Canadian Pharmacists Journal - May/June 2019 - 163

PRACTiCeTOOL
Patients should seek urgent care when they
are soaking 2 sanitary pads per hour for more
than 2 hours, when they are passing tissue larger
than a lemon for more than 2 hours and when
the pain is unbearable and is not improving with
medicine.1,5,8 A fever of 38°C (100.4°F), nausea,
vomiting, diarrhea, dizziness or weakness occurring more than 24 hours after MISO administration warrants emergency care.1,5

Practice tips

MA provides an additional opportunity for
pharmacists to provide patient-centred care.
Here are some points to remember:
* Pharmacists do not need to complete a
training or certification course to dispense
MA.3
* MA is covered by most provincial public
drug plans.3
* MA administration does not need to be
witnessed.3
* MA is safe and effective. It is approved for use
up to 63 days of pregnancy but can be used
up to 70 days.1
* Keeping a list of contraindications can be
helpful to review with every patient before
dispensing MA.

* Consider adjusting steroid therapy by increasing the dose for 1 week after taking MISO and
monitoring closely.1
* Always assess for CYP3A4 drug interactions
with MIFE and notify the patient on how MA
will be affected.1,5
* Educate patients that heavy bleeding usually
starts within 3 hours of misoprostol administration and light bleeding can last up to 2 weeks.1,5
* Patients should not use tampons, only sanitary pads, during MA.1,5
* Counsel patients about how to manage side
effects with over-the-counter therapies such
as NSAIDs, loperamide or dimenhydrinate.
* Educate patients on when they need another
dose of medication if they vomit.
* Follow up with your patients to see how they
are doing-having a strong support system
can be helpful for patients and will strengthen
the patient-pharmacist relationship.

Conclusion

Pharmacists are in a vital position when it comes
to patient education and MA. The next time you
see a prescription for MIFE/MISO, take the
time to educate your patients on what to expect.
It will alleviate much of the discomfort and fears
they may have and they will thank you for it. ■

From the University of Waterloo School of Pharmacy, Waterloo, Ontario. Contact kgrindrod@uwaterloo.ca.
Acknowledgments: We wish to acknowledge Adrian Poon, who designed the infographic. Thank you to Dr. Judith Soon, Dr. Nese
Yuksel and Dr. Sheila Dunn on their feedback on the development of the infographic.
Disclosures: KG conceived of the project. Both researchers were involved in drafting the manuscript and approving the final draft.
Declaration of Conflicting Interests: The authors have no conflicts of interest to declare.
Funding: No funding was received for this project.

References
1. Costescu D, Guilbert E, Bernardin J, et al. Medical abortion. J Obstet Gynaecol Can 2016;38(4):366-89.
2. Norman WV. Induced abortion in Canada 1974-2005:
trends over the first generation with legal access. Contraception 2012;85:185-91.
3. Government of Canada. Recalls and safety alerts.
Mifepristone and misoprostol tablets: updates to product monograph and risk management plan. Available:
http://healthycanadians.gc.ca/recall-alert-rappel-avis/hcsc/2017/65030a-eng.php. (accessed Aug. 2, 2018).
4. Jones RK, Henshaw SK. Mifepristone for early medical
abortion: experiences in France, Great Britain and Sweden.
Perspect Sex Reprod Health 2002;34:154-61.
5. Norman W, Soon JA. Medical abortion. In: Compendium of therapeutics for minor ailments. Ottawa (ON):
C P J / R P C * M ay / J u n e 2 0 1 9 * V O L 1 5 2 , N O 3

Canadian Pharmacists Association. Available: www.etherapeutics.ca (accessed Aug. 2, 2018).
6. Canadian Abortion Providers Support. Medical abortion charting form. Available: https://www.caps-cpca.ubc.
ca/AnnokiUploadAuth.php/e/e0/Canadian_Resource_
1_-_Medical_Abortion_Prescriber_Checklist_2018-07-11.
pdf (accessed Aug. 2, 2018).
7. Soon J, Costescu D, Guilbert E. Medications used in
evidence-based regimens for medical abortion an overview.
J Obstet Gynaecol Can 2016;38(7):636-45.
8. Sexual Health Options Resources Education (SHORE)
Centre. Abortion pill. Available: https://www.shorecentre.ca/
pill/ (accessed Aug. 2, 2018).

163

http://www.etherapeutics.ca http://www.etherapeutics.ca https://www.caps-cpca.ubc.ca/AnnokiUploadAuth.php/e/e0/Canadian_Resource_1_-_Medical_Abortion_Prescriber_Checklist_2018-07-11.pdf https://www.caps-cpca.ubc.ca/AnnokiUploadAuth.php/e/e0/Canadian_Resource_1_-_Medical_Abortion_Prescriber_Checklist_2018-07-11.pdf https://www.caps-cpca.ubc.ca/AnnokiUploadAuth.php/e/e0/Canadian_Resource_1_-_Medical_Abortion_Prescriber_Checklist_2018-07-11.pdf https://www.caps-cpca.ubc.ca/AnnokiUploadAuth.php/e/e0/Canadian_Resource_1_-_Medical_Abortion_Prescriber_Checklist_2018-07-11.pdf http://healthycanadians.gc.ca/recall-alert-rappel-avis/hcsc/2017/65030a-eng.php http://healthycanadians.gc.ca/recall-alert-rappel-avis/hcsc/2017/65030a-eng.php https://www.shorecentre.ca/pill/ https://www.shorecentre.ca/pill/

Canadian Pharmacists Journal - May/June 2019

Table of Contents for the Digital Edition of Canadian Pharmacists Journal - May/June 2019