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For the song RU486 by Stone Sour, see House of Gold & Bones - Part 1.
| Systematic (IUPAC) name | |
|---|---|
| 11β-[p-(Dimethylamino)phenyl]-17β-hydroxy-17-(1-propynyl)estra-4,9-dien-3-one | |
| Clinical data | |
| AHFS/Drugs.com | monograph |
| MedlinePlus | a600042 |
| Pregnancy cat. | X (US) Used for terminating pregnancy |
| Legal status | ℞-only (US) |
| Routes | Oral |
| Pharmacokinetic data | |
| Bioavailability | 69% |
| Protein binding | 98% |
| Metabolism | hepatic |
| Half-life | 18 hours |
| Excretion | Fecal: 83%; Renal: 9% |
| Identifiers | |
| CAS number | 84371-65-3 Y |
| ATC code | G03XB01 |
| PubChem | CID 55245 |
| IUPHAR ligand | 2805 |
| DrugBank | DB00834 |
| ChemSpider | 49889 Y |
| UNII | 320T6RNW1F Y |
| KEGG | D00585 Y |
| ChEBI | CHEBI:50692 Y |
| ChEMBL | CHEMBL157 Y |
| Chemical data | |
| Formula | C29H35NO2 |
| Mol. mass | 429.60 g/mol |
|
SMILES
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InChI
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| Physical data | |
| Density | 1.189 g/cm³ |
| Melt. point | 194 °C (381 °F) |
| Boiling point | 629 °C (1164 °F) |
| Y (what is this?) (verify) |
|
Mifepristone is a synthetic steroid compound used as a pharmaceutical. It is a progesterone receptor antagonist used as an abortifacient in the first months of pregnancy, and in smaller doses as an emergency contraceptive. Mifepristone is also a powerful glucocorticoid receptor antagonist, and has occasionally been used in refractory Cushing's Syndrome (due to ectopic/neoplastic ACTH/Cortisol secretion). During early trials, it was known as RU-38486 or simply RU-486, its designation at the Roussel Uclaf company, which designed the drug. The drug was initially made available in France, and other countries then followed—often amid controversy. It is marketed under tradenames Korlym and Mifeprex, according to FDA Orange Book.
Contents
- 1 Medication uses
- 1.1 Other uses
- 2 Contraindications
- 3 Adverse effects
- 4 Pharmacology
- 5 History
- 6 Legal status
- 6.1 United States
- 6.1.1 Subsection H
- 6.1.2 FDA controversy
- 6.2 Europe
- 6.3 Other countries
- 6.1 United States
- 7 Notes and references
- 8 External links
Medication uses[edit source | edit]
According to the current RCOG abortion evidence-based clinical guideline:[1]
- All methods of first-trimester abortion carry a small risk of failure to terminate the pregnancy. The risk for surgical abortion is around 0.23% and for medical abortion between 0.1% and 1.4% (depending on the regimen used and the experience of the centre).
- Medical abortion using mifepristone plus prostaglandin is the most effective method of abortion at gestations of less than 7 weeks.
- Conventional vacuum aspiration below 7 weeks have a higher failure rate than at later gestations. Protocols should include examination of the aspirate for the presence of the gestational sac and/or follow-up serum human chorionic gonadotrophin estimation, to ensure abortion completion.
- Early vacuum aspiration using a rigorous protocol (which includes magnification of aspirated material and indications for serum βhCG follow-up) may be used at gestations below 7 weeks, although data suggest that the failure rate is higher than for medical abortion.
- Medical abortion using mifepristone plus prostaglandin continues to be an appropriate method for women in the 7–9 week gestation band.
Mifepristone is sold outside the United States by Exelgyn Laboratories as Mifegyne, made in France, and is approved for:
- Medical termination of intrauterine pregnancies of up to 49 days gestation (up to 63 days gestation in Britain and Sweden)
- Softening and dilatation of the cervix prior to mechanical cervical dilatation for pregnancy termination
- Use in combination with gemeprost for termination of pregnancies between 13 and 24 weeks gestation
- Labor induction in fetal death in utero.[2]
Mifepristone is sold in the United States by Danco Laboratories as Mifeprex, made in China,[3] and is U.S. Food and Drug Administration-approved to terminate intrauterine pregnancies of up to 49 days gestation. Under the FDA-approved regimen, a 600 mg dose is administered by a clinician following a counseling session. Two days later, a clinician administers 400 µg of another medicine, misoprostol, to induce contractions. In European studies, this method terminated 96 to 99% of pregnancies of up to 49 days gestation, but in one large multicenter trial in the United States conducted from September 1994 to September 1995, the efficacy was lower (92%), which the authors of the study suggested may have been due to lack of experience with this method in the United States and/or the design of their study.[4] In Europe and China, an observation period of several hours is required after administration of misoprostol. If expulsion of fetal tissue does not occur during the observation period, surgical abortion is offered. There is no required observation period in the United States, but it is strongly recommended.[5]
Mifepristone can also be used in smaller doses as an emergency contraceptive; if taken after sex but before ovulation, it can prevent ovulation and so prevent pregnancy. In this role, a 10 mg dose is not as effective as the 600 mg dose, but has fewer side-effects. [6] Mifeprex and Mifegyne are only available in 200 mg tablets.[7]
A review of studies in humans found that the contraceptive effects of the 10 mg dose were probably due mainly to its effects on ovulation, and not inhibition of implantation, but "the knowledge of the mechanism of action remains incomplete". Treatment with 200 mg of mifepristone changes steroid receptor expression in the fallopian tube, inhibits endometrial development, and effectively prevents implantation. [8]
Other uses[edit source | edit]
Other medical applications of mifepristone that have been studied in Phase II clinical trials include regular long-term use as an oral contraceptive, and treatment of: uterine fibroids, endometriosis, major depression with psychotic features, glaucoma, meningiomas, breast cancer, ovarian cancer, and prostate cancer. Mifepristone has been used to treat Cushing's syndrome with treatment durations being as long as 10 years without noticeable adverse effect. [9]
Mifepristone has been studied as an antiretroviral for its in vivo interference with the HIV regulatory protein vpr. It showed no detectable anti-HIV activity in clinical trials.[10] [11][12][13] It is currently being studied as a treatment for chronic multisymptom illness.[14] Mifepristone has not been approved by the FDA for any of these uses.
