Medical Abortion Regimens: Take Two...Or More And Call Me In The Morning

After looking at blog discussions of recent reports of deaths in women undergoing a medical termination of pregnancy (MTP) I can see that there is still a lot of confusion about the regimens used. Let me try to clarify some facts.

First, there's only one FDA-approved MTP regimen for RU-486 and misoprostol. [There have been no reported deaths in women using this regimen.]

The approved regimen is administered up to 49 days after the first day of the last normal menstrual period (LNMP) and consists of 3 tablets of RU-486 (600 mg) orally, followed by 2 tablets of misoprostol (400 mcg) orally.

FDA-approved regimen: up to 49 days, two drugs [RU-486 and misoprostol], 600 mg RU-486 and 400 mcg misoprostol, both taken by mouth (orally).

Second, several other MTP regimens, for RU-486 and misoprostol, *as well as* for other drug combinations, are in use. All have been studied and found to be safe and effective. [Some are more effective vs. the FDA-approved regimen.] Here are some of these other regimens, in no particular order:

One regimen, let's call it regimen A, is administered up to 63 days after the LNMP and consists of 3 tablets of RU-486 (600 mg) orally, followed by 4 tablets of misoprostol (800 mcg) vaginally.

Regimen A: up to 63 days, two drugs [RU-486 and misoprostol], 600 mg RU-486 and 800 mcg misoprostol, the first orally, the second vaginally.

Another regimen (B) is administered up to 63 days after the LNMP and consists of 1 tablet of RU-486 (200 mg) orally, followed by 4 tablets of misoprostol (800 mcg) vaginally.

Regimen B: up to 63 days, two drugs [RU-486 and misoprostol], 200 mg RU-486 and 800 mcg misoprostol, the first orally, the second vaginally.

Yet another regimen (C) is administered up to 49 days after the LNMP and consists of 1 injection of methotrexate (75 mg) IM, followed by 4 tablets of misoprostol (800 mcg) vaginally.

Regimen C: up to 49 days, two drugs [methotrexate and misoprostol], 75 mg methotrexate and 800 mcg misoprostol, the first IM, the second vaginally.

A final regimen (D) is administered up to 56 days after the LNMP and consists of several tablets of methotrexate (25-50 mg) orally, followed by 4 tablets of misoprostol (800 mcg) vaginally.

Regimen D: up to 56 days, two drugs [methotrexate and misoprostol], 25-50 mg methotrexate and 800 mcg misoprostol, the first orally, the second vaginally.

Bottom line: There are a number of MTP regimens in use. They have been studied and found to be safe and effective (some more than other). The timing of administration, drugs, doses, and routes of administration vary. Being aware of these basic facts is essential when discussing the benefits/risks of MTP regimens.