How do medical abortion pills work?
Prescription required
Mifepristone Tablets, 200 mg is only available with a prescription from a healthcare professional. Your provider may give you mifepristone in-person or they may order a prescription from a certified pharmacy to be picked up by you. In some cases, depending on the pharmacy and your state, you may have the option for the prescription to be mailed directly to you.
Before your healthcare provider can prescribe Mifepristone Tablets, 200 mg, you will need to review and sign a Patient Agreement and Medication Guide. These documents are required by the FDA to ensure that you understand how to take the medication, what to expect, possible risks, and who to contact in case problems arise during treatment.
Treatment timeline
Before starting treatment
Meet with your healthcare provider to review and sign the Patient Agreement. You will also receive a Medication Guide to walk you through the medical abortion process. Your provider will give you contact information for questions during treatment or in case of emergency.
Your provider will give you instructions on how to take the 200 mg mifepristone tablet and discuss when to take the misoprostol tablets.
Your provider will prescribe one 200 mg mifepristone tablet and four misoprostol tablets. Your provider may give you the medication in person or your prescription may be filled by a certified pharmacy.
Day 1
Take one 200 mg mifepristone tablet by mouth.
Day 2-3
Once 24-48 hours have passed since you took the mifepristone tablet, place 2 tablets of misoprostol in each cheek pocket. You will have all 4 tablets in your mouth at once.
Leave the tablets in your cheeks for 30 minutes, then swallow all the remnants with water or some other liquid. You can find more information about this step in the Medication Guide.
You can expect side effects like cramping and bleeding within the first 24 hours of taking misoprostol. Other side effects, though rare, are serious and life-threatening. If you notice any of the following side effects after taking misoprostol, seek urgent medical care. In a small number of cases, serious infections have led to death. There is no indication that the use of mifepristone and misoprostol caused these deaths.
Prolonged and/or abnormally heavy bleeding, abdominal pain, lack of bleeding within 24 hours of taking misoprostol, and fever are signs that you should seek immediate medical attention. See "How to know when to seek help" below for more information.
Days 7-14
Have a follow-up appointment with your doctor. This step is very important because it will allow your provider to confirm that the treatment was successful and that you are no longer pregnant.
Medical abortion pills are highly effective, but 2 to 7 people out of every 100 will need follow-up care, like surgical aspiration, to end a pregnancy or to address excessive bleeding.
How to know when to seek help
You can expect side effects like cramping and bleeding within the first 24 hours of taking misoprostol. Other side effects, though rare, are serious and life-threatening. If you notice any of the following side effects after a medical abortion procedure, seek urgent medical care. In a small number of cases, serious infections have led to death. There is no indication that the use of mifepristone and misoprostol caused these deaths.
Contact your healthcare provider immediately if you notice any of the following symptoms:
Heavy Bleeding
Heavy vaginal bleeding, defined by bleeding enough to soak through two full-size sanitary pads per hour for two consecutive hours. Consult your physician if you have concerns about heavy bleeding that are not addressed by this definition.
Severe Abdominal Pain
Abdominal pain or general discomfort that causes you to feel sick, weak, nauseous, or to vomit or have diarrhea, more than 24 hours after you take misoprostol. This pain may or may not be accompanied by a fever. These could be signs of infection or ectopic pregnancy.
Persistent Fever
A fever of 100.4°F (38°C) or higher that persists longer than 4 hours after you take the misoprostol tablets. Fever can be a symptom of infection.
If you cannot contact your provider, go to your nearest emergency room. Bring your Medication Guide with you. The provider who assists you will need to know that you were administered medical abortion with mifepristone.
Mifepristone is not for everyone
Ask your healthcare provider if you are eligible for mifepristone. You should not take mifepristone for a medical abortion if you:
Are over 70 days (10 weeks) into your pregnancy. Your healthcare provider can help you determine how advanced you are in your pregnancy.
Have chronic adrenal failure.
Have porphyria.
Use an IUD (intrauterine device). A provider will need to remove the IUD before administering the pills.
Take blood thinners.
Take steroid medicines. Talk to your provider about contraindications.
If you are diagnosed with an ectopic pregnancy (a pregnancy outside the uterus) by a healthcare provider.
Have a bleeding problem.
Are allergic to mifepristone, misoprostol, or medicines that contain these drugs, like Cytotec or Arthrotec.
Post-abortion contraceptive options
Please note that you can become pregnant again after your pregnancy is terminated. For this reason, you may want to consider starting birth control. Contraception like the oral contraception pill, patch, or ring can be started the day after you take misoprostol. Talk with your healthcare provider about your contraceptive options and what method best suits your lifestyle.
Preparing for medical abortion
People may react differently to taking medical abortion medication, but the following are general recommendations to help improve your experience:
Ask your provider to prescribe or recommend over-the-counter medicines to help with symptoms like cramps and nausea.