Mifepristone has shown significant effectiveness[15] in psychotic major depression, a form of depression resistant to normal treatment. The effect was rapid and the study was double-blinded, but it was limited by small study group and limited treatment duration. Mifepristone treatment has also produced clinical improvement in PTSD symptoms however the study was limited by small group size.[16]
Use as a cervical ripening agent has also been described.[17]
Contraindications[edit source | edit]
In clinical trials, nearly all women using mifepristone experienced abdominal pain, uterine cramping, and vaginal bleeding or spotting for an average of 9–16 days. Up to 8% of women experienced some type of bleeding for 30 days or more. Other less common side effects included nausea, vomiting, diarrhea, dizziness, fatigue, and fever.[18] Pelvic inflammatory disease (PID) is a very rare but serious complication.[19] Excessive bleeding and incomplete termination of a pregnancy require further intervention by a doctor (such as vacuum aspiration). Between 4.5 and 7.9% of women required surgical intervention in clinical trials.[18] Mifepristone is contraindicated in the presence of an intrauterine device (IUD), as well as with ectopic pregnancy, adrenal failure, hemorrhagic disorders, inherited porphyria, and anticoagulant or long-term corticosteroid therapy.[18]
The FDA prescribing information states that there are no data on the safety and efficacy of mifepristone in women with chronic medical conditions, and that "women who are more than 35 years of age and who also smoke 10 or more cigarettes per day should be treated with caution because such patients were generally excluded from clinical trials of mifepristone."[18]
Adverse effects[edit source | edit]
No long-term studies to evaluate the carcinogenic potential of mifepristone have been performed. Results from studies conducted in vitro and in animals have revealed no genotoxic potential for mifepristone.
Neonatal exposure to a single large dose of mifepristone in rats was not associated with any reproductive problems, although chronic low-dose exposure of newborn rats to mifepristone was associated with structural and functional reproductive abnormalities.[18]
Teratology studies in mice, rats and rabbits revealed teratogenicity for rabbits, but not rats or mice.[18] The rate of birth defects in human infants exposed in utero to mifepristone and misoprostol is very low,[20] and may be due to misoprostol alone.[21]
A postmarketing summary found that, of about 1.52 million women who had received mifepristone until April 2011 in the United States, fourteen were reported to have died after application. Eight of these cases were associated with sepsis; the other six had various causes like drug abuse and suspected murder. Other incidents reported to the FDA included 612 non-lethal hospitalizations, 339 blood transfusions, 48 severe infections, and 2,207 (0.15%) adverse events altogether.[22]
Pharmacology[edit source | edit]
In the presence of progesterone, mifepristone acts as a competitive progesterone receptor antagonist (in the absence of progesterone, mifepristone acts as a partial agonist). Mifepristone is a 19-nor steroid with a bulky p-(dimethylamino)phenyl substituent above the plane of the molecule at the 11β-position responsible for inducing or stabilizing an inactive receptor conformation and a hydrophobic 1-propynyl substituent below the plane of the molecule at the 17α-position that increases its progesterone receptor binding affinity.[23][11][24]
In addition to being an antiprogestogen, mifepristone is also an antiglucocorticoid and a weak antiandrogen. Mifepristone's relative binding affinity at the progesterone receptor is more than twice that of progesterone, its relative binding affinity at the glucocorticoid receptor is more than three times that of dexamethasone and more than ten times that of cortisol; its relative binding affinity at the androgen receptor is less than one third that of testosterone. It does not bind to the estrogen receptor or the mineralocorticoid receptor.[25]
Mifepristone as a regular contraceptive at 2 mg daily prevents ovulation (1 mg daily does not). A single preovulatory 10 mg dose of mifepristone delays ovulation by 3 to 4 days and is as effective an emergency contraceptive as a single 1.5 mg dose of the progestin levonorgestrel.[12]
In women, mifepristone at doses greater or equal to 1 mg/kg antagonizes the endometrial and myometrial effects of progesterone. In humans, an antiglucocorticoid effect of mifepristone is manifested at doses greater or equal to 4.5 mg/kg by a compensatory increase in ACTH and cortisol. In animals, a weak antiandrogenic effect is seen with prolonged administration of very high doses of 10 to 100 mg/kg.[2][26]
