Start dispensing mifepristone today
Become a certified pharmacy to start dispensing
Certified pharmacies can better serve their customers with a new mifepristone option. Pharmacy-friendly packaging, seamless ordering, and timely fulfillment bring healthcare into the hands of your customers.
Becoming certified to dispense mifepristone is simple. Follow these steps to become an Evita Solutions certified pharmacy:
Identify a champion to serve as your authorized representative to streamline communication, oversee implementation of the Mifepristone Risk Evaluation and Mitigation Strategy (REMS) Program, and manage compliance.
Download a Pharmacy Agreement.
Complete the form and sign where indicated.
Return the Pharmacy Agreement form to the fax number listed on the form or to customerservice@evitasolutionsllc.com.
Pharmacists can also fill out the Pharmacy Agreement online through our secure portal.
Our distributor will contact you directly once you are ready to begin ordering mifepristone.
Dispensing regulations
Mifepristone is available only under an FDA-mandated Risk Evaluation and Mitigation Strategy (REMS) program. To become a certified pharmacy and start filling prescriptions for Evita Solutions generic Mifepristone Tablets, 200 mg, a pharmacy must meet the requirements of the Mifepristone REMS Program.
All pharmacies dispensing mifepristone must:
Identify an authorized representative acting on behalf of the pharmacy to oversee implementation and compliance with the Mifepristone REMS Program.
Deliver Mifepristone Tablets, 200 mg to the patient within 4 calendar days of the date the pharmacy receives the prescription, unless otherwise approved by the prescriber.
Record the NDC and lot number of each package of Mifepristone Tablets, 200 mg dispensed in the patient's record.
Track and verify receipt of each shipment of Mifepristone Tablets, 200 mg.
Contact the prescriber and Evita Solutions immediately to report any adverse events, designating the patient by a non-identifiable reference and the recorded NDC and lot number of the dispensed Evita Solutions generic mifepristone.
Train all relevant staff on the Mifepristone REMS Program requirements.
Prescribing regulations
Mifepristone is used in combination with misoprostol to end an early pregnancy. "Early" is defined as up to 70 days from the first day of the patient's last menstrual period.
Inform patients:
To orally administer one 200 mg mifepristone tablet.
To buccally administer four 200 mcg misoprostol tablets 24-48 hours after mifepristone is ingested. Two tablets are placed in each cheek pouch for 30 minutes and any remnants are swallowed with liquid.
That the healthcare provider may prescribe or recommend additional medicine or prescriptions to help manage common cramps or gastrointestinal symptoms.
That most pregnancies will be expelled within 2-24 hours after the administration of the misoprostol.
That patients must follow up with their healthcare provider 7 to 14 days following ingestion of the generic mifepristone to assess bleeding and confirm termination of pregnancy.
Mifepristone Tablets, 200 mg is indicated, in a regimen with misoprostol, for the medical termination of intrauterine pregnancy through 70 days gestation.
Important Safety Information
WARNING: SERIOUS AND SOMETIMES FATAL INFECTIONS AND BLEEDING
Serious and sometimes fatal infections and bleeding occur very rarely following spontaneous, surgical, and medical abortions, including following Mifepristone Tablets, 200 mg use. No causal relationship between the use of Mifepristone Tablets, 200 mg and misoprostol and these events has been established.
Atypical Presentation of Infection. Patients with serious bacterial infections (e.g., Clostridium sordellii) and sepsis can present without fever, bacteremia, or significant findings on pelvic examination following an abortion. Very rarely, deaths have been reported in patients who presented without fever, with or without abdominal pain, but with leukocytosis with a marked left shift, tachycardia, hemoconcentration, and general malaise. A high index of suspicion is needed to rule out serious infection and sepsis.
Bleeding. Prolonged heavy bleeding may be a sign of incomplete abortion or other complications and prompt medical or surgical intervention may be needed. Advise patients to seek immediate medical attention if they experience prolonged heavy vaginal bleeding.
Because of the risks of serious complications described above, Mifepristone Tablets, 200 mg is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the Mifepristone REMS Program.
Before prescribing mifepristone tablets, inform the patient about the risk of these serious events. Ensure that the patient knows whom to call and what to do, including going to an Emergency Room if none of the provided contacts are reachable, if they experience sustained fever, severe abdominal pain, prolonged heavy bleeding, or syncope, or if they experience abdominal pain or discomfort, or general malaise (including weakness, nausea, vomiting, or diarrhea) for more than 24 hours after taking misoprostol.
