RU-486 (Mifepristone) Tablets

Active Ingredient	Mifepristone
Type	Abortion
Manufacturer	Zydus Lifesciences Limited

How It Works

RU-486 falls under the class of drugs known as anti progestational steroids. It works by blocking the effects of the female hormone progesterone and causing uterine contractions. Progesterone is an essential female sex hormone that plays a crucial role in the menstrual cycle and maintenance of pregnancy. It helps thicken the lining of the uterus to prepare for a fertilized egg. RU-486 or Mifepristone terminates early pregnancy by blocking the activity of progesterone at the progesterone receptors. 

For people suffering from Cushing’s syndrome, it reduces blood glucose levels by blocking the activity of Cortisol. Cortisol is a stress hormone and a major natural glucocorticoid in the human body. It affects many bodily functions such as controlling blood sugar levels, regulating metabolism, reducing inflammation, and assisting with memory formulation.

Uses

RU-486 is prescribed for the treatment of the following conditions:

1. Abortion – used in combination with Misoprostol to terminate an early pregnancy (not more than 9 weeks) in women.
2. Cushing’s Syndrome – a condition that occurs when the body makes too much of Cortisol resulting in elevated blood sugar levels.

Dosage

RU-486 (Mifepristone) tablet is used in combination with Misoprostol to bring about an early abortion in women. A single pill is intended to be taken orally given by the doctor at the time of your clinical visit. Four tablets of Misoprostol are recommended to be taken after 24 to 48 hours to cause an abortion.

Mifepristone comes in the form of a 200 mg tablet. For the treatment of Cushing’s syndrome, a starting dose of 300 mg per day is recommended. The dosage may be increased within 2 to 4 weeks of the treatment after a proper examination by the doctor. Follow your doctor’s prescription carefully and avoid consuming an overdose of the drug.

Missed Dosage: If you are taking this medication for the termination of pregnancy, missing a dose is not possible. On the other hand, if you take this medication to treat Cushing’s syndrome, take the missed dose as soon as possible. If it’s time for your next scheduled dose, skip the missed dose. Do not take an overdose to make up for the missed dose.

Overdose: An overdose of the drug can lead to serious side effects. If an overdose is suspected, contact your doctor immediately.

Important Advisory

Before you take RU-486, tell your doctor:

1. If it has been more than 10 weeks since your last menstrual period.
2. If you have an IUD in place.
3. If you have a bleeding disorder such as hemophilia.
4. If you have a condition for which you take blood thinners.
5. If you have an ectopic pregnancy.
6. If you have kidney or liver diseases.
7. If you have a history of stroke, heart attack, or congestive heart failure.
8. If you suffer from problems such as diabetes, hypertension, angina, etc.
9. If you are allergic to prostaglandins.
10. If you have endometrial hyperplasia.
11. If you have endometrial cancer.
12. If you have unusual vaginal bleeding.

Side Effects

Common side effects of RU 486 (Mifepristone) include:

1. Vaginal bleeding
2. Cramps
3. Infections
4. Headaches
5. Dizziness
6. Diarrhea
7. Difficult or painful urination
8. Fever, chills, or weakness
9. Nausea
10. Vomiting
11. Uterine cramping
12. Abdominal pain
13. Pain in arms and legs
14. Pelvic pain
15. Fatigue

If any of these side effects persist for long, contact your doctor immediately.

Drug Interactions

Certain drugs are known to interact with RU-486 (Mifepristone) and affect the way it works. If you take any herbal, OTC, recreational, or any other form of drugs, let your doctor know about them.

1. Cyclosporine
2. Fentanyl
3. Blood thinners such as warfarin
4. Dexamethasone
5. Antibiotics such as erythromycin
6. Oral antifungals such as ketoconazole
7. Calcium channel blockers such as amlodipine
8. Carbamazepine
9. Atorvastatin
10. Pimozide
11. Ergotamine
12. HIV Protease inhibitors such as indinavir and ritonavir
13. Phenytoin
14. Rifampin
15. St. John’s Wort

Interaction with alcohol

Consumption of alcohol should be avoided at all costs. Alcohol can deteriorate your health and lead to serious side effects. 

Interaction with grapefruit juice

Grapefruit juice can interact with this medication and lead to various side effects. It can also alter the levels of this medicine in the blood. Avoid consuming grapefruit juice along with this medicine.

