprex (mifepristone) with misoprostol for a missed miscarriage. While the pregnancy did spontaneously end, some people experience an incomplete miscarriage, where the pregnancy hasn’t passed through the uterus. Therefore, Mifeprex with misoprostol might be used in this situation to help the pregnancy pass through the uterus.
Mifepristone is also available as a brand-name medication called Korlym. The Food and Drug Administration (FDA) approved Korlym to treat high blood sugar in people with type 2 diabetes due to Cushing’s syndrome. Cushing’s syndrome is a medical condition of too much of a naturally occurring hormone called cortisol.
What Are the Side Effects of Mifeprex?
This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.
Your healthcare provider will assess whether Mifeprex and misoprostol worked during your follow-up visit, which is seven to 14 days after you took Mifeprex.
Common Side Effects
Common side effects of Mifeprex may include:
Diarrhea Dizziness Fever or chills Headaches Nausea or vomiting Weakness
Severe Side Effects
The following is a list of possible complications with pregnancies, abortions, and Mifeprex.
Infection: Mifeprex with misoprostol isn’t directly linked to a higher infection rate. However, there are reports of serious infections with all types of abortions. Serious infections may include fever, severe stomach pain, and a fast heartbeat. Other symptoms may also include weakness, diarrhea, nausea, and vomiting.
Uterine bleeding: Some uterine bleeding is expected with Mifeprex and misoprostol. Many people assigned female at birth experience heavy bleeding for two days, transitioning to some bleeding or spotting for up to 16 days. Some people may even notice bleeding for more than 30 days.
In general, how long the bleeding takes depends on the duration of your pregnancy before the abortion. However, heavy bleeding that doesn’t go away might mean an incomplete abortion or other complications.
Ectopic pregnancy: In an ectopic pregnancy, the fertilized egg (one unit that contains the egg and sperm) doesn’t bind to the endometrium (lining of the uterus). Instead, the fertilized egg attaches to another place—like the fallopian tube. This condition can be life-threatening.
A possible symptom of an ectopic pregnancy is severe stomach pain. If you’re experiencing severe stomach pain, let your healthcare provider know.
Mifeprex with misoprostol doesn’t work if you have an ectopic pregnancy. Therefore, people with an ectopic pregnancy should avoid this combination. Additionally, their side effects or symptoms are very similar if you start on Mifeprex and misoprostol with an ectopic pregnancy. So, Mifeprex with misoprostol might make it harder for your healthcare provider to assess whether you have an ectopic pregnancy.
Rhesus (Rh) incompatibility: Rh is a protein that might be found on the surfaces of red blood cells (RBCs). Rh incompatibility may happen when a pregnant person has Rh-negative blood and the fetus has Rh-positive blood.
An Rh-negative person might develop Rh incompatibility after a miscarriage, abortion, or first pregnancy with an Rh-positive fetus. After being exposed to Rh-positive blood, the Rh-negative person’s immune system (the body’s defense system) will attack the blood of an Rh-positive fetus in the future. A RhoGAM injection can typically prevent complications with future pregnancies.
If you have questions or concerns about these complications, talk with your healthcare provider. Get medical help immediately if you develop any of these complications. Call 911 if your symptoms feel life-threatening.
Long-Term Side Effects
While there are potentially serious complications with Mifeprex, they are rare. As long as these complications are addressed, Mifeprex doesn’t typically adversely affect future pregnancies, breast cancer risk, or your general health.
As for severe or long-term mental health concerns with people taking Mifeprex, they’re not more likely to happen when compared to people who gave birth. The risk of mental health concerns is higher for the following people:
People who had to choose an abortion for health-related reasonsPeople who experienced a lack of support for their decision of an abortionPeople with a history of a mental health condition
Dosage: How Much Mifeprex Should I Take?
Modifications
The following modifications (changes) should be kept in mind when using Mifeprex:
If you experience a serious side effect, you or your provider may send a report to the FDA’s MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage form (tablets): For termination of pregnancy (70 days or less) taken together with misoprostol: Adults—200 milligrams (mg) as a single dose on Day 1. This is followed 2 days later by 800 micrograms (mcg) (four-200 mcg tablets) of misoprostol as a single dose placed in the cheeks. Children—Use is not recommended. For treatment of hyperglycemia in patients with Cushing’s syndrome: Adults—At first, 300 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 1200 mg per day. Children—Use and dose must be determined by your doctor.
