The potential of mifepristone (RU-486) as an emergency contraceptive drug

The potential of mifepristone to be an emergency contraceptive is reviewed. Mifepristone prevents 92-100% of pregnancies with an acceptable side-effect profile on oral intake of a 10-600-mg dose within 72 h of unprotected intercourse. A single dose of 10 mg mifepristone resulted in a pregnancy rate of 1.5%, similar to a 1.5-mg single dose or two doses of 0.75 mg levonorgestrel 12 h apart, administered within 120 h (current standard) of unprotected sexual intercourse. Mifepristone and levonorgestrel do not differ in efficacy as emergency contraceptives. The mode of action of emergency contraception (EC) with mifepristone or levonorgestrel is primarily associated with inhibition of ovulation rather than prevention of implantation. Different doses of mifepristone appear to have similar effects. However, delay in the onset of subsequent menstruation caused by mifepristone is dose dependent and is reduced with a lower dose without affecting its efficacy. Patient acceptability of mifepristone as EC is high. However, the optimum standard dose of mifepristone is yet to be established for its application as an effective and acceptable emergency contraceptive drug for ordinary clinical use or practice.