In medical abortion regimens, mifepristone blockade of progesterone receptors directly causes endometrial decidual degeneration, cervical softening and dilatation, release of endogenous prostaglandins and an increase in the sensitivity of the myometrium to the contractile effects of prostaglandins. Mifepristone induced decidual breakdown indirectly leads to trophoblast detachment, resulting in decreased syncytiotrophoblast production of hCG, which in turn causes decreased production of progesterone by the corpus luteum (pregnancy is dependent on progesterone production by the corpus luteum through the first 9 weeks of gestation—until placental progesterone production has increased enough to take the place of corpus luteum progesterone production). When followed sequentially by a prostaglandin, mifepristone 200 mg is (100 mg may be, but 50 mg is not) as effective as 600 mg in producing a medical abortion.[23][24]
Contragestion is a term promoted by Étienne-Émile Baulieu in the context of his advocacy of mifepristone, defining it as inclusive of some hypothesized mechanisms of action of some contraceptives and those of mifepristone to induce abortion.[27] Baulieu's definition of a contragestive included any birth control method that could possibly act after fertilization and before nine weeks gestational age.[27]
History[edit source | edit]
In April 1980, as part of a formal research project at Roussel-Uclaf for the development of glucocorticoid receptorantagonists, chemist Georges Teutsch synthesized mifepristone (RU-38486, the 38,486th compound synthesized by Roussel-Uclaf from 1949 to 1980; shortened to RU-486); which was discovered to also be a progesterone receptor antagonist.[28][29] In October 1981, endocrinologist Étienne-Émile Baulieu, a consultant to Roussel-Uclaf, arranged tests of its use for medical abortion in eleven women in Switzerland by gynecologist Walter Herrmann at the University of Geneva's Cantonal Hospital, with successful results announced on April 19, 1982.[28][30] On October 9, 1987, following worldwide clinical trials in 20,000 women of mifepristone with a prostaglandin analogue (initially sulprostone or gemeprost, later misoprostol) for medical abortion, Roussel-Uclaf sought approval in France for their use for medical abortion, with approval announced on September 23, 1988.[28][31]
On October 21, 1988, in response to antiabortion protests and concerns of majority (54.5%) owner Hoechst AG of Germany, Roussel-Uclaf’s executives and board of directors voted 16 to 4 to stop distribution of mifepristone, which they announced on October 26, 1988.[28][32] Two days later, the French government ordered Roussel-Uclaf to distribute mifepristone in the interests of public health.[28][33] French Health Minister Claude Évin explained that: "I could not permit the abortion debate to deprive women of a product that represents medical progress. From the moment Government approval for the drug was granted, RU-486 became the moral property of women, not just the property of a drug company."[28] Following use by 34,000 women in France from April 1988 to February 1990 of mifepristone distributed free of charge, Roussel-Uclaf began selling Mifegyne (mifepristone) to hospitals in France in February 1990 at a price (negotiated with the French government) of $48 per 600 mg dose.[28]
Mifegyne was subsequently approved in Great Britain on July 1, 1991,[34] and in Sweden in September 1992,[35] but until his retirement in late April 1994, Hoechst AG chairman Wolfgang Hilger, a devout Roman Catholic, blocked any further expansion in availability.[28][36] On May 16, 1994, Roussel-Uclaf announced that it was donating without remuneration all rights for medical uses of mifepristone in the United States to the Population Council,[37] which subsequently licensed mifepristone to Danco Laboratories, a new single-product company immune to antiabortion boycotts, which won FDA approval as Mifeprex on September 28, 2000.[38]
On April 8, 1997, after buying the remaining 43.5% of Roussel-Uclaf stock in early 1997,[39] Hoechst AG ($30 billion annual revenue) announced the end of its manufacture and sale of Mifegyne ($3.44 million annual revenue) and the transfer of all rights for medical uses of mifepristone outside of the United States to Exelgyn S.A., a new single-product company immune to antiabortion boycotts, whose CEO was former Roussel-Uclaf CEO Édouard Sakiz.[40] In 1999, Exelgyn won approval of Mifegyne in 11 additional countries, and in 28 more countries over the following decade.[41]
Legal status[edit source | edit]
United States[edit source | edit]
Roussel Uclaf did not seek U.S. approval, so in the United States legal availability was not initially possible.[42] The United States banned importation of mifepristone for personal use in 1989, a decision supported by Roussel Uclaf. In 1994 Roussel Uclaf gave the U.S. drug rights to the Population Council in exchange for immunity from any product liability claims.[37][43] The Population Council sponsored clinical trials in the United States.[44] The drug went on approvable status from 1996. Production was intended to begin through the Danco Group in 1996 but they withdrew briefly in 1997 due to a corrupt business partner, delaying availability again.[45][46] Mifepristone was approved for abortion in the United States by the FDA, in September 2000.[47] It is legal and available in all 50 states, Washington, D.C., Guam, and Puerto Rico.[48] It is a prescription drug, but it is not available to the public through pharmacies; its distribution is restricted to specially qualified licensed physicians, sold by Danco Laboratories under the tradename Mifeprex.
