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BMJ (Clinical Research Ed.) Mar 2022
Topics: Abortifacient Agents, Steroidal; Humans; Mifepristone; Misoprostol
PubMed: 35351689
DOI: 10.1136/bmj.o819 -
The Annals of Pharmacotherapy Jun 2001To review the efficacy and safety of mifepristone (with misoprostol) for the termination of early pregnancy. (Review)
Review
OBJECTIVE
To review the efficacy and safety of mifepristone (with misoprostol) for the termination of early pregnancy.
DATA SOURCES
A MEDLINE search (1966-October 2000) was conducted, and additional references listed in articles were included; unpublished data obtained from the manufacturer were used to identify data from the scientific literature. Studies evaluating mifepristone were considered for inclusion.
STUDY SELECTION
Human clinical studies in the English language were reviewed and evaluated. Clinical trials selected for detailed review were limited to those including the regimens of mifepristone and misoprostol, recently approved by the Food and Drug Administration for early pregnancy termination.
DATA SYNTHESIS
Mifepristone is an antiprogestin available for pregnancy termination in combination with a prostaglandin such as misoprostol. Mifepristone offers efficacy similar to, if not better than, other drugs used for pregnancy termination, but appears less efficacious overall than surgical termination of pregnancy. Mifepristone in combination with misoprostol commonly causes adverse effects such as abdominal pain and, less commonly, can cause serious adverse effects such as incomplete abortion; endometritis; and bleeding warranting transfusion, hospitalization, or surgery. Mifepristone is metabolized by the cytochrome P450 system. Thus, the potential for drug interactions with this agent exists, although this has not been well studied. Data are included from clinical trials evaluating the safety, tolerability, efficacy, and pharmacoeconomics of mifepristone combined with misoprostol for early pregnancy termination. Data comparing the use of these agents with surgical abortion and other drugs used for pregnancy termination are included where available.
CONCLUSIONS
Mifepristone in combination with misoprostol for the termination of early pregnancy (amenorrhea of < or = 49 d) is effective in 92-95% of women. Incomplete abortion requiring surgical abortion after the fact occurs in 3-5% of women, and pregnancy continues 1-2% of the time. Mifepristone with misoprostol treatment is not without significant risks, including hemorrhage, infection, and potential for long-term emotional consequences.
Topics: Abortifacient Agents, Steroidal; Abortion, Induced; Clinical Trials as Topic; Cost-Benefit Analysis; Counseling; Drug Interactions; Female; Humans; Mifepristone; Treatment Outcome
PubMed: 11408990
DOI: 10.1345/aph.10397 -
Clinical Obstetrics and Gynecology Jun 1996
Review
Topics: Animals; Antineoplastic Agents, Hormonal; Breast Neoplasms; Clinical Trials as Topic; Female; Hormone Antagonists; Humans; Meningeal Neoplasms; Meningioma; Mifepristone
PubMed: 8734014
DOI: 10.1097/00003081-199606000-00023 -
Contraception Jan 2010While pregnant women have sought abortifacients for thousands of years, they had no success at finding one that both worked and did not jeopardize their lives in the... (Review)
Review
While pregnant women have sought abortifacients for thousands of years, they had no success at finding one that both worked and did not jeopardize their lives in the process. The discovery of mifepristone, with both anti-glucocorticoid and anti-progesterone properties, has had a profound effect on women's lives while weaving the abortion-related political hazards. Despite the controversies, millions of women around the world have used mifepristone for medical abortion. This review describes how researchers addressed the numerous barriers of a mifepristone abortion (i.e., gestational age limitation, lengthy process, high costs, complex regimen, failures, side effects and complications) and continue to improve upon the limited numbers and types of clinicians offering mifepristone.
Topics: Abortifacient Agents, Steroidal; Abortion, Induced; Female; Humans; Mifepristone; Pregnancy
PubMed: 20004266
DOI: 10.1016/j.contraception.2009.08.004 -
Seminars in Reproductive Medicine Feb 2005With the addition of a prostaglandin analog, mifepristone allows for successful outpatient termination of pregnancy up to 63 days gestation in 92-99% of women. In the... (Review)
Review
With the addition of a prostaglandin analog, mifepristone allows for successful outpatient termination of pregnancy up to 63 days gestation in 92-99% of women. In the inpatient setting, studies have shown that mifepristone in combination with a prostaglandin analog is also effective as an abortifacient in the late first trimester. In the second trimester, the addition of mifepristone to a prostaglandin regimen has been shown to expedite induction time. At all stages of pregnancy, the use of mifepristone facilitates and ameliorates prostaglandins' expulsive effects on the uterine contents. The rich literature regarding mifepristone in the setting of abortion care has made an important contribution to how physicians treat undesired and problem pregnancies. As with any area of medicine, treatment options provide important flexibility for patients and clinicians alike.