Contraindications
Administration of Mifepristone Tablets, 200 mg and misoprostol for the termination of pregnancy (the "treatment procedure") is contraindicated in patients with any of the following conditions:
- Confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass (the treatment procedure will not be effective to terminate an ectopic pregnancy)
- Chronic adrenal failure (risk of acute adrenal insufficiency)
- Concurrent long-term corticosteroid therapy (risk of acute adrenal insufficiency)
- History of allergy to mifepristone, misoprostol, or other prostaglandins (allergic reactions including anaphylaxis, angioedema, rash, hives, and itching have been reported)
- Hemorrhagic disorders or concurrent anticoagulant therapy (risk of heavy bleeding)
- Inherited porphyrias (risk of worsening or of precipitation of attacks)
Use of Mifepristone Tablets, 200 mg and misoprostol for termination of intrauterine pregnancy is contraindicated in patients with an intrauterine device ("IUD") in place (the IUD might interfere with pregnancy termination). If the IUD is removed, Mifepristone Tablets, 200 mg may be used.
Warnings and Precautions
Infection and Sepsis
As with other types of abortion, cases of serious bacterial infection, including very rare cases of fatal septic shock, have been reported following the use of Mifepristone Tablets, 200 mg. Healthcare providers evaluating a patient who is undergoing a medical abortion should be alert to the possibility of this rare event. A sustained (> 4 hours) fever of 100.4°F or higher, severe abdominal pain, or pelvic tenderness in the days after a medical abortion may be an indication of infection.
A high index of suspicion is needed to rule out sepsis (e.g., from Clostridium sordellii) if a patient reports abdominal pain or discomfort or general malaise (including weakness, nausea, vomiting, or diarrhea) more than 24 hours after taking misoprostol. Very rarely, deaths have been reported in patients who presented without fever, with or without abdominal pain, but with leukocytosis with a marked left shift, tachycardia, hemoconcentration, and general malaise. No causal relationship between Mifepristone Tablets, 200 mg and misoprostol use and an increased risk of infection or death has been established. Clostridium sordellii infections have also been reported very rarely following childbirth (vaginal delivery and caesarian section), and in other gynecologic and non-gynecologic conditions.
Uterine Bleeding
Uterine bleeding occurs in almost all patients during a medical abortion. Prolonged heavy bleeding (soaking through two thick, full-size sanitary pads per hour for two consecutive hours) may be a sign of incomplete abortion or other complications, and prompt medical or surgical intervention may be needed to prevent the development of hypovolemic shock. Counsel patients to seek immediate medical attention if they experience prolonged heavy vaginal bleeding following a medical abortion.
Women should expect to experience vaginal bleeding or spotting for an average of 9 to 16 days. Women report experiencing heavy bleeding for a median direction of 2 days. Up to 8% of all subjects may experience some type of bleeding for 30 days or more. In general, the duration of bleeding and spotting increased as the duration of the pregnancy increased.
Decreases in hemoglobin concentration, hematocrit, and red blood cell count may occur in patients who bleed heavily.
Excessive uterine bleeding usually requires treatment by uterotonics, vasoconstrictor drugs, surgical uterine evacuation, administration of saline infusions, and/or blood transfusions. Based on data from several large clinical trials, vasoconstrictor drugs were used in 4.3% of all subjects, there was a decrease in hemoglobin of more than 2 g/dL in 5.5% of subjects, and blood transfusions were administered to ≤ 0.1% of subjects. Because heavy bleeding requiring surgical uterine evacuation occurs in about 1% of patients, special care should be given to patients with hemostatic disorders, hypocoagulability, or severe anemia.
Mifepristone REMS Program
Mifepristone Tablets, 200 mg is available only through a restricted program under a REMS called the Mifepristone REMS Program, because of the risks of serious complications.
Notable requirements of the Mifepristone REMS Program include the following:
- Prescribers must be certified with the program by completing the Prescriber Agreement Form.
- Patients must sign a Patient Agreement Form.
- Mifepristone Tablets, 200 mg must be dispensed to patients by or under the supervision of a certified prescriber, or by certified pharmacies on prescriptions issued by certified prescribers.
Further information is available at 1-866-718-0098.
Ectopic Pregnancy
Mifepristone Tablets, 200 mg is contraindicated in patients with a confirmed or suspected ectopic pregnancy because mifepristone is not effective for terminating ectopic pregnancies. Healthcare providers should remain alert to the possibility that a patient who is undergoing a medical abortion could have an undiagnosed ectopic pregnancy because some of the expected symptoms experienced with a medical abortion (abdominal pain, uterine bleeding) may be similar to those of a ruptured ectopic pregnancy. The presence of an ectopic pregnancy may have been missed even if the patient underwent ultrasonography prior to being prescribed Mifepristone Tablets, 200 mg.
Patients who became pregnant with an IUD in place should be assessed for ectopic pregnancy.
Rhesus Immunization
The use of Mifepristone Tablets, 200 mg is assumed to require the same preventive measures as those taken prior to and during surgical abortion to prevent rhesus immunization.
Adverse Reactions
Most common adverse reactions (>15%) are nausea, weakness, fever/chills, vomiting, headache, diarrhea, and dizziness.
This is the Important Safety Information. For additional information about Mifepristone Tablets, 200 mg, see the Full Prescribing Information, including Boxed Warning.