Normal side effects of misoprostoclass="underline" chills, elevation of body temperature, pain, and cramping. Some women experience headaches, mild dizziness, hot flashes, nausea, vomiting and diarrhea. Usually these side effects go away by themselves. Allergic reactions are rare, but usually present with mild itching and hives.
• Misoprostol brand names: Cytotec™ (United States), Apo-Misoprostol™ (Canada), Novo-Misoprostol ™(Canada), Cityl™ (Colombia), Cyprostol™ (Austria), Cytolog™ (India), Misoprost™ (India), Zitotec™(India), Gastotec™ (Korea), Misel™ (Korea), Gastrul™ (Indonesia), Misotrol™ (Chile), Mibetec™ (Argentina), Isoprolor™ (UK), U-Miso™ (Taiwan), Gymiso™ (France), Prostokos™ (Brazil), Vagiprost™ (Egypt), Arthrotec™ 50 or 75 (United States arthritis medicine with diclofenac), and Oxaprost™ 75 (Central and South America arthritis medicine with diclofenac).
Methotrexate \metha TREX ate\
Methotrexate is an antimetabolite drug that interferes in the metabolism of folic acid. Methotrexate inhibits DNA synthesis and affects rapidly dividing cells. In early pregnancy, methotrexate can interfere with implantation and is commonly used to encourage an abortion in the event of an ectopic pregnancy. During the long struggle to get mifepristone (RU486) approved for use in the United States, some physicians began to experiment with low doses of methotrexate in combination with misoprostol for medical abortion. Results were similar to the mifepristone/misoprostol combination. However, side effects and unpredictable bleeding for a few days up to six weeks forced doctors to abandon methotrexate for mifepristone as soon as mifepristone was approved by the FDA for use in the United States.
Methotrexate can cause severe bone marrow and liver damage, so women with alcoholism or liver problems should not take it. Methotrexate can also suppress the immune system; women with immune deficiency should not take it. More mild side effects of methotrexate are: mouth sores, stomach upset, headache, drowsiness, itching, skin rash, dizziness, and hair loss. On rare occasions, methotrexate use has caused lung toxicity which presents with a dry, non-productive cough.
• Methotrexate Brand Name: Rheumatrex™.
Gemeprost™, Prostin E2™, and Cervidil™ Pessaries
Gemeprost™, like misoprostol, is a synthetic analogue to Prostaglandin E1. Gemeprost™ vaginal pessaries are used in the United Kingdom and Sweden for dilation of the cervix prior to a first trimester surgical abortion and for the termination of pregnancy in the second trimester. For first trimester cervical dilation, one Gemeprost™ pessary 1.0 mg is inserted into the vagina up to three hours before the operation. For termination of a second trimester pregnancy, one Gemeprost™ pessary 1.0 mg is inserted every three hours, up to five pessaries total.
Prostin E2™ vaginal pessaries, containing 20 mg of dinoprostone, are used in the United States to terminate pregnancies in the second trimester. Prostin E2™ vaginal pessaries are inserted every four hours, for up to 48 hours, until abortion occurs.
Cervidil™ vaginal pessaries contain 10 mg of dinoprostone are FDA approved to induce labor in full term pregnancies.
Gemeprost™, Prostin E2™, and Cervidil™ pessaries are packed in foil pouches, stored in a freezer, and allowed to come to room temperature before use.
• Gemeprost™ Brand Names: Gemeprost™ and Cervagem™.
• Dinoprostone (PGE2) Brand Names: Prostin E2™ (20 mg) and Cervidil™ (10mg).
Words to the Wise: Contraindications for medical abortion are having an IUD (must be removed prior to medical abortion), long term corticosteroid therapy, chronic heart, liver, respiratory, or kidney disease, severe anemia, uncontrolled high blood pressure, HIV positive status, IV drug use, inflammatory bowel disease, porphyria (a genetic condition), bleeding disorders, active genital herpes infection, known allergy to medical abortion medicines, a scarred uterus (for example, from a caesarean section), and having an infection or sickness.
