What medication is used for managing miscarriage?

From the Guidelines

Misoprostol is the primary medication used for managing miscarriage, often in combination with mifepristone for increased effectiveness. For a complete medical management regimen, mifepristone 200mg is taken orally, followed 24-48 hours later by misoprostol 800mcg administered vaginally or buccally (between cheek and gum) 1. In settings where mifepristone is unavailable, misoprostol alone can be used at a dose of 800mcg vaginally, buccally, or sublingually, potentially repeated after 3 hours if expulsion hasn't occurred.

Key Considerations

• Patients should expect cramping and bleeding, often heavier than a normal period, which typically begins within hours of misoprostol administration.
• Pain management with ibuprofen (600-800mg every 6 hours) and possibly stronger prescription pain medication is recommended.
• Follow-up is essential 1-2 weeks after treatment to confirm complete expulsion through ultrasound or blood tests measuring pregnancy hormone levels.
• These medications work by causing uterine contractions that help expel pregnancy tissue, with misoprostol specifically causing cervical softening and uterine contractions while mifepristone blocks progesterone receptors, destabilizing the pregnancy.

Important Safety Information

• Use of misoprostol in women with previous cesarean delivery should be avoided because of the possibility of uterine rupture 1.
• The use of higher dosages of misoprostol (50 µg every six hours) to induce labor may be appropriate in some situations, although increased risk of complications, including uterine hyperstimulation, has been reported.

Cost Considerations

• According to the ACOG committee, there is a significant cost difference between misoprostol and dinoprostone for induction of labor, with misoprostol being the more cost-effective option 1.

From the FDA Drug Label

Mifepristone is contraindicated in pregnant patients. Mifepristone reduces the effectiveness of hormonal contraceptives Mifepristone can cause serious side effects, including: Loss of a pregnancy Women who can become pregnant must: have a negative pregnancy test before starting mifepristone Mifepristone is a prescription medicine used to treat high blood sugar (hyperglycemia) caused by high cortisol levels in the blood (hypercortisolism) in adults with endogenous Cushing's syndrome

Mifepristone is used for managing miscarriage as it can cause loss of a pregnancy.

• Main uses: Mifepristone is used to treat high blood sugar caused by high cortisol levels in adults with endogenous Cushing's syndrome.
• Contraindications: Mifepristone is contraindicated in pregnant patients.
• Side effects: Mifepristone can cause serious side effects, including loss of a pregnancy. 2

From the Research

Medication for Managing Miscarriage

The medication used for managing miscarriage typically involves a combination of mifepristone and misoprostol.

• Mifepristone is a progesterone receptor antagonist, and misoprostol is a prostaglandin E1 analogue 3, 4, 5.
• The most effective regimens for medication management of early pregnancy loss and medication abortion include 200 mg of oral mifepristone followed by 800 mcg of misoprostol administered buccally or vaginally 3.
• The addition of mifepristone to medical treatment regimens for first trimester miscarriage significantly decreases the need for repeat medical dosing and surgical curettage 4.

Administration and Efficacy

• Mifepristone and misoprostol can be administered simultaneously or 24 hours apart for abortion, with similar efficacy and adverse effects 6.
• The complete abortion rate for simultaneous administration is statistically noninferior to that for a 24-hour dosing interval 6.
• The efficacy of the medication regimen decreases with increasing gestational age, with higher failure rates and more adverse effects observed in women with pregnancies of 57-63 days' duration 7.

Adverse Effects and Management

• Adverse effects of misoprostol include low-grade fever, gastrointestinal symptoms, nausea, diarrhea, and vaginal bleeding 3, 6, 7.
• These adverse effects can be managed with nonsteroidal anti-inflammatory drugs or antiemetics 3.
• Ongoing pregnancy, infection, hemorrhage, undiagnosed ectopic pregnancy, and the need for unplanned uterine aspiration are rare complications 3.