Severe allergic reaction: Avoid using Mifeprex if you have a known allergy to it or its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you’re unsure.
Pregnancy: Mifeprex with misoprostol is used to end a pregnancy. If Mifeprex with misoprostol didn’t work, then the effects on your continued pregnancy are unknown. Since Mifeprex with misoprostol might interrupt normal fetal development, adverse effects are possible. There was a higher chance of fetal loss in mouse, rat, and rabbit animal studies. In rabbit animal studies, the fetus experienced abnormal skull development, possibly due to uterine contractions from Mifeprex’s effects.
Follow up with your healthcare provider seven to 14 days after your initial Mifeprex dose. They will assess whether the pregnancy passed through your uterus. If Mifeprex with misoprostol didn’t end your pregnancy, your healthcare provider will advise you on the next steps.
Breastfeeding: At a 200-milligram dose of Mifeprex (mifepristone), minimal amounts of the medication are present in human breastmilk. Therefore, based on currently available information, there’s no need to stop or interrupt breastfeeding your baby with a single 200-milligram dose of Mifeprex.
Talk with your healthcare provider if you plan to breastfeed. Your healthcare provider will help you weigh the benefits and risks of taking Mifeprex while nursing. They can also discuss the different ways available to feed your baby.
Older adults over 65: There was no information about people in this age group to see whether they respond differently from younger adults.
Children: Mifeprex is generally safe and effective for pregnant people assigned female at birth that are younger than age 17.
Missed Dose
Mifeprex is typically taken as a one-time dose during an appointment with your healthcare provider. So, it’s unlikely that you will miss this Mifeprex dose. If you miss this first appointment, however, your pregnancy will continue.
After 24 to 48 hours of taking your Mifeprex dose, you’ll need to place two tablets of misoprostol 200 micrograms on the inside of each cheek. If you take misoprostol after 48 hours, Mifeprex with misoprostol won’t work as well. So, there’s a higher chance that your pregnancy didn’t end.
Seven to 14 days after your initial Mifeprex dose, you’ll have a follow-up visit with your healthcare provider to assess your health status. If you miss this follow-up appointment, it’ll be difficult for your healthcare provider to determine that you bled and your pregnancy passed through your uterus. It’ll also be hard for them to identify complications and advise you on the next steps.
Try to find ways that work for you to help yourself remember to keep your appointments and take your medication routinely.
Overdose: What Happens If I Take Too Much Mifeprex?
Healthy non-pregnant volunteers were able to tolerate a high one-time dose of 1,800 milligrams. The symptoms of a suspected overdose of Mifeprex, however, may include:
Blurry visionBreathing difficultiesDizzinessFaintingFast heartbeatNauseaTirednessWeakness
If you think that you’re experiencing an overdose or life-threatening symptoms, seek immediate medical attention.
Precautions
What Are Reasons I Shouldn’t Take Mifeprex?
Before taking Mifeprex, talk with your healthcare provider if any of the following applies to you.
If someone collapses or isn’t breathing after taking Mifeprex, call 911 immediately.
Using Korlym™ while you are pregnant can harm your unborn baby. Use an effective form of birth control (eg, a condom, a diaphragm, or a cervical cap) to keep from getting pregnant during therapy and for 1 month after the last dose of this medicine. If you think you have become pregnant while using the medicine, tell your doctor right away.
Do not use this medicine if you are also using cyclosporine (Gengraf®, Neoral®, Sandimmune®), dihydroergotamine (D.H.E. 45®, Migranal®), ergotamine (Ergomar®, Ergostat®), fentanyl (Sublimaze®), lovastatin (Altocor®, Mevacor®), pimozide (Orap®), quinidine (Quinora®), simvastatin (Zocor®), sirolimus (Rapamune®), tacrolimus (Prograf®), or a steroid medicine (such as dexamethasone, hydrocortisone, methylprednisolone, prednisone, Medrol®). Using these medicines together may cause serious problems.
Check with your doctor if the vaginal bleeding becomes severe or seems to last longer than expected (eg, soaking through two thick full-size sanitary pads per hour for 2 consecutive hours) while using this medicine.
You may need to have a surgical procedure to stop excessive vaginal bleeding or to terminate a pregnancy that was not terminated with the Mifeprex® treatment procedure.