All successful medical abortions result in bleeding. In medical abortions using mifepristone and misoprostol, most women begin bleeding after taking the misoprostol. Most women abort within five hours of taking the misoprostol. Most medical abortions with mifepristone combined with misoprostol completely evacuate the uterus in seven days, however bleeding and spotting may continue for more than thirty days.
Vitamins containing folic acid should be discontinued while taking methotrexate. Most methotrexate abortions are complete within seven days however up to 20% of women take up to thirty days to complete.
Normal side-effects to medical abortion are bleeding and cramping, usually heavier than a normal period. A woman may feel dizzy, have a fever or chills, diarrhea, nausea, or vomiting. However, a woman should not experience signs of an incomplete abortion, such as heavy or prolonged bleeding, extreme pain, or prolonged fever.
Medical abortion becomes less effective as the pregnancy becomes more established. Most forms of medical abortion have been shown to be effective through the first trimester (12 weeks LMP), and they have also been shown to have some effectiveness into the second trimester.[78] After 9 weeks (LMP), medical abortions have a higher rate of complications. Approximately 8% of medical abortions are unsuccessful. To be absolutely sure that the abortion was successful, an ultrasound can be done ten days after the medical abortion. A pregnancy test taken three weeks after a medical abortion will show reduced gonadotropin hormone, if the medical abortion was successful.
Medical abortion has all the risks of any abortion procedure. Temperature and blood loss should be monitored for signs of infection and hemorrhage. If complications arise, such as prolonged heavy bleeding soaking through three or more thick pads in three hours or less or a fever of 101˚F (38˚C) indicating infection, a woman should seek immediate emergency medical care. A handful of deaths have resulted when vaginal application of medical abortion pharmaceuticals triggered a rapidly spreading infection which led to sepsis and death.
All abortive agents are potential teratogens which cause abnormal changes in the growing fetus. Many case reports indicate that medical abortion pharmaceuticals are known or suspected teratogens. Mifepristone has been shown to be a teratogen when tested on rabbits, however in tests on rats and monkeys, no teratogenic effect was observed.[79] Very few cases are recorded of ineffective mifepristone medical abortion and the woman choosing to continue the pregnancy; but in these cases the babies born were normal.[80] With misoprostol, several case reports have associated misoprostol use with human limb defects and Mobius syndrome.[81] Multiple case reports show methotrexate acts as a teratogen causing growth retardation in the fetus exposed in the womb to methotrexate.[82] And PGE1 and PGE2 pessaries, being similar to misoprostol, are likely teratogens; however scientific studies have yet to show teratogenic effects.[83]
Many scientific studies have been done on medical abortion regimes at different dosages, and their effectiveness has been tested. However, medical abortion is relatively new as an abortion technique, so there is debate regarding the safest and most effective dosage regime to use. Once a dosage regime is chosen, it is most effective to adhere to the regime faithfully.
78
Ranjun Basu, Tina Gunlach, and Margaret Tasker, “Mifepristone and Misoprostol for Medical Termination of Pregnancy: The Effectiveness of a Flexible Regime.”
79
A. Jost, “New Data on the Hormonal Requirement of the Pregnant Rabbit; Partial Pregnancies and Fetal Anomalies Resulting from Treatment with a Hormonal Antagonist, Given at a Sub-Abortive Dosage,”
80
R. Henrion, “RU 486 abortions.”
81
M. Philip, Caitlin Shannon, and Beverly Winikoff, eds., “Misoprostol and Teratogenicity: Reviewing the Evidence,”
82
M. Wheeler, P. O’Meara, and M. Stanford, “Fetal Methotrexate and Misoprostol Exposure: The Past Revisited,”
83
E.J. Lazda and V.R. Sams, “The Effects of Gemeprost on the Second Trimester Fetus,”