Medical abortions voluntarily reported by 33 U.S. states[49] to the CDC have increased as a percentage of total abortions every year since the approval of mifepristone: 1.0% in 2000, 2.9% in 2001, 5.2% in 2002, 7.9% in 2003, 9.3% in 2004, 9.9% in 2005, 10.6% in 2006, 13.1% in 2007 (20.3% of those at less than 9 weeks gestation).[50] A Guttmacher Institute survey of abortion providers estimated that medical abortions accounted for 17% of all abortions and slightly over 25% of abortions before 9 weeks gestation in the United States in 2008 (94% of non-hospital medical abortions used mifepristone and misoprostol, 6% used methotrexate and misoprostol).[51] Medical abortions accounted for 32% of first trimester abortions at Planned Parenthood clinics in the United States in 2008.[52]
Subsection H[edit source | edit]
Some drugs are approved by the FDA under sub-section H, which has two sub-parts. The first sets forth ways to rush experimental drugs, such as aggressive HIV and cancer treatments, to market when speedy approval is deemed vital to the health of potential patients. The second part of sub-section H applies to drugs that not only must meet restrictions for use due to safety requirements, but also are required to meet postmarketing surveillance to establish that the safety results shown in clinical trials are seconded by use in a much wider population. Mifepristone was approved under the second part of sub-section H. The result is that women cannot pick the drug up at a pharmacy but must now receive it directly from a doctor. Due to the possibility of adverse reactions such as excessive bleeding which may require a blood transfusion and incomplete abortion which may require surgical intervention, the drug is only considered safe if a physician who is capable of administering a blood transfusion or a surgical abortion is available to the patient in the event of such emergencies.[53] The approval of mifepristone under Subsection H included a black box warning.
FDA controversy[edit source | edit]
Many pro-life groups in the United States actively campaigned against the approval of mifepristone,[54][55][56] and continue to actively campaign for its withdrawal.[57] They cite either ethical issues with abortion or safety concerns regarding the drug and the adverse reactions associated with it, including death.[58] The proposed "RU-486 Suspension and Review Act", also known as Holly's Law, was initiated by a citizen's petition to the FDA from namesake Holly Patterson's father,[59] and the May 17, 2006 House Subcommittee on Criminal Justice, Drug Policy and Human Resources hearing entitled "RU-486 - Demonstrating a Low Standard for Women's Health?"[60]—called by its pro-life chairman Rep. Mark Souder—are the principal results of this effort. Religious and pro-life groups outside the United States have also protested mifepristone, especially in Germany[61] and Australia.[62][63]
A group of female scientists from MIT's Institute on Women and Technology published a report called "Feminist International Network of Resistance to Reproductive and Genetic Engineering" (FINRRAGE) in the early 1990s to express their opposition to mifepristone.[citation needed] The report's authors stated that they "felt what was being lost in the political debate was how the drug affects women. In contrast with the groups who are anti-feminist and anti-abortion, the Institute on Women and Technology advocates women's rights to abortion and self determination". Additional critics who call themselves feminists[64] exist, such as Pauline Connor (LI.B.) of Feminists Against Eugenics in England who stated, "What has been presented as a simple, pill-popping exercise is, in fact, an intensely medicalized and painful procedure which can involve up to four clinic visits and last 12 days".[65]
Europe[edit source | edit]
Outside the United States it is marketed and distributed by Exelgyn Laboratories under the tradename Mifegyne. Mifepristone was approved for use in France in 1988 (initial marketing in 1989), the United Kingdom in 1991, Sweden in 1992, then Austria, Belgium, Denmark, Finland, Germany, Greece, Luxembourg, the Netherlands, Spain, and Switzerland in 1999.[66] In 2000, it was approved in Norway, Russia and Ukraine. Serbia and Montenegro approved it in 2001,[67] Belarus and Latvia in 2002, Estonia in 2003, Moldova in 2004, Albania and Hungary in 2005, Portugal in 2007, and Romania in 2008.[41] In Italy clinical trials have been constrained by protocols requiring women be hospitalized for three days, but the drug was finally approved on the July 30, 2009 (officialized later in the year), despite strong opposition from the Vatican. In Italy the pill must be prescribed and used in a clinical structure and is not sold at chemists.[68] It was approved in Hungary in 2005, but as of 2005 had not been released on the market yet, and was the target of protests.[69] Mifepristone is not approved in Ireland, where abortion is illegal, or Poland, where abortion is highly restricted.[70]