Topics: Abortifacient Agents, Steroidal; Abortion, Induced; Female; History, 19th Century; History, 20th Century; History, Ancient; Humans; Mifepristone; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second
PubMed: 15714392
DOI: 10.1055/s-2005-864036 -
Diskussionsforum Medizinische Ethik 1992The antiprogestin RU 486 converts the early pregnant uterus by increasing the sensitivity of the myometrium to prostaglandin (PG). These effects of antiprogestin have... (Review)
Review
The antiprogestin RU 486 converts the early pregnant uterus by increasing the sensitivity of the myometrium to prostaglandin (PG). These effects of antiprogestin have resulted in the development of nonsurgical procedures to abort embryos based on a combination of RU 486 and different PG-analogues administered vaginally or intramuscularly. RU 486 also has a softening effect on the cervix which may be used as pretreatment in second and third trimester abortions. The effects, mode of action, dangers, and the many other postulated clinical implications (like breast cancer, meningioma, ectopic pregnancy, fetal death in utero, induction of labour, initiation and promotion of lactation, endometrial or ovarian cancers, leukemia, Cushing's syndrome, uterine adenomyosis, acute uremia, leiomyosarcoma, hypertension, etc.) are discussed.
Topics: Abnormalities, Drug-Induced; Abortion, Induced; Animals; Ethics, Medical; Female; Humans; Mifepristone; Pregnancy
PubMed: 1514299
DOI: No ID Found -
Nederlands Tijdschrift Voor Geneeskunde Oct 2022All current hormonal contraceptives have side effects and contraindications related to estrogens and progestins. Users are often dissatisfied with this. There is a great...
All current hormonal contraceptives have side effects and contraindications related to estrogens and progestins. Users are often dissatisfied with this. There is a great need for a new contraceptive drug without these hormones with the associated side effects and contraindications; with also a favorable bleeding profile; that can be used orally and not daily; that can serve as a contraceptive and after-care and can also be used on demand. Mifepristone 50 mg seems to provide the answer to all these wishes but is not (yet) registered in the Netherlands.
Topics: Female; Humans; Mifepristone; Progestins; Contraceptives, Oral, Hormonal; Estrogens; Netherlands
PubMed: 36300464
DOI: No ID Found -
Clinical Obstetrics and Gynecology Jun 1996
Review
Topics: Animals; Brain; Endometrium; Female; Genitalia, Female; Hormone Antagonists; Humans; Male; Mifepristone; Ovary; Receptors, Progesterone; Spermatozoa
PubMed: 8734008
DOI: 10.1097/00003081-199606000-00017 -
The New England Journal of Medicine Mar 1990
Topics: Female; Humans; Mifepristone; Pregnancy; Prostaglandins, Synthetic; United States; United States Food and Drug Administration
PubMed: 2304493
DOI: 10.1056/NEJM199003083221009 -
Current Opinion in Obstetrics &... Jun 2002Mifepristone is an orally active progesterone antagonist. It can be used for both contraceptive and non-contraceptive clinical indications. It is a very effective drug... (Review)
Review
Mifepristone is an orally active progesterone antagonist. It can be used for both contraceptive and non-contraceptive clinical indications. It is a very effective drug for emergency contraception with a low incidence of side effects. There is a potential for mifepristone to be used as a once-a-month pill. There is a need, however, for a simple, inexpensive and accurate method to identify the luteinizing hormone surge before this method can be used in clinical practice. The daily administration of mifepristone offers promise as an effective method of contraception but more studies need to be done. The combination of mifepristone with a prostaglandin analogue is a well-established method for termination of pregnancy of up to 9 weeks. Recent data suggest that this combination may also be used up to 9-13 weeks of pregnancy. Although mifepristone is effective in dilating the cervix before vacuum aspiration, misoprostol is probably the drug of choice in most situations. In the second trimester, mifepristone is effective in shortening the abortion process induced by prostaglandin analogues. The combination of mifepristone and prostaglandin also offers a medical method for management of miscarriages. Mifepristone has been used for a number of other indications, but further studies are needed before such treatment can be recommended.
Topics: Abortifacient Agents, Steroidal; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital, Synthetic; Female; Humans; Mifepristone; Pregnancy
PubMed: 12032390
DOI: 10.1097/00001703-200206000-00013