E688 CMAJ | JUNE 4, 2018 | VOLUME 190 | ISSUE 22 © 2018 Joule Inc. or its licensors 1 Mifepristone, the drug for medical abortion, became available in Canada in January 2017 Mifepristone in combination with misoprostol is approved for abortion up to 63 days gestation, but evidence supports its use up to 70 days. 1,2 It may be pre- scribed by physicians and other health care providers, such as nurse practition- ers, where authorized by their provincial licensing regulator, and may be dis- pensed by pharmacists directly to the patient. Online training and resources are available but are no longer mandatory to be able to prescribe mifepristone. 3,4 2 Combined mifepristone and misoprostol is safe and highly efective Mifepristone, a progesterone receptor antagonist with antiglucocorticoid properties, blocks progesterone support of the pregnancy. The prosta- glandin misoprostol, used one to two days later, stimulates uterine con- tractions and expulsion of the products of conception, a process similar to a natural miscarriage. This combination has an efectiveness of 95% to 98% up to 63 days gestation. 2 Short-lived bleeding and cramping are the most notable adverse efects. Although uncommon, complications, such as hemorrhage or infection, may require emergency care. 3 There are few contraindications for using mifepristone Suspected or confirmed ectopic pregnancy, anemia, hemorrhagic disor- ders, uncontrolled asthma, porphyria and adrenal insuficiency are the most important contraindications. Patients receiving oral or inhaled ster- oids for other conditions may require dose adjustments. 4 Mifepristone abortion can be provided in primary care Ultrasonography is commonly used to assess gestational age and rule out ectopic pregnancy. If ultrasonography is unavailable and there are no symp- toms or risks for ectopic pregnancy, a reliable last menstrual period and consistent bimanual examination can be used instead. 2,3 Follow-up, either by an ofice visit or telephone, combined with ultrasonography or serial lev- els of human chorionic gonadotropin tested before and seven to 14 days afer mifepristone, are needed to confirm complete abortion. 2 Aspiration may be required for incomplete or failed abortion, or problematic bleeding. 5 Many government insurance plans cover mifepristone and misoprostol Alberta, British Columbia, New Brunswick, Nova Scotia, Ontario and Que- bec, and the federal Non-Insured Health Benefits Program (for patients who are First Nations or Inuit) provide universal coverage of mifepristone and misoprostol. 4 The Interim Federal Health Program (for patients who are refugees) covers costs in most provinces. 5 PRACTICE | FIVE THINGS TO KNOW ABOUT ... Mifepristone Sheila Dunn MD MSc, Melissa Brooks MD n Cite as: CMAJ 2018 June 4;190:E688. doi: 10.1503/cmaj.180047 References 1. Sanhueza Smith P, Peña M, Dzuba IG, et al. Safety, eficacy and acceptability of outpatient mifepristone-misoprostol medical abortion through 70 days since last menstrual period in public sector facilities in Mexico City. Reprod Health Matters 2015;22(Suppl 1):75-82. 2. Costescu D, Guilbert E, Bernardin J, et al. Society of Obstetri- cians and Gynecologists of Canada. Medical abortion. J Obstet Gynaecol Can 2016;38:366-89. 3. Accredited medical abortion training program. Ottawa: Society of Obstetricians and Gynaecologists of Canada. Available: https://sogc.org/online-courses/courses.html/event-info/details /id/229 (accessed 2018 Jan. 5). 4. Canadian Abortion Providers Support (CAPS) [home page]. Available: https://www.caps-cpca.ubc.ca/index.php/Main_Page (accessed 2018 Jan. 18). 5. Action Canada. Is mifegymiso available in Canada? Available: www.mifegymiso.com/mifegymiso-in-Canada (accessed 2018 May 14). Competing interests: Sheila Dunn received financial compensation from the Society of Obstetricians and Gynaecologists of Canada for the development of the Medical Abortion Training Program. No other com- peting interests were declared. This article has been peer reviewed. Afiliations: Department of Family and Community Medicine (Dunn), University of Toronto; Women’s College Research Institute (Dunn), Women’s College Hospital, Toronto, Ont.; Department of Obstetrics and Gynecology (Brooks), IWK Health Center, Dal- housie University, Halifax, NS Acknowledgements: The authors thank the Can- adian Mifepristone Implementation Research Study team and the Women’s College Hospital Family Prac- tice Peer Support Writing Group for their support and advice in the production of this manuscript. Correspondence to: Sheila Dunn, sheila.dunn@ wchospital.ca CMAJ invites submissions to “Five things to know about …” Submit manuscripts online at http://mc. manuscriptcentral.com/cmaj