In France, the percentage of medical abortions of all abortions continues to increase: 38% in 2003, 42% in 2004, 44% in 2005, 46% in 2006, 49% in 2007 (vs. 18% in 1996).[71] In England and Wales, 52% of early abortions (less than 9 weeks gestation) in 2009 were medical; the percentage of all abortions that are medical has increased every year for the past 14 years (from 5% in 1995 to 40% in 2009) and has more than doubled in the last five years.[72] In Scotland, 81.2% of early abortions (less than 9 weeks gestation) in 2009 were medical (up from 55.8% in 1992 when medical abortion was introduced); the percentage of all abortions that are medical has increased every year for the past 17 years (from 16.4% in 1992 to 69.9% in 2009).[73] In Sweden, 85.6% of early abortions (before the end of the 9th week of gestation) and 73.2% of abortions before the end of the 12th week of gestation in 2009 were medical; 68.2% of all abortions in 2009 were medical.[74] In Great Britain and Sweden, mifepristone is licensed for use with vaginal gemeprost or oral misoprostol. As of 2000, more than 620,000 women in Europe had had medical abortions using a mifepristone regimen.[75] In Denmark, mifepristone was used in between 3,000 and 4,000 of just over 15,000 abortions in 2005.[76]
Other countries[edit source | edit]
Mifepristone was banned in Australia in 1996. In late 2005, a Private Member's bill was introduced to the Australian Senate to lift the ban and transfer the power of approval to the Therapeutic Goods Administration (TGA). The move caused much debate in the Australian media and amongst politicians. The Bill passed the Senate on 10 February 2006, and mifepristone is now legal in Australia. It is provided regularly at several specialized abortion clinics per state.[77][78]
In New Zealand, pro-choice doctors established an import company, Istar, and submitted a request for approval to MedSafe, the New Zealand pharmaceutical regulatory agency. After a court case brought by Right to Life New Zealand failed, use of mifepristone was permitted.[79]
The drug was approved in Israel in 1999.[80]
Clinical trials of mifepristone in China began in 1985. In October 1988, China became the first country in the world to approve mifepristone. Chinese organizations tried to purchase mifepristone from Roussel Uclaf, who refused to sell it to them, so in 1992 China began its own domestic production of mifepristone. In 2000, the cost of medical abortion with mifepristone was higher than surgical abortion and the percentage of medical abortions varied greatly, ranging from 30% to 70% in cities to being almost nonexistent in rural areas.[81][82] A report from the United States Embassy in Beijing in 2000 said mifepristone had been widely used in Chinese cities for about two years, and that according to press reports a black market had developed with many women starting to buy it illegally (without a prescription) from private clinics and drugstores for about $15, causing Chinese authorities to worry about medical complications from use without physician supervision.[83]
In 2001, mifepristone was approved in Taiwan.[84] Vietnam included mifepristone in the National Reproductive Health program in 2002.[85]
It is approved in only one subsaharan African country—South Africa, where it was approved in 2001.[86] It is also approved in one north African country—Tunisia, also in 2001.[87]
Mifepristone was approved for use in India in 2002, where medical abortion is referred to as "Medical Termination of Pregnancy" (MTP). It is only available under medical supervision, not by prescription, due to adverse reactions such as excessive bleeding, and there are criminal penalties for buying or selling it on the black market or over-the-counter at pharmacies.[88]
Mexico is the only country in Latin-America that it uses mifepristone for the legal interruption of pregnancy.[citation needed]
Medical abortion is available in Canada on a limited basis using methotrexate and misoprostol; mifepristone is not legally approved, and importation of that drug into Canada is currently illegal. Clinical trials were done in 2000 in various Canadian cities comparing methotrexate to mifepristone, after approbation by the federal government. While both drugs had overall similar results, mifepristone was found to act faster.[89] As of May 2005, it is unclear whether or when RU-486 will be approved for use in Canada.[90]
Mifepristone was registered for use in Azerbaijan, Georgia, and Uzbekistan in 2002, in Guyana and Moldova in 2004, in Mongolia in 2005, and in Armenia in 2007.[41][91]
Notes and references[edit source | edit]
- ^ RCOG (2004). The Care of Women Requesting Induced Abortion : Evidence-based clinical guideline number 7 (PDF). London: RCOG Press. ISBN 1-904752-06-3. Archived from the original on February 27, 2008.
- ^ a b Exelgyn Laboratories (February 2006). "Mifegyne UK Summary of Product Characteristics (SPC)". Retrieved 2007-03-09.
- ^ Pan, Philip P. (2000-10-12). "Chinese to Make RU-486 for U.S.". Washingtonpost.com. Retrieved 2006-08-22.
- ^ Spitz, I. M., Bardin, C. W., Benton, L., Robbins, A. (1998). "Early pregnancy termination with mifepristone and misoprostol in the United States". New England Journal of Medicine 338 (18): 1241–7. doi:10.1056/NEJM199804303381801. PMID 9562577.
- ^ Suzanne Daley (October 5, 2000). "Europe Finds Abortion Pill is No Magic Cure-All". The New York Times. Retrieved 2006-09-16.
