Mifegymiso, also known by the name RU-486, is a two-drug combination of mifepristone and misoprostol that can be used to terminate a pregnancy in Canada up to 49 days (7 weeks) from the start of the last menstrual period. American women can now take it up to 70 days into a pregnancy.
Mifegymiso, already used in more than 60 countries for decades, is free as of August 10th in Ontario. It took a decade for the drug to be approved in Canada, one of the longest drug-approval processes ever. The Province is poised to give women more autonomy over their reproductive health and rights. It is touted as a way to give women in rural and remote areas a less invasive option to terminate their pregnancies.
This drug was approved for use in Canada in July 2015 after a lengthy study by Health Canada. It has slowly become available for distribution in Canada since then.
Women will be able to fill their prescription at a pharmacy and have the abortion — which is the same experience as an early-term miscarriage — at home.
Doctors must also confirm the pregnancy is in its early stages with an ultrasound before the drug can be prescribed and to make sure there are no medical complications (especially ectopic pregnancy).
Mifegymiso has been available with a prescription since January 2017 in Ontario, but cost between $300 and $400. Pharmacists bill the ministry $337.25 for the drug, which includes the mark-up and dispensing fee. Doctors prescribing it have to take an online training course of six hours. For the patient, now it’s free in Ontario.
A few words about the two drugs that compose Mifegymiso.
First drug is Mifepristone: this is synthetic steroid which block the progesterone receptors, inducing contraction in the myometrium (the smooth muscle that comprises the middle layer of the uterine wall) which will start the expulsion of the fetus. It has a boxed warning (highest level of warning that FDA requires sometimes) for bacterial infection and bleeding that were reported when used for termination of pregnancy (with an atypical presentation) but these side effects were very rare.
The second drug is Misoprostol: this is a prostaglandin. It is used to reduce the amount of acid released by the stomach and protecting the stomach lining, which helps to reduce the risk of stomach ulcers. It was discovered that has abortifacient properties when women taking it for stomach ulcers had the surprise of their lives when they started to bleed and lost their pregnancy. So now it comes with a boxed warning too, saying that “ADMINISTRATION TO WOMEN WHO ARE PREGNANT CAN CAUSE BIRTH DEFECTS, ABORTION, PREMATURE BIRTH OR UTERINE RUPTURE”.
So imagine now these two drugs taken together.
The combination is highly effective in inducing an abortion, with a 95- to 98-percent effectiveness rate.
Mifegymiso is a composite pack containing one mifepristone 200 mg tablet for oral use and four misoprostol 200 mcg tablets for oral use and there is a 2-step process when you want to take this that will be explained to you when you get your prescription. It is important to take it exactly as prescribed.
The side effects: mainly bleeding (up to 10 days), pain and cramping. Other side effects can or may include diarrhea, nausea, vomiting, fever/chills, headache, dizziness and weakness.
All patients should be followed up by a physician 7 to 14 days after taking this to confirm complete pregnancy termination and to verify that there is no excessive bleeding or infection.