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Home/ Areas of Care/ Maternal, Newborn and Paediatric Care/ Pregnancy and Birth/ During Pregnancy/ Early Pregnancy Assessment Clinic/ Miferpristone & Misoprostol Combination Therapy for Miscarriage

Miferpristone & Misoprostol Combination Therapy for Miscarriage

Mifepristone and misoprostol used together are an effective way to treat your miscarriage and potentially avoid surgery. Mifepristone and misoprostol together are more effective than misoprostol alone. This treatment is 80-90% effective in completing a miscarriage. Occasionally some women may need an additional dose of Misoprostol or a dilation and curettage (D&C), or prefer to wait.

The North York General Hospital pharmacy will give you:

  • Mifegymiso
    • Green box: Mifepristone (1 tablet)
    • Orange box: one dose (4 tablets) of Misoprostol
  • An additional bottle with (4 tablets) of Misoprostol

* The hospital Pharmacy will waive its dispensing fees for the Mifegymiso and the extra Misoprostol

WHEN TO TAKE THE MEDICINES

1. Take one tablet of Mifepristone (Green box) by mouth with lots of water.

  • You might have some bleeding but often you will feel nothing different.

2. 24 hours after you take the Mifepristone, take the Misoprostol tablets (Orange box).

  • These tablets are placed in your vagina (see instructions below).

3. 48 hours after you take the Mifepristone tablets (step one), place the second dose of Misoprostol (from the Pharmacy bottle) into your vagina, whether you have bleeding or not.

HOW TO INSERT THE MISOPROSTOL INTO YOUR VAGINA

  • Each dose of Misoprostol consists of four tablets.
  • Wash your hands and lie down with your legs apart. You do not need to wear gloves.
  • Gently push one tablet at a time, for a total of four tablets, as far up into your vagina as you can. You cannot put them in too far.
  • Note the time you inserted the first dose of Misoprostol tablets (Step 2) so you know when to take the second dose of Misoprostol (Step 3).
  • Rest for 20 minutes before resuming normal activity.
  • Do not worry if you still find tablets present in your vagina several hours later.
    • The medication is rapidly absorbed by your body shortly after the tablets are inserted and there is no harm to you. Occasionally they may even fall out.

WHO SHOULD NOT TAKE THESE MEDICATIONS

Mifegynemiso should not be used if you have chronic adrenal failure, severe asthma, inherited porphyria, an allergy to the medications, a bleeding disorder, an IUD in the uterus or if you are taking long-term corticosteroids (for example, prednisone or cortisone), anticoagulants or if you are unable to access emergency medical care in the event of excessive bleeding (you are soaking more than 2-3 thick pads per hour for more than 2 hours).

WHAT TO EXPECT

  • Cramping
    • Cramping and bleeding often starts 2 – 4 hours after the insertion of the tablets into your vagina.
    • You may feel uncomfortable and want to rest or be away from public areas so plan your activities with this in mind.
    • Cramping can be quite painful so use your pain medication
      • You may take Tylenol® 1000mg every 6 hours
      • You may take Naprosyn® 500mg every 12 hours
      • Tylenol® and Naprosyn® can be taken together
      • If you are still having pain, take Hydromorphone 1mg (prescription medication) every 6 hours as needed
      • If you are taking Hydromorphone, you should not drive
  • Bleeding
    • Usually lasts between 1 – 4 hours but may continue for 24 hours in some women.
    • These are average times and Misoprostol takes longer to work in some women.
    • You will need to wear a thick sanitary pad. Do not wear tampons at this time.
    • Over the next few days, the bleeding should slow down.
    • Most women have light bleeding for 7 – 10 days after the passage of the pregnancy.
    • Some women may bleed for longer, some for less time, as long as it is not heavy bleeding (soaking a pad an hour) this is okay.
  • Side-effects
    • Side-effects of Misoprostol: chills, fever, nausea, vomiting and diarrhea.
    • Most people find these side effects tolerable.
  • Go to the nearest EMERGENCY DEPARTMENT if you have any of the following:
    • Excessive bleeding (more than 2-3 thick pads per hour for more than 2 hours)
    • Severe pain or cramping that is not relieved with pain medication
  • Call the Early Pregnancy Assessment Clinic (EPAC) at 416-756-6837 if you have fever, chills or foul-smelling vaginal discharge.
    • Clinic hours are Monday, Wednesday and Friday from 9 a.m. to 12 p.m.
    • Urgent telephone messages are addressed on Tuesday and Thursday afternoons.
    • If outside normal business hours, please go to the Emergency Department.

FOLLOW-UP

  • Routine follow-up arranged at EPAC within 10-14 days.
    • We will do an ultrasound and discuss any concerns that you have.
  • If you have not had bleeding or cramping within 2-7 days after completing the medication and wish to discuss other options, please call us for an earlier appointment.
  • Emotional and Bereavement Support
    • Everyone responds to a miscarriage in a different way.
    • Please reach out to a member of the team if you need additional support or resources.
    • Pregnancy and Infant Loss Network offers free group & individual peer support services. o https://pailnetwork.sunnybrook.ca/ or Tel:1-888-303-7245.