- ^ Piaggio G et al. (2003). "Meta-analysis of randomized trials comparing different doses of mifepristone in emergency contraception". Contraception 68 (6): 447–52. doi:10.1016/S0010-7824(03)00142-2. PMID 14698075.
- ^ Wertheimer, Randy E. (2000-11-15). "Emergency Postcoital Contraception". American Family Physician (American Academy of Family Physicians). Retrieved 2006-07-23.
- ^ Gemzell-Danielsson, K.; Marions, L. (2004-06-10). "Mechanisms of action of mifepristone and levonorgestrel when used for emergency contraception". Human Reproduction Update (Oxford University Press) 10 (4): 341–348. doi:10.1093/humupd/dmh027. PMID 15192056.
- ^ Healy, David (2009). "Mifepristone: an overview for Australian practice". Australian Prescriber, 32:152-154. Available at http://www.australianprescriber.com/magazine/32/6/152/4/
- ^ Flexner, Charles. "HIV drug development: the next 25 years". National Review of Drug Discovery. 2007 Dec;6(12):959-66.
- ^ a b Schimmer, Bernard P.; Parker, Keith L. (2006). "Adrenocorticotropic Hormone; Adrenocortical Steroids and Their Synthetic Analogs; Inhibitors of the Synthesis and Actions of Adrenocortical Hormones". In in Brunton, Laurence L.; Lazo, John S.; Parker, Keith L. (eds.). Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed.). New York: McGraw-Hill. pp. 1587–1612. ISBN 0-07-142280-3.
- ^ a b Chabbert-Buffet N, Meduri G, Bouchard P, Spitz IM (2005). "Selective progesterone receptor modulators and progesterone antagonists: mechanisms of action and clinical applications". Hum Reprod Update 11 (3): 293–307. doi:10.1093/humupd/dmi002. PMID 15790602.
- ^ Tang OS, Ho PC (2006). "Clinical applications of mifepristone". Gynecol Endocrinol 22 (12): 655–9. doi:10.1080/09513590601005946. PMID 17162706.
- ^ "A Controlled Trial of Mifepristone in Gulf War Veterans With Chronic Multisymptom Illness". ClinicalTrials.gov. U.S. National Institutes of Health. June 2008. Retrieved on November 7, 2008.
- ^ Belanoff JK, Flores BH, Kalezhan M, Sund B, Schatzberg AF (October 2001). "Rapid reversal of psychotic depression using mifepristone". J Clin Psychopharmacol 21 (5): 516–21. doi:10.1097/00004714-200110000-00009. PMID 11593077.
- ^ Golier, J. A.; Caramanica, K.; Demaria, R.; Yehuda, R. (2012). "A Pilot Study of Mifepristone in Combat-Related PTSD". Depression Research and Treatment 2012: 1. doi:10.1155/2012/393251. PMC 3348629. PMID 22611490. edit
- ^ Clark, K., Ji, H., Feltovich, H., Janowski, J., Carroll, C., Chien, E. K. (May 2006). "Mifepristone-induced cervical ripening: structural, biomechanical, and molecular events". Am. J. Obstet. Gynecol. 194 (5): 1391–8. doi:10.1016/j.ajog.2005.11.026. PMID 16647925.
- ^ a b c d e f "Mifeprex label" (PDF). FDA. 2005-07-19. Archived from the original on 2006-06-28. Retrieved 2006-08-22.
- ^ Lawton, BA et al. (2006). "Atypical presentation of serious pelvic inflammatory disease following mifepristone-induced abortion". Contraception 73 (4): 431–2. doi:10.1016/j.contraception.2005.09.003. PMID 16531180.
- ^ Margaret M. Gary and Donna J. Harrison (December 2005). "Analysis of Severe Adverse Events Related to the Use of Mifepristone as an Abortifacient". The Annals of Pharmacology. Retrieved 2006-09-14.
- ^ Orioli, IM and Castilla, EE (2000). "Epidemiological assessment of misoprostol teratogenicity". BJOG 107 (4): 519–23. doi:10.1111/j.1471-0528.2000.tb13272.x. PMID 10759272.
- ^ "Mifepristone U.S. Postmarketing Adverse Events Summary through 04/30/2011" (PDF). Retrieved 2011-11-14.
- ^ a b Loose, Davis S.; Stancel, George M. (2006). "Estrogens and Progestins". In in Brunton, Laurence L.; Lazo, John S.; Parker, Keith L. (eds.). Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed.). New York: McGraw-Hill. pp. 1541–1571. ISBN 0-07-142280-3.
- ^ a b Fiala C, Gemzel-Danielsson K (2006). "Review of medical abortion using mifepristone in combination with a prostaglandin analogue". Contraception 74 (1): 66–86. doi:10.1016/j.contraception.2006.03.018. PMID 16781264.
- ^ Heikinheimo O, Kekkonen R, Lahteenmaki P (2003). "The pharmacokinetics of mifepristone in humans reveal insights into differential mechanisms of antiprogestin action". Contraception 68 (6): 421–6. doi:10.1016/S0010-7824(03)00077-5. PMID 14698071.
