What You Need to Know Mifepristone Safety Overview
For over 15 years, medical evidence has indicated thatmifepristone (Mifeprex
Use of mifepristone (Mifeprex®) has been
commonly used medications such as over-the-counter non-
associated with fewer deaths than Tylenol or
steroidal anti-inflammatory drugs and anti-histamines,
Viagra, and is safer than full term pregnancy.
and is less risky than continuing a pregnancy to term. In2007, however, anti-choice legislators re-introduced the
the use of mifepristone and misoprostol and these events
RU-486 Suspension and Review Act, a bill to halt
distribution and sale of mifepristone in the US. Despitemifepristone's established safety record, the bill asserts that
Comparing Medical Risks of Other
mifepristone "has caused a significant number of deaths,near deaths, and adverse reactions."
Medications Mifepristone is safer than acetaminophen (Tylenol®), Mifepristone's Safety Is Well-Established
Aspirin®, and sildenafil (Viagra®). Adverse drug events
Worldwide, millions of women have used mifepristone for
are not uncommon, even with well-accepted and widely
safe and effective early abortion. It is approved for use in
used medications. For example, accidental
38 countries and has been used for nearly 20 years in
acetaminophen overdose is the single most common cause
Europe. In the first 18 months after mifepristone approval
of catastrophic liver failure in the US, causing
in the US, an estimated 80,000 women were treated; 139
approximately 150 deaths annually.3 The American
experienced an adverse event.1 These events-including
Association of Poison Control Centers reported 59 deaths
rash, elevated liver enzymes, medical conditions unrelated
from aspirin poisoning in 2003. Estimates of the number
to mifepristone use, the need for an aspiration procedure,
of excess deaths due to gastrointestinal bleeding from use
as well as one death from ectopic pregnancy-occurred
of aspirin and other non-steroidal anti-inflammatory
at a rate of less than 1% (0.17%, or 170 per 100,000
drugs (such as ibuprofen) range in the thousands.4 From
women treated; see table). Of the more than 850,000 US
1993 to 2000, the US Food and Drug Administration
women who have used mifepristone for early abortion
received over 4,000 adverse event reports, including 55
since its approval nearly eight years ago, seven deaths
reports of death, involving loratadine (Claritin®), a drug
have occurred, one from a ruptured ectopic pregnancy
which recently gained over-the-counter status.5 Among
and the others from overwhelming Clostridium infections
users of sildenafil, there have been approximately five
after women used mifepristone orally and misoprostol
deaths for every 100,000 prescriptions provided.6
vaginally (6 cases) and bucally (1 case). One of these
According to the manufacturer, Pfizer, more than 23
deaths occurred during a clinical trial in Canada. In five
million men worldwide have been prescribed the erectile
of the infection cases, the organism was identified as
dysfunction medication Viagra and more than 1 billion
Clostridium sordellii, an organism which has been seen in
rare infections associated with both childbirth andabortion. The sixth case involved infection with
Comparing Medical Risks of Continuing
Clostridium perfringens. No causal relationship between
Pregnancy to Term A medication abortion with mifepristone is safer than a full term pregnancy, which is often associated with Quick Facts
complications; full-term pregnancy being most risky. Complications of pregnancy and delivery are common
enough that at least 20 to 25% of women require
cesarean section, a major surgery. Pregnancy-relateddeaths, including those at delivery, stillbirth, and ectopic
pregnancy, claim the lives of two to three US women
every day-with 13 deaths reported for every 100,000live births in 1999 (see figure).7
What You Need to Know is a publication of the Association of Reproductive Health Professionals (ARHP) for
health care professionals, educators, and researchers working in the field of reproductive health.
Hausknecht R. Mifepristone and misoprostol for early medical abortion: 18 months
Distribution of pregnancy-related deaths by
experience in the United States. Contraception 2003;67(6):463-465. outcome of pregnancy 1991-1999
U.S. Food and Drug Administration. Questions and Answers on Mifeprex(mifepristone). August 2007. Available at www.fda.gov/cder/drug/infopage/mifepristone/qa2007.htm Accessed on February 26, 2008.
Ostapowicz G, Fontana R, Schiodt F, et al. Results of a prospective study of acute
liver failure at 17 tertiary care centers in the United States. Ann Intern Med
McNeil Consumer & Specialty Pharmaceuticals. Aspirin and other OTC NSAIDs
Background information for Nonprescription Drugs Advisory Committee Meeting,September 20, 2002.
US Food and Drug Administration. Executive Summary on Risk Issues Draftpresented at joint meeting of the Nonprescription Drugs Advisory Committee andthe Pulmonary - Allergy Drugs Advisory Committee. May 11, 2001.
Mitka M. Some men who take Viagra die-why? JAMA 2000;283(5):5901-5591.
Chang J, Elam-Evans L, Berg C, et al. Pregnancy-related mortality surveillance-
United States, 1991-1999. MMWR 2003;52(SS02):1-14.
Patient sought treatment for side effects,
Aspiration procedure for bleeding or persistent
Continuing pregnancy (requiring aspiration
Breast abscess from insect bite resulting in
Mifepristone Safety Overview Updated April 2008
Clinical Rounds Women’s Health I N T E R N A L M E D I C I N E N E W S • S e p t e m b e r 1 5 , 2 0 0 5 D R U G S , P R E G N A N C Y , L A C T A T I O N B Y S H A R O N W O R C E S T E R The autoimmune disorder traindicated in pregnancy. Exposure ofS T. P E T E B E A C H , F L A . — A total of228 adverse e
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