First-lineMifegyne
Mifepristone
Selective progesterone receptor modulator (antiprogestin)
Primes the pregnancy for misoprostol — medical TOP and miscarriage.
Oral
First-line for
- Medical termination of pregnancy (up to 24 weeks)
- Management of missed/incomplete miscarriage
Mechanism
Competitive progesterone receptor antagonism → decidual breakdown, ↑ uterine PG sensitivity, cervical softening.
“M&M” combo
- Mifepristone day 1 → Misoprostol 24–48 h later
- M primes, M expels
Dosing
- EMA (≤10 wks)
- 200 mg PO, misoprostol 24–48 h later
- Missed miscarriage
- 200 mg PO, misoprostol 48 h later
Contraindications
- AbsoluteChronic adrenal failure
- AbsoluteSuspected ectopic pregnancy
- AbsoluteInherited porphyria, long-term corticosteroid therapy
Side effects
- Nausea, cramping, light bleeding
- Headache, fatigue
- Rarely: rash
Fetal & maternal notes
- • If pregnancy continues after exposure — increased risk of malformations; offer surgical completion.
Key interactions
NSAIDs
OKDo NOT reduce efficacy — co-prescribe for pain
CYP3A4 inhibitors/inducers
CautionAlter mifepristone levels
Clinical pearls
- 💡 Anti-D required for Rh-negative women >10 weeks.
- 💡 Confirm completion with hCG fall or USS.
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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