You should check with your physician immediately if symptoms of serious infection (such as continuing fever ≥ 100.4 °F, severe stomach pain, pelvic tenderness, weakness, nausea, vomiting, diarrhea, non-productive cough shortness of breath, weight loss, or abnormally fast heartbeat) occur.
This medicine may cause adrenal gland problems. Check with your doctor if you have darkening of the skin, diarrhea, lightheadedness, dizziness, or fainting, increased hunger, mental depression, nausea or vomiting, skin rash, or unusual tiredness or weakness.
This medicine can cause changes in heart rhythms, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Contact your doctor right away if you have any symptoms of heart rhythm problems, such as fast, pounding, or uneven heartbeats.
Do not eat grapefruit or drink grapefruit juice while you are using this medicine. Grapefruit and grapefruit juice may change the amount of this medicine that is absorbed in the body.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John’s wort) or vitamin supplements.
Severe allergic reaction: If you have a severe allergic reaction to Mifeprex, misoprostol, or any of their components (ingredients), then these medications aren’t viable options for you.
Adrenal gland problems: The adrenal glands sit on top of your kidneys. If you have chronic (long-term) adrenal gland failure, your adrenal glands aren’t making enough of certain naturally occurring hormones—like cortisol and aldosterone. If your adrenal glands aren’t working as well, you may have symptoms of low blood pressure, patchy or dark skin, weight loss, and worsening tiredness.
Taking Mifeprex with misoprostol can worsen this condition. Therefore, these medications aren’t recommended for people with adrenal gland problems.
Bleeding condition: If you have a bleeding condition, then Mifeprex with misoprostol isn’t recommended. A bleeding condition—like von Willebrand disease (VWD)—will increase the likelihood of heavy bleeding with these medications. VWD is a condition that runs in families. People with VWD have a problem with their von Willebrand protein that prevents the blood from clotting appropriately.
Ectopic pregnancy: Ectopic pregnancy can be a life-threatening condition. If you have an ectopic pregnancy, Mifeprex with misoprostol will be ineffective at ending your pregnancy.
Pregnancy: Mifeprex with misoprostol is used to end a pregnancy. Continuing your pregnancy after taking these medications might have negative effects on the unborn fetus. If you’re more than 70 days (10 weeks) pregnant, Mifeprex isn’t an ideal option for you in certain states.
Breastfeeding: At a single dose of Mifeprex milligrams, small amounts of this medication are present in human breastmilk. Therefore, based on currently available information there is no need to stop or interrupt breastfeeding your child with a one-time Mifeprex 200-milligram dose. Talk with your healthcare provider to assess the benefits and harms of taking Mifeprex while breastfeeding.
Children: Mifeprex is typically safe and effective for pregnant people who are under age 17 and were assigned female at birth.
Intrauterine device (IUD) use: An IUD is used to prevent pregnancy. If you have an IUD in your uterus, it can interfere with ending your established pregnancy. Therefore, the IUD will need to be removed before taking Mifeprex with misoprostol.
Adults over 65: There is no information about Mifeprex in older adults to assess differences in response between them in younger adults.
Porphyria: Porphyria is a group of rare conditions that run in families. In these conditions, there is a build-up of porphyrins that can cause symptoms of stomach pain, light sensitivity, and nervous or muscle system problems.
In people with porphyria, porphyrins build up in the body because of abnormalities in the multi-step process of making heme. Heme is an important component (part) of hemoglobin, which is a protein that carries oxygen in red blood cells (RBCs).
If you have porphyria, taking Mifeprex with misoprostol isn’t recommended due to a higher risk of a porphyria attack.
What Other Medications Interact With Mifeprex?