- ^ Danco Laboratories (July 19, 2005). "Mifeprex U.S. prescribing information" (PDF). Archived from the original on 2007-01-07. Retrieved 2007-03-09.
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Bonner, Staci (July 1991). "Drug of choice". SPIN 7 (4): 55–56, 88. ISSN 0996-3032 ISSN 0996-3032.
Baulieu, Étienne-Émile; Rosenblum, Mort (November 15, 1991). The "abortion pill": RU-486: a woman's choice (translation of: 'Génération pilule). New York: Simon & Schuster. pp. 18, 26–28. ISBN ISBN 0-671-73816-X.
Beck, Joan (January 2, 1992). "RU-486 pill adds a new dimension to the abortion debate". Chicago Tribune. p. 25.
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Baulieu, Étienne-Émile (April 13, 1993). "1993: RU 486—a decade on today and tomorrow". In Donaldson, Molla S.; Dorflinger, Laneta; Brown, Sarah S. et al. Clinical applications of mifepristone (RU 486) and other antiprogestins; assessing the science and recommending a research agenda; (Committee on Anti-progestins: Assessing the Science; Division of Health Promotion and Disease Prevention; Institute of Medicine). Washington, D.C.: National Academy Press. pp. 71–119. ISBN 0-309-04949-0.|displayeditors=suggested (help)
Baulieu, Étienne-Émile (June 1994). "RU 486: a compound that gets itself talked about". Human Reproduction 9 (Suppl 1): 1–6. doi:10.1093/humrep/9.suppl_1.1. PMID 7962455.
Baulieu, Étienne-Émile (1997). "Innovative procedures in family planning". In Johannisson, Elisabeth; Kovács, László; Resch, Bela A et al. Assessment of research and service needs in reproductive health in Eastern Europe — concerns and commitments. Proceedings of a workshop organized by the ICRR and the WHO Collaborating Centre on Research in Human Reproduction in Szeged, Hungary, 25–27 October 1993. New York: Parthenon Publishing. pp. 51–60. ISBN 1-85070-696-4.|displayeditors=suggested (help)
. (2008). "contragestive". The American Heritage medical dictionary. Boston: Houghton Mifflin. p. 124. ISBN 978-0-618-94725-6.adj. Capable of preventing gestation, either by preventing implantation or by causing the uterine lining to shed after implantation. —n. A contragestive drug or agent.
Ammer, Christine (2009). "contragestive". The encyclopedia of women's health (6th ed.). New York: Facts On File. pp. 124–125. ISBN 978-0-8160-7407-5.
Also contragestant, abortion pill. A substance called mifepristone, or RU-486, which was developed by Dr. Etienne Baulieu and the Roussel-Uclaf company. The contragestive blocks progesterone receptors in the endometrium (uterine lining), preventing its buildup by progesterone; hence the uterus cannot sustain a pregnancy. It does not prevent fertilization or implantation, so technically it is an ABORTIFACIENT rather than a contraceptive.
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Teutsch, G; Philibert, D (June 1994). "History and perspectives of antiprogestins from the chemist's point of view". Human Reprod 9 (Suppl 1): 12–31. PMID 7962457.
Sittig, Marshall (ed.), ed. (2007). "Mifepristone". Pharmaceutical manufacturing encyclopedia (3rd ed.). Norwich, NY: William Andrew Publishing. pp. 2307–2310. ISBN 1-60119-339-4.
US patent 4,386,085, Teutsch, Jean G.; Costerousse, Germain; Philibert, Daniel; Deraedt, Roger, "Novel steroids", issued 1983-05-31 assigned to Roussel Uclaf - ^ Eder, Richard (April 20, 1982). "Birth control: 4-day pill is promising in early test". The New York Times. p. C1.
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"F.D.A. says company delays abortion pill". New York Times. Associated Press. April 16, 1993. p. A14.
Jouzaitis, Carol (October 17, 1994). "Abortion pill battle surprises French firm". Chicago Tribune. p. 1 (Business). - ^ a b Seelye, Katharine Q. (May 17, 1994). "Accord opens way for abortion pill in U.S. in 2 years". New York Times. p. A1.
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- ^ Moore, Stephen D.; Kamm, Thomas; Fleming, Charles (December 11, 1996). "Hoechst to seek rest of Roussel-Uclaf; expected $3.04 billion offer would add to the wave of drug-sector linkups". Wall Street Journal. p. A3.
Marshall, Matt (December 11, 1996). "Hoechst offers to pay $3.6 billion for rest of Roussel". Wall Street Journal. p. A8.
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Jouzaitis, Carol (April 9, 1997). "Abortion pill maker bows to boycott heat; German firm gives up RU-486 patent; little impact likely in U.S.". Chicago Tribune. p. 4.
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. (April 18, 1997). "Roussel-Uclaf to transfer RU 486 rights". Reprod Freedom News 6 (7): 8. PMID 12292550.
