MTP Kit (Combipack of Mifepristone and Misoprostol)

Description

MTP Kit is a combination of Mifepristone 200 mg and Misoprostol 200 mcg that belongs to a class of drugs known as ‘Abortifacient’. This medication is used for the termination of pregnancy of not more than 9 weeks (counted from the first day of your last menstrual cycle). It works by blocking the effects of progesterone to stop the growth of pregnancy and increase uterine contractions for the pregnancy tissue to be expelled from the body. While Mifepristone needs to be taken orally, the four pills of Misoprostol are intended to be taken either orally or vaginally. A follow-up visit to the doctor is needed approximately 14 days after pregnancy termination.

How does it work?

MTP Kit consists of Mifepristone and Misoprostol tablets. Mifepristone is an anti-progestational steroid that works by blocking the activity of progesterone, causing the placenta to separate from the endometrium. Misoprostol 200 mcg causes the cervix to soften and the uterus to contract to expel the pregnancy tissue.

A follow-up visit is recommended two weeks after the pregnancy has been terminated. Your doctor or nurse may ask you to visit the clinic for an ultrasound or get a pregnancy test at home.

Uses

Medical abortion: Medical abortion is a procedure that uses medicine to end a pregnancy. It does not require surgery or anesthesia.

Recommended MTP Kit dosage

MTP Kit consists of a tablet of Mifepristone 200 mg and four tablets of Misoprostol 200 mcg. Mifepristone is recommended to be taken orally with water. The four tablets of Misoprostol are recommended to be taken approximately 24 to 48 hours after taking Mifepristone.
Misoprostol can be taken either orally or vaginally. When taken orally, the four tablets should be placed between the cheeks for roughly 25 to 30 minutes. Once the contents get dissolved, they can then be swallowed with water. If your doctor has recommended vaginal administration, in that case, the pills need to be inserted one by one at the farthest spot in the vagina. After inserting the pills, lie down so that the pills do not fall out.

Missed dose

You are less likely to miss a dose as the medication is taken as prescribed.

Side effects

Common side effects include:

• Vaginal bleeding or spotting
• Cramps
• Pelvic pain
• Vaginal burning, itching, or discharge
• Headache
• Nausea
• Diarrhea
• Fever
• Menorrhagia (heavy menstrual bleeding)

If any of the above-mentioned side effects persist for long, seek medical help immediately.

Safety advice

Some precautions are to be taken while using the MTP Kit:

• Individuals allergic to mifepristone or misoprostol should check with their doctor before using it.
• Individuals taking corticosteroids should consult their doctor before taking this medication.
• If you take any prescription or non-prescription medications, let your doctor know about them.
• If you have had an ectopic pregnancy, adrenal failure, porphyria, or an IUD inserted, check with your doctor.
• Avoid consuming alcohol or grapefruit juice along with this medication.

Drug interactions

MTP Kit can interact with certain medications that can affect the way it works. These include:

• Benzodiazepines such as alprazolam (Xanax),
• Diazepam (Diastat, Valium),
• Midazolam, or triazolam (Halcion); buspirone;
• Calcium channel blockers such as amlodipine (Norvasc),
• Diltiazem (Cardizem, Cartia, Diltzac, others),
• Felodipine, nifedipine (Adalat, Afeditab CR, Procardia),
• Nisoldipine (Sular), or verapamil (Calan, Verelan, in Tarka);
• Carbamazepine (Equetro, Tegretol, Teril, others);
• Chlorpheniramine (antihistamine in cough and cold products);
• Cholesterol-lowering medications (statins) such as atorvastatin (Lipitor, in Caduet),
• Lovastatin (Altoprev, in Advicor), or simvastatin (Simcor, Zocor, in Vytorin);
• Clarithromycin (Biaxin, in Prevpac);
• Cyclosporine (Gengraf, Neoral, Sandimmune);
• Erythromycin (E.E.S., Erythrocin, others);
• St. John’s wort

Storage instructions

• Keep this medication in the container it came in, and tightly closed.
• Keep it out of reach of children.
• Store it at room temperature and away from heat and moisture.

References

• Chu JJ, Devall AJ, Beeson LE, Hardy P, Cheed V, Sun Y, Roberts TE, Ogwulu CO, Williams E, Jones LL, La Fontaine Papadopoulos JH, Bender-Atik R, Brewin J, Hinshaw K, Choudhary M, Ahmed A, Naftalin J, Nunes N, Oliver A, Izzat F, Bhatia K, Hassan I, Jeve Y, Hamilton J, Deb S, Bottomley C, Ross J, Watkins L, Underwood M, Cheong Y, Kumar CS, Gupta P, Small R, Pringle S, Hodge F, Shahid A, Gallos ID, Horne AW, Quenby S, Coomarasamy A. Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomised, double-blind, placebo-controlled trial. Lancet. 2020 Sep 12;396(10253):770-778. doi: 10.1016/S0140-6736(20)31788-8. Epub 2020 Aug 24. PMID: 32853559; PMCID: PMC7493715. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31788-8/fulltext
• Wingo E, Raifman S, Landau C, Sella S, Grossman D. Mifepristone-misoprostol versus misoprostol-alone regimen for medication abortion at ≥24 weeks’ gestation. Contraception. 2020 Aug;102(2):99-103. doi: 10.1016/j.contraception.2020.05.001. Epub 2020 May 12. PMID: 32407810. https://www.contraceptionjournal.org/article/S0010-7824(20)30149-9/fulltext
• Sonalkar S, Koelper N, Creinin MD, Atrio JM, Sammel MD, McAllister A, Schreiber CA. Management of early pregnancy loss with mifepristone and misoprostol: clinical predictors of treatment success from a randomized trial. Am J Obstet Gynecol. 2020 Oct;223(4):551.e1-551.e7. doi: 10.1016/j.ajog.2020.04.006. Epub 2020 Apr 17. PMID: 32305259; PMCID: PMC7529708.
  https://www.ajog.org/article/S0002-9378(20)30431-2/fulltext
• Chen MJ, Creinin MD. Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review. Obstet Gynecol. 2015 Jul;126(1):12-21. doi: 10.1097/AOG.0000000000000897. PMID: 26241251.
  https://journals.lww.com/greenjournal/Abstract/2015/07000/Mifepristone_With_Buccal_Misoprostol_for_Medical.4.aspx
• Schreiber CA, Creinin MD, Atrio J, Sonalkar S, Ratcliffe SJ, Barnhart KT. Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss. N Engl J Med. 2018 Jun 7;378(23):2161-2170. doi: 10.1056/NEJMoa1715726. PMID: 29874535; PMCID: PMC6437668.
  https://www.nejm.org/doi/10.1056/NEJMoa1715726