Storage Instructions

RU-486 tablets should be stored properly and safely in their original packaging.

1. Keep the tablets away from direct heat, moisture, and sunlight.
2. Keep the tablets out of reach of children.
3. Once the pack is opened, store the remaining pills in an airtight container.
4. Do not consume the medicine past its expiration date.

Substitutes Available

Frequently Asked Questions (FAQs)

How to use the RU 486 abortion pill?

Ans. RU 486, Mifepristone, or the abortion pill is usually taken at the doctor’s clinic. A single tablet of RU 486 or Mifepristone 200 mg is given to you by the doctor which is taken orally as soon as you choose to go with a medical abortion. RU 486 works by blocking the effects of progesterone and stops the pregnancy from growing.

When can RU 486 be taken?

RU-486 should be taken (under the guidance of a doctor) as soon as the pregnancy is diagnosed and you choose to have a medical abortion. RU 486 along with Misoprostol helps to terminate the first-trimester pregnancy of not more than nine weeks.

How effective is RU-486?

Ans. RU-486 is an effective abortion pill that terminates an early pregnancy (of not more than 9 weeks) in women. When taken along with Misoprostol, the efficacy of this regimen is around 97%.

Is RU-486 the same as Plan B?

Ans. RU-486 is an abortion pill whereas Plan B is an emergency contraceptive. RU-486 is used to bring about an abortion in women who are no more than 9 weeks pregnant. On the other hand, Plan B (also known as the morning-after pill) is an emergency contraceptive that is used to stop a pregnancy before it starts.

Can RU486 cause infertility?

Having a medical abortion does not usually cause any complications with future pregnancies. However, there’s a small risk to your fertility and future pregnancies if a womb infection develops during the process. The womb infection spreads to the fallopian tubes and ovaries which increases the risk of infertility or an ectopic pregnancy.

When does the bleeding start after taking Mifepristone?

Most women bleed within the first 24 to 48 hours of consuming Mifepristone. The flow is similar to that of a menstrual period. The bleeding can be managed with the help of sanitary pads.

When does the bleeding stop after taking Mifepristone?

Vaginal bleeding and spotting can last for 9 to 16 days or longer after taking Mifepristone. Your doctor may ask you to visit the clinic for a follow-up after 14 days to check whether the pregnancy has been terminated and to check the amount of bleeding.

References

• Gatter M, Cleland K, Nucatola DL. Efficacy and safety of medical abortion using mifepristone and buccal misoprostol through 63 days. Contraception. 2015 Apr;91(4):269-73. doi: 10.1016/j.contraception.2015.01.005. Epub 2015 Jan 13. PMID: 25592080; PMCID: PMC4373977. Available from: https://pubmed.ncbi.nlm.nih.gov/25592080/
• Drugs H. Mifepristone (Mifeprex): MedlinePlus Drug Information [Internet]. Medlineplus.gov. 2022 [cited 2022 Sep 23]. Available from: https://medlineplus.gov/druginfo/meds/a600042.html
• [Internet]. Medicinenet.com. 2022 [cited 2022 Sep 23]. Available from: https://www.medicinenet.com/mifepristone-oral/article.htm#what_is_mifepristone_and_how_does_it_work_mechanism_of_action
• Mifeprex, Korlym (mifepristone) dosing, indications, interactions, adverse effects, and more [Internet]. Reference.medscape.com. 2022 [cited 2022 Sep 23]. Available from: https://reference.medscape.com/drug/mifeprex-korlym-mifepristone-343130
• Mifepristone: Uses, Interactions, Mechanism of Action | DrugBank Online [Internet]. Go.drugbank.com. 2022 [cited 2022 Sep 23]. Available from: https://go.drugbank.com/drugs/DB00834
• Can having an abortion affect my fertility? [Internet]. nhs.uk. 2022 [cited 2022 Sep 23]. Available from: https://www.nhs.uk/common-health-questions/womens-health/can-having-an-abortion-affect-my-fertility/
• Mifepristone (Mifepristone Linepharma) followed by misoprostol (GyMiso) for terminating early pregnancy | NPS MEDICINEWISE [Internet]. nps.org.au. 2022 [cited 2022 Sep 23]. Available from: https://www.nps.org.au/news/mifepristone-mifepristone-linepharma-followed-by-misoprostol-gy-miso-for-terminating-early-pregnancy

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