Mifepristone (Medically Induced Abortion Drug) _ Uses, Mechanism Of Action, Dose, Adverse Effects

Mifepristone, is a progesterone and glucocorticoid receptor antagonist, given along with misoprostol, for medically induced termination of pregnancy within the first 10 weeks of gestation. In addition, it is also indicated for the treatment of hyperglycemia in patients with Cushing syndrome. Off label uses of mifepristone include, post coital emergency contraception. Induction of cervical maturation. And as an adjunct therapy for uterine fibroids.
Progesterone is one of the 2 major sex hormones in females, and it plays a major role in early pregnancy. It is secreted in large amounts by the corpus luteum of the ovary during the early weeks of gestation. It is responsible for preparing and maintaining the uterine endometrium for implantation. In addition, it suppresses the maternal immunologic response against fetal antigens, which prevents maternal rejection of the embryo. It also inhibits prostaglandin synthesis in the body. Prostaglandin promotes contraction of uterine smooth muscles, which may lead to expulsion of the fetus during early pregnancy. Finally, progesterone is also important in the development of maternal breast tissue.
Antagonism of progesterone receptors by mifepristone leads to decreased action of progesterone on the uterine endometrium, and leads to unopposed prostaglandin synthesis. Decreased progesterone action leads to necrosis and shedding of the decidual endometrium, which makes it unfavorable for the implantation. Unopposed prostaglandin synthesis leads to increased contractions of the uterine smooth muscle cells, which also makes the implantation difficult.
Mifepristone is taken per orally. It is available as 200 and 300mg tablets. For pregnancy termination, a 200mg single dose is recommended. For the treatment of hyperglycemia in Cushing syndrome, the initial dose should be 300mg once daily with meals, and the dose can be increased subsequently up to 1200mg per day. For emergency contraception, a 600mg single dose is recommended within 72 hours of unprotected sexual intercourse.
Serious adverse effects of mifepristone include, anaphylaxis. Toxic epidermal necrolysis. And angioedema. Moderate adverse effects include, hypokalemia. Peripheral edema. Hypertension. Hypoglycemia. Constipation. And vaginal bleeding. Mild side effects include, nausea and vomiting. Abdominal pain. Fatigue. Headache. Dizziness. And menstrual irregularities.

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