Mifepristone + Misoprostol interactions

Food & lifestyle

• grapefruit juice

  Moderate

  Others

  Food may significantly increase the plasma concentrations of mifepristone.

  What to do: When mifepristone is used daily to control hyperglycemia secondary to hypercortisolism in patients with endogenous Cushing's syndrome, it should be taken with food to achieve consistent plasma drug levels. Patients should be advised to avoid consuming grapefruit or grapefruit juice during treatment with mifepristone, as it may cause increased adverse effects such as headache, dizziness, fatigue, nausea, vomiting, cramping, diarrhea, hypokalemia, adrenal insufficiency, vaginal bleeding, arthralgia, peripheral edema, and hypertension. Because mifepristone is eliminated slowly from the body, the interaction with grapefruit juice may be observed for a prolonged period.

  2 sources

  1. "Product Information. Mifeprex (mifepristone)." Danco Laboratories (2001):
  2. "Product Information. Korlym (mifepristone)." Corcept Therapeutics Incorporated (2012):

Conditions

Conditions in which Mifepristone + Misoprostol needs care, as documented in this source.

• Uterine Hemorrhage

  Major

  Mifepristone is contraindicated in women with unexplained vaginal bleeding, and women with endometrial hyperplasia with atypia or endometrial carcinoma, as it promotes endometrial proliferation that may result in endometrium thickening, cystic dilatation of endometrial glands, and vaginal bleeding. It should also be used with caution in women with hemorrhagic disorders or those receiving anticoagulation therapy.

  1 source

  1. "Product Information. Korlym (mifepristone)." Corcept Therapeutics Incorporated (2012):

• Cardiovascular Diseases

  Moderate

  Mifepristone does not reduce serum cortisol levels, and elevated cortisol levels might activate mineralocorticoid receptors which are expressed in cardiac tissue. Caution should be used in patients with underlying heart conditions, including heart failure and coronary vascular disease.

  1 source

  1. "Product Information. Korlym (mifepristone)." Corcept Therapeutics Incorporated (2012):

• Cardiovascular Diseases

  Moderate

  Caution should be employed when administering misoprostol to patients with preexisting cardiovascular disease.

  1 source

  1. "Product Information. Cytotec (misoprostol)." Searle (2001):

• Diarrhea

  Moderate

  Diarrhea may occur in up to 40% of patients receiving misoprostol. Misoprostol should be administered cautiously in patients with underlying conditions such as inflammatory bowel disease and dehydration. Careful monitoring during therapy is recommended.

  2 sources

  1. Wildeman RA "Focus on misoprostol: review of worldwide safety data." Clin Invest Med 10 (1987): 243-5
  2. "Product Information. Cytotec (misoprostol)." Searle (2001):

• Hepatic Insufficiency

  Moderate

  There is limited information on the safety of mifepristone in patients with mild to moderate hepatic impairment, hence the manufacturers recommend that the maximum dose should not exceed 600 mg per day. The use of mifepristone is not recommended in patients with severe hepatic disease as the pharmacokinetics in these patients have not been studied.

  1 source

  1. "Product Information. Korlym (mifepristone)." Corcept Therapeutics Incorporated (2012):

• Kidney Diseases

  Moderate

  No change in the initial dose of mifepristone is needed for renal impairment; but the manufacturers recommend that the maximum dose should not exceed 600 mg per day in these patients.

  1 source

  1. "Product Information. Korlym (mifepristone)." Corcept Therapeutics Incorporated (2012):

• Long QT Syndrome

  Moderate

  Mifepristone prolongs the QTc interval in a dose-related manner. There is little or no experience with high exposure, concomitant dosing with other QT- prolonging drugs, or potassium channel variants resulting in long QT interval. Caution and monitoring is advised if used in patients with long QT. To minimize risk, the lowest effective dose should always be used.

  1 source

  1. "Product Information. Korlym (mifepristone)." Corcept Therapeutics Incorporated (2012):