Mifeprin (Mifepristone)
Also sold as: Mifeprin, MTP-kit (mifepristone + misoprostol), Korlym, Mifeprex, Trugest
Pregnancy
Cat X
Lactation
Avoid
Schedule
H
Forms
Tablet 200mg (most common in India) +1
Indications
- Medical termination of pregnancy (MTP) — up to 10 weeks (63 days from LMP) in combination with misoprostol (WHO/Indian protocol)
- Missed abortion / failed pregnancy (with misoprostol)
- Emergency contraception (single dose 10–25 mg — off-label; less used than levonorgestrel)
- Cushing's syndrome due to ectopic ACTH or adrenal carcinoma (Korlym — 300 mg, not widely available in India)
- Uterine fibroids (pre-surgical size reduction — specialist use)
Adult Dosing
MTP ≤63 days (WHO regimen)
Mifepristone 200 mg PO on Day 1, then Misoprostol 800 mcg vaginally/sublingual 24–48 hours later
Efficacy >95% at ≤49 days; 92–95% at 49–63 days. Follow-up at 10–14 days mandatory (confirm completion, rule out ongoing pregnancy). Legal in India under MTP Act with registered provider.
MTP 63–84 days (2nd trimester)
Mifepristone 200 mg → Misoprostol 400 mcg vaginally/sublingually every 3 hours × 5 doses
Specialist/hospital setting required
Pediatric Dosing
Adolescent MTP: legally allowed with guardian consent in India under MTP Act 2021
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Mild-moderate CKD | No specific adjustment for MTP use |
Hepatic Adjustment
Caution in severe hepatic impairment — CYP3A4 metabolism; consult specialist
Pregnancy & Lactation
Pregnancy: Category X
Used specifically TO TERMINATE pregnancy — clearly not appropriate for wanted pregnancies. If ongoing pregnancy after failed MTP: fetal exposure to mifepristone is associated with limb defects and genital malformations — surgical termination recommended.
Lactation: Avoid
Excreted in breast milk — avoid breastfeeding for at least 5 days after mifepristone. Discard milk during this period.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Corticosteroids | Mifepristone antagonises glucocorticoid receptors — avoid in patients requiring steroid therapy (may precipitate adrenal insufficiency) | Major |
| NSAIDs (ibuprofen, aspirin) | Theoretical reduction in misoprostol efficacy (prostaglandin inhibition) — avoid high-dose NSAIDs for 8–12 days around MTP | Moderate |
| CYP3A4 inhibitors (ketoconazole, itraconazole) | Increase mifepristone levels | Moderate |
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Side Effects
Common
- Cramping and abdominal pain (expected — uterine expulsion)
- Nausea and vomiting
- Diarrhoea
- Dizziness
- Headache
- Fever (misoprostol component)
- Chills (misoprostol)
Serious / Discontinue If
- Heavy or prolonged bleeding (haemorrhage — requires urgent medical attention)
- Incomplete abortion (retained products — requires surgical evacuation)
- Serious infection (rare — Clostridium sordellii toxic shock — fatal if untreated; present without fever)
- Ongoing pregnancy (0.5–3% failure rate — surgical termination required)
- Ectopic pregnancy NOT treated by mifepristone (must rule out before)
Contraindications
- Ectopic pregnancy (does not treat ectopic — diagnose before)
- IUD in situ (remove before MTP)
- Coagulopathy or anticoagulant therapy
- Chronic adrenal failure
- Inherited porphyria
- Corticosteroid dependency
- Uncontrolled severe asthma
- Gestational age > 63 days (for outpatient medical MTP protocol)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Mifeprin 200mg | Cipla | 1 tab ₹185 |
| MTP Kit (Mifepristone 200mg + Misoprostol 4 × 200 mcg) | Various (Cipla, Mankind) | Kit ₹350–600 |
| Trugest 200mg | Zydus | 1 tab ₹175 |
Monitoring Required
- Serial beta-hCG at 10–14 days post-MTP (to confirm completion)
- Ultrasound if clinical concern (incomplete abortion)
- Heavy bleeding assessment (pad count)
- Signs of infection (fever, malodorous discharge, severe pelvic pain)
Patient Counseling Points
- This is a 2-step process — mifepristone first, then misoprostol 24–48 hours later — both are required
- Cramping and bleeding start after misoprostol — this is expected
- Use sanitary pads (not tampons) — allows monitoring of bleeding
- ⚠️ Seek emergency care immediately for: soaking more than 2 large pads per hour for 2+ hours, signs of infection (fever, chills without using misoprostol, severe pain), or no bleeding at all after misoprostol
- Follow-up appointment at 10–14 days is MANDATORY — ensures procedure complete
- Normal contraception can be started same day (IUD/implant) or at follow-up visit
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Clinically reviewed by: Dr. Anitha Krishnamurti, DGO, DNB (Obstetrics & Gynaecology), Senior Consultant
Last reviewed: 2026-04-01
References
- WHO Safe Abortion Technical and Policy Guidance (3rd ed)
- MTP Act India 2021 Amendment
- FOGSI MTP Guidelines 2022
- BNF — Mifepristone
- Lancet — MTP safety meta-analysis