Use caution when taking Mifeprex with the following medications:
Blood-thinning meds: If you’re taking a blood-thinning medication (e. g. , warfarin), you’ll have a higher risk of heavy bleeding with the Mifeprex and misoprostol combo. Therefore, Mifeprex isn’t recommended. Steroids: If you’re taking steroid medications—like prednisone, avoid Mifeprex. Combining these medications can raise your risk of adrenal gland problems. CYP3A4-inducing medications: CYP3A4 is a protein in the liver. It’s responsible for breaking down medications—like Mifeprex. CYP3A4-inducing medications—like phenytoin for seizures—encourage CYP3A4 to break down Mifeprex quickly. This fast breakdown may result in less Mifeprex in the body to effectively end your pregnancy. Therefore, it’s essential to have a follow-up visit with your healthcare provider seven to 14 days after taking Mifeprex. They can determine whether your pregnancy passed through the uterus. CYP3A4-inhibiting medications: CYP3A4-inhibiting medications—like the erythromycin antibiotic—may prevent CYP3A4 from working well. As a result, there might be a build-up of Mifeprex in your body, which may raise your risk of side effects. CYP3A4 substrate medications: CYP3A4 substrates are medications broken down by CYP3A4. Mifeprex is a CYP3A4 substrate. Since Mifeprex takes a long time to clear out of the body, Mifeprex might interfere with other CYP3A4 substrates—causing a build-up of these medications and raising your risk of side effects from these medications. Everolimus is an example of a CYP3A4 substrate. It has many uses, including preventing organ transplant rejections and treating different types of cancer.
Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Mifeprex.
And be sure to talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter, nonprescription products, vitamins, herbs, or plant-based medicines.
What Medications Are Similar?
The antiprogestin class only has Mifeprex as its member, but there are different types of abortions, which include the abortion pill type. Mifeprex with misoprostol is the only option for the abortion pill type. It’s typically used to end a pregnancy that’s less than 10 weeks old. Some states might allow the abortion pill for a pregnancy up to 11 weeks old.
The other type of abortion is an in-clinic abortion. While it’s sometimes called surgical abortion, it’s more of an in-office procedure typically used to end a pregnancy in the second trimester.
Vacuum aspiration is an example of an in-clinic abortion. The other type of in-clinic abortion is dilation and evacuation (D&E). In general, suction is used to remove the pregnancy from your uterus for both of these procedures.
How Can I Stay Healthy While Taking Mifeprex?
If you’re taking Mifeprex with misoprostol, you have your reasons for choosing abortion. After you make this difficult decision, make sure to take care of yourself. And do check your state’s laws about abortions.
Mifeprex also has a Risk Evaluation and Mitigation Strategy (REMS) program. As a result, your healthcare provider and pharmacy will need to be REMS-certified.
Misoprostol, on the other hand, has a little more flexibility. Your healthcare provider can give you misoprostol tablets or send a prescription to your retail pharmacy.
If cost is a concern, visit a nearby Planned Parenthood. They can provide you with additional information about costs. They can also let you know about some funds that may help cover the cost of the abortion pill.
Mifeprex is effective at ending 87% of pregnancies that are 10 to 11 weeks old. With an extra dose, however, Mifeprex’s effectiveness increases to 98% for a pregnancy that’s 10 to 11 weeks old.
As for serious or long-term mental health concerns with people taking the abortion pill, they’re generally not more common when compared to people who gave birth.
Keep an eye out for the following possible side effects or complications with the abortion pill.
Alert your healthcare provider if your heavy bleeding concerns you. You’re probably bleeding too much if you used at least two maxi-pads in one hour for two hours. You’re also probably bleeding too much if you used one maxi-pad every hour for more than three hours. Notify your healthcare provider if you’re having severe cramps that won’t go away. Call your healthcare provider if you have vaginal discharge that’s itchy, painful, bad-smelling, or pus-like. Contact your healthcare provider if your blood clots are larger than a lemon. Reach out to your healthcare provider if you’re fainting, having a fever, or feeling like you’re still having pregnancy symptoms (e. g. , morning sickness).
Refer below for some other general tips to support your health:
Take it easy and rest for the first couple days after the abortion. Don’t perform strenuous exercises for one week after the abortion. Don’t stimulate your nipples. Stimulating your nipples might result in some breast discharge. Use a heating pad and drink fluids (e. g. , tea or hot cocoa) if you’re having cramps. If you have cramps or heavy bleeding, perform a deep uterine massage for 10 minutes. To give yourself a uterine massage, use your fingertips to press down on your stomach and firmly rub in circular motions from your belly button to your pubic bone. Consider taking ibuprofen and limiting physical activity if you’re experiencing cramping or heavy bleeding. Avoid eating grapefruit or drinking grapefruit juice with this medication. Consider support groups or work with a mental health professional to help you find coping strategies to change the way you think, feel, react, or respond to having an abortion. Keep your follow-up appointment with your healthcare provider seven to 14 days after your first Mifeprex dose. Discuss birth control options with your healthcare provider.
