Mifepristone in the context of "Misoprostol"

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⭐ Core Definition: Mifepristone

Mifepristone, and also known by its developmental code name RU-486, is a drug typically used in combination with misoprostol to bring about a medical abortion during pregnancy. This combination is 97% effective during the first 63 days (9 weeks) of pregnancy, and is effective in the second trimester as well. It is also used on its own to treat Cushing's syndrome or in low doses as an emergency contraceptive.

The most common adverse effects include abdominal pain, feeling tired, and vaginal bleeding. Serious side effects may include heavy vaginal bleeding, bacterial infection, and, if pregnant, birth defects. When used, appropriate follow-up care needs to be available. Mifepristone is primarily an antiprogestogen. It works by blocking the effects of progesterone, making both the cervix and uterine vessels dilate and causing uterine contraction. Mifepristone also works, to a lesser extent, as an antiglucocorticoid and diminishes the effects of hypercortisolism.

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👉 Mifepristone in the context of Misoprostol

Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. It is taken by mouth when used to prevent gastric ulcers in people taking nonsteroidal anti-inflammatory drugs (NSAID). For abortions it is typically used in conjunction with mifepristone or methotrexate, but can be used alone. By itself, effectiveness for abortion is between 82% and 100%. Its efficacy with mifepristone is higher, but varies based on gestational age. The misoprostol-only abortion regimen is typically recommended only when mifepristone is not available. For labor induction or abortion, it is taken by mouth, dissolved in the mouth, or placed in the vagina. For postpartum bleeding it may also be used rectally.

Common side effects include diarrhea and abdominal pain. It is in pregnancy category X, meaning that it is known to result in negative outcomes for the fetus if taken during pregnancy. In rare cases, uterine rupture may occur. It is a prostaglandin analogue—specifically, a synthetic prostaglandin E1 (PGE1).

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Mifepristone in the context of Abortion

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. The unmodified word abortion generally refers to induced abortion, or deliberate actions to end a pregnancy. Abortion occurring without intervention is known as spontaneous abortion or "miscarriage", and occurs in roughly 30–40% of all pregnancies. Common reasons for inducing an abortion are birth-timing and limiting family size. Other reasons include maternal health, an inability to afford a child, domestic violence, lack of support, feelings of being too young, wishing to complete an education or advance a career, and not being able, or willing, to raise a child conceived as a result of rape or incest.

When done legally in industrialized societies, induced abortion is one of the safest procedures in medicine. Modern methods use medication or surgery for abortions. The drug mifepristone (aka RU-486) in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimesters of pregnancy. Self-managed medication abortion is highly effective and safe throughout the first trimester. The most common surgical technique involves dilating the cervix and using a suction device. Birth control, such as the pill or intrauterine devices, can be used immediately following an abortion. When performed legally and safely on a woman who desires it, an induced abortion does not increase the risk of long-term mental or physical problems. In contrast, unsafe abortions performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities cause between 22,000 and 44,000 deaths and 6.9 million hospital admissions each year — responsible for between 5% and 13% of maternal deaths, especially in low-income countries. The World Health Organization states that "access to legal, safe and comprehensive abortion care, including post-abortion care, is essential for the attainment of the highest possible level of sexual and reproductive health". Public health data show that making safe abortion legal and accessible reduces maternal deaths.

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Mifepristone in the context of Medical abortion

A medical abortion, also known as medication abortion or non-surgical abortion, occurs when drugs (medication) are used to bring about an abortion. Medical abortions are an alternative to surgical (also called procedural or instrumentation) abortions such as vacuum aspiration or dilation and curettage. Medical abortions are more common than surgical abortions in most places around the world.

Medical abortions are most commonly performed by administering a two-drug combination: mifepristone followed by misoprostol. This two-drug combination is more effective than other drug combinations. When mifepristone is not available, misoprostol alone may be used in some situations.

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Mifepristone in the context of Antiglucocorticoid

Antiglucocorticoid drugs are a class of medications that act to reduce the effects of glucocorticoids, primarily cortisol, in the body. They include direct glucocorticoid receptor antagonists such as mifepristone and synthesis inhibitors such as metyrapone, ketoconazole, and aminoglutethimide. They are used to treat Cushing's syndrome.

These drugs have also been investigated for their potential therapeutic benefits in various psychiatric disorders, particularly depression and psychosis. The rationale behind using antiglucocorticoids in psychiatry stems from the observed dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in many psychiatric conditions, which often manifests as elevated cortisol levels.

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