Stock up on pads before taking misoprostol, as you will experience bleeding.
Take misoprostol on a day off from school or work so you can focus on self-care.
Minimize obligations and distractions the day you take misoprostol. Make plans for childcare and petcare.
If you feel comfortable, disclose your medical abortion plan to friends and family who you trust so they can help you during the process.
Important Safety Information
What is the most important information I should know about Mifepristone Tablets, 200 mg?
What symptoms should I be concerned with? Although cramping and bleeding are an expected part of ending a pregnancy, rarely, serious and potentially life-threatening bleeding, infections, or other problems can occur following a miscarriage, surgical abortion, medical abortion, or childbirth. Seeking medical attention as soon as possible is needed in these circumstances. Serious infection has resulted in death in a very small number of cases. There is no information that use of Mifepristone Tablets, 200 mg, and misoprostol caused these deaths. If you have any questions, concerns, or problems, or if you are worried about any side effects or symptoms, you should contact your healthcare provider.
Be sure to contact your healthcare provider promptly if you have any of the following:
Heavy Bleeding. Contact your healthcare provider right away if you bleed enough to soak through two thick full-size sanitary pads per hour for two consecutive hours or if you are concerned about heavy bleeding. In about 1 out of 100 women, bleeding can be so heavy that it requires a surgical procedure (surgical aspiration or D&C).
Abdominal Pain or "Feeling Sick." If you have abdominal pain or discomfort, or you are "feeling sick," including weakness, nausea, vomiting, or diarrhea, with or without fever, more than 24 hours after taking misoprostol, you should contact your healthcare provider without delay. These symptoms may be a sign of a serious infection or another problem (including an ectopic pregnancy, a pregnancy outside the womb).
Fever. In the days after treatment, if you have a fever of 100.4°F or higher that lasts for more than 4 hours, you should contact your healthcare provider right away. Fever may be a symptom of a serious infection or another problem.
If you cannot reach your healthcare provider, go to the nearest hospital emergency room. Take the Medication Guide with you. When you visit an emergency room or a healthcare provider who did not give you your Mifepristone Tablets, 200 mg, you should give them your Medication Guide so that they understand that you are having a medical abortion with Mifepristone Tablets, 200 mg.
What to do if you are still pregnant after Mifepristone Tablets, 200 mg with misoprostol treatment. If you are still pregnant, your healthcare provider will talk with you about a surgical procedure to end your pregnancy. In many cases, this surgical procedure can be done in the office/clinic. The chance of birth defects if the pregnancy is not ended is unknown.
Talk with your healthcare provider. Before you take Mifepristone Tablets, 200 mg, you should read the Medication Guide and you and your healthcare provider should discuss the benefits and risks of your using Mifepristone Tablets, 200 mg.
What is Mifepristone Tablets, 200 mg?
Mifepristone Tablets, 200 mg is used in a regimen with another prescription medicine called misoprostol to end an early pregnancy. Early pregnancy means it is 70 days (10 weeks) or less since your last menstrual period began. Mifepristone Tablets, 200 mg is not approved for ending pregnancies that are further along. Mifepristone Tablets, 200 mg blocks a hormone needed for your pregnancy to continue. When you use Mifepristone Tablets, 200 mg on Day 1, you also need to take another medicine called misoprostol 24 to 48 hours after you take Mifepristone Tablets, 200 mg to cause the pregnancy to be passed from your uterus.
The pregnancy is likely to be passed from your uterus within 2 to 24 hours after taking Mifepristone Tablets, 200 mg and misoprostol. When the pregnancy is passed from the uterus, you will have bleeding and cramping that will likely be heavier than your usual period. About 2 to 7 out of 100 women taking Mifepristone Tablets, 200 mg will need a surgical procedure because the pregnancy did not completely pass from the uterus or to stop bleeding.
Who should not take Mifepristone Tablets, 200 mg?
Some patients should not take Mifepristone Tablets, 200 mg. Do not take Mifepristone Tablets, 200 mg if you:
- Have a pregnancy that is more than 70 days (10 weeks). Your healthcare provider may do a clinical examination, an ultrasound examination, or other testing to determine how far along you are in pregnancy.
- Are using an IUD (intrauterine device or system). It must be taken out before you take Mifepristone Tablets, 200 mg.
- Have been told by your healthcare provider you have a pregnancy outside the uterus (ectopic pregnancy).
- Have problems with your adrenal glands (chronic adrenal failure).
- Take medicine to thin your blood.
- Have a bleeding problem.
- Have porphyria.
- Take certain steroid medicines.
- Are allergic to mifepristone, misoprostol or medicines that contain misoprostol, such as Cytotec or Arthrotec.
Ask your healthcare provider if you are not sure about all your medical conditions before taking this medicine to find out if you can take Mifepristone Tablets, 200 mg.
What should I tell my healthcare provider before taking Mifepristone Tablets, 200 mg?
