Protocols for Administering Mifepristone Can Be Modified.

ALBUQUERQUE--NOW that mifepristone is available for use in medical abortion, physicians who intend to offer the procedure face some practical issues in patient care, Dr. Linda W Prine said at a conference on patient education sponsored by the Society of Teachers of Family Medicine and the American Academy of Family Physicians.

It's fairly straightforward to use the drug, formerly known as RU 486, but the manufacturer's protocol is "out of date" because 4 years passed between the time the Food and Drug Administration granted approvable status to the drug and the time it was released for use, said Dr. Prine, a family physician who is chair of the Society of Teachers of Family Medicine's Group on Abortion Training and Access.

She recommended these modifications to the current protocol for using mifepristone (Mifeprex) based on recent research:

* Use a lower dose. Research has shown that one 200-mg dose is just as effective as the recommended 600-mg dose in achieving a medical abortion (Contraception 59[1]:1-6, 1999). The lower dose also reduces the cost of the procedure, said Dr. Pine, who practices at a community medical center affiliated with the Institute for Urban Family Health, New York.

* Prescribe the adjunctive medication, misoprostol, for vaginal instead of oral administration. This will increase misoprostol's efficacy and minimize its GI side effects. Vaginal use requires a higher dose--800 [micro]g instead of 400 [micro]g.

* Have patients use misoprostol at home, rather than in the office, between 24 and 72 hours after taking mifepristone. This ...