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- ^ "Catholic and Evangelical students join Muslims in RU-486 fight". Catholic News. February 9, 2006. Retrieved 2006-09-18. [dead link]
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- ^ Stojnic J et al. (2006). "Medicamentous abortion with mifepristone and misoprostol in Serbia and Montenegro". Vojnosanitetski pregled. Military-medical and pharmaceutical review 63 (6): 558–63. doi:10.2298/VSP0606558S. PMID 16796021.
- ^ BBC News (July 31, 2009). "Abortion pill approved in Italy". Retrieved 2009-07-31.
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External links[edit source | edit]
- U.S. Food and Drug Administration Mifeprex (mifepristone) Information
- ZACAFEMYL Mifepristone in Mexico Information
- Commonly asked questions about RU-486 from the education arm of the National Coalition of Abortion Providers
- Danco product web site - EarlyOptionPill.com
- Danco prescribing information
- Australians for RU-486 - established in February 2006 to lobby for passage of bill in Australia's Parliament to enable the availability of Mifepristone
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UpToDate Contents
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- 1. 妊娠初期における薬物による中絶 first trimester medication abortion termination of pregnancy
- 2. 妊娠中絶の概要 overview of pregnancy termination
- 3. 子宮平滑筋腫（子宮筋腫）の治療の概要 overview of treatment of uterine leiomyomas fibroids
- 4. 副腎皮質機能亢進症の内科的治療（クッシング症候群） medical therapy of hypercortisolism cushings syndrome
- 5. プロゲステロン受容体モジュレーター（PRM）の薬理学および作用機序 pharmacology and mechanism of action of progesterone receptor modulators prms
English Journal
- Sex and estrous cycle influence diazepam effects on anxiety and memory: Possible role of progesterone.
- Silva AF1, Sousa DS1, Medeiros AM2, Macêdo PT1, Leão AH1, Ribeiro AM3, Izídio GS4, Silva RH5.
- Progress in neuro-psychopharmacology & biological psychiatry.Prog Neuropsychopharmacol Biol Psychiatry.2016 Oct 3;70:68-76. doi: 10.1016/j.pnpbp.2016.05.003. Epub 2016 May 18.
- Studies with rodents and humans show the relationship between female sex hormones and cognitive/emotional tasks. However, despite the greater incidence of anxiety disorders in women, the data are still inconclusive regarding the mechanisms related to this phenomenon. We evaluated the effects of a cl
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- Behavioural brain research.Behav Brain Res.2016 Oct 1;312:362-5. doi: 10.1016/j.bbr.2016.06.048. Epub 2016 Jun 27.
- Mild traumatic brain injuries (TBIs) comprise three-quarters of all TBIs occurring in the United States annually, and psychological symptoms arising from them can last years after injury. One commonly observed symptom following mild TBI is generalized anxiety. Most mild TBIs happen in stressful situ
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- Corticosterone and dopamine D2/D3 receptors mediate the motivation for voluntary wheel running in C57BL/6J mice.
- Ebada ME1, Kendall DA1, Pardon MC2.
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Japanese Journal
- Effect of the steroid receptor antagonist RU486 (mifepristone) on an IFNγ-induced persistent Chlamydophila pneumoniae infection model in epithelial HEp-2 cells
- ISHIDA Kasumi,YAMAZAKI Tomohiro,MOTOHASHI Kazuki,KOBAYASHI Miho,MATSUO Junji,OSAKI Takako,HANAWA Tomoko,KAMIYA Shigeru,YAMAMOTO Yoshimasa,YAMAGUCHI Hiroyuki
- Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 18(1), 22-29, 2012-02-01
- … We have previously demonstrated that the steroid receptor antagonist mifepristone (RU486) causes growth inhibition of Chlamydophila pneumoniae by binding to and subsequently destroying the bacteria during their normal developmental cycle in epithelial HEp-2 cells. … In the present study, we assessed the efficacy of treatment with RU486 against persistent C. …
- NAID 10030226251
- Glucocorticoids Decrease Astrocyte Numbers by Reducing Glucocorticoid Receptor Expression In Vitro and In Vivo
- Unemura Kazuhiro,Kume Toshiaki,Kondo Minami,Maeda Yuki,Izumi Yasuhiko,Akaike Akinori
- Journal of Pharmacological Sciences 119(1), 30-39, 2012
- … RU486, a GR antagonist, inhibited the reduction in both astrocyte proliferation and GR expression. …
- NAID 130001889270
- Progesterone Is a Sperm-Releasing Factor from the Sperm-Storage Tubules in Birds
- Ito Tomomi,Yoshizaki Norio,Tokumoto Toshinobu,Ono Hiroko,Yoshimura Takashi,Tsukada Akira,Kansaku Norio,Sasanami Tomohiro
- Endocrinology 152(10), 3952-3962, 2011-08-02
- … A binding assay using [(3)H]-progesterone indicated the presence of a high affinity, limited capacity, saturable and single binding site for [(3)H]-progesterone in the membrane fraction of the UVJ, and this receptor did not interact with the synthetic antiprogestin RU486. …
- NAID 120004442651
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