Before you take Mifepristone Tablets, 200 mg, tell your healthcare provider if you:
- Cannot follow-up within approximately 7 to 14 days of your first visit.
- Are breastfeeding. Mifepristone Tablets, 200 mg can pass into your breast milk. The effect of the Mifepristone Tablets, 200 mg and misoprostol regimen on the breastfed infant or on milk production is unknown.
- Are taking medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Mifepristone Tablets, 200 mg and certain other medicines may affect each other if they are used together. This can cause side effects.
How should I take Mifepristone Tablets, 200 mg?
Mifepristone Tablets, 200 mg will be given to you by a healthcare provider or pharmacy.
You and your healthcare provider will plan the most appropriate location for you to take the misoprostol, because it may cause bleeding, cramps, nausea, diarrhea, and other symptoms that usually begin within 2 to 24 hours after taking it.
Most women will pass the pregnancy within 2 to 24 hours after taking the misoprostol tablets.
Follow the instruction below on how to take Mifepristone Tablets, 200 mg and misoprostol:
Mifepristone Tablets, 200 mg (1 tablet) orally + misoprostol (4 tablets) buccally
Day 1:
Take 1 Mifepristone 200 mg Tablet by mouth.
24 to 48 hours after taking Mifepristone Tablets, 200 mg:
Take 4 misoprostol tablets by placing 2 tablets in each cheek pouch (the area between your teeth and cheek) for 30 minutes and then swallow anything left over with a drink of water or another liquid.
The medicines may not work as well if you take misoprostol sooner than 24 hours after Mifepristone Tablets, 200 mg or later than 48 hours after Mifepristone Tablets, 200 mg.
Misoprostol often causes cramps, nausea, diarrhea, and other symptoms. Your healthcare provider may send you home with medicines for these symptoms.
Follow-up Assessment at Day 7 to 14:
This follow-up assessment is very important. You must follow up with your healthcare provider about 7 to 14 days after you have taken Mifepristone Tablets, 200 mg, to be sure you are well, that you have had bleeding, and the pregnancy has passed from your uterus.
Your healthcare provider will assess whether your pregnancy has passed from your uterus. If your pregnancy continues, the chance that there may be birth defects is unknown. If you are still pregnant, your healthcare provider will talk with you about a surgical procedure to end your pregnancy.
If your pregnancy has ended, but not yet completely passed from your uterus, your provider will talk with you about other choices you have, including waiting, taking another dose of misoprostol, or having a surgical procedure to empty your uterus.
When should I begin birth control?
You can become pregnant again right after your pregnancy ends. If you do not want to become pregnant again, start using birth control as soon as your pregnancy ends or before you start having sexual intercourse again.
What should I avoid while taking Mifepristone Tablets, 200 mg and misoprostol?
Do not take any other prescription or over-the-counter medicines (including herbal medicines or supplements) at any time during the treatment period without first asking your healthcare provider about them because they may interfere with the treatment. Ask your healthcare provider about what medicines you can take for pain and other side effects.
What are the possible side effects of Mifepristone Tablets, 200 mg and misoprostol?
Mifepristone Tablets, 200 mg may cause serious side effects. See "What is the most important information I should know about Mifepristone Tablets, 200 mg?" above.
Cramping and bleeding. Cramping and vaginal bleeding are expected with this treatment. Usually, these symptoms mean that the treatment is working. But sometimes you can get cramping and bleeding and still be pregnant. This is why you must follow-up with your healthcare provider approximately 7 to 14 days after taking Mifepristone Tablets, 200 mg. See "How should I take Mifepristone Tablets, 200 mg?" for more information on your follow-up assessment. If you are not already bleeding after taking Mifepristone Tablets, 200 mg, you probably will begin to bleed once you take misoprostol, the medicine you take 24 to 48 hours after Mifepristone Tablets, 200 mg. Bleeding or spotting can be expected for an average of 9 to 16 days and may last for up to 30 days. Your bleeding may be similar to, or greater than, a normal heavy period. You may see blood clots and tissue. This is an expected part of passing the pregnancy.
The most common side effects of Mifepristone Tablets, 200 mg treatment include: nausea, weakness, fever/chills, vomiting, headache, diarrhea and dizziness. Your provider will tell you how to manage any pain or other side effects. These are not all the possible side effects of Mifepristone Tablets, 200 mg.
Call your healthcare provider for medical advice about any side effects that bother you or do not go away. You may report side effects to FDA at 1-800-FDA-1088.
General information about the safe and effective use of Mifepristone Tablets, 200 mg.
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. This Medication Guide summarizes the most important information about Mifepristone Tablets, 200 mg. If you would like more information, talk with your healthcare provider. You may ask your healthcare provider for information about Mifepristone Tablets, 200 mg, that is written for healthcare professionals.
For additional information about Mifepristone Tablets, 200 mg, go to www.medicalabortionpill.com or call 1-866-718-0098.