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| Gastrointestinal Side Effects |  Gastrointestinal side effects, even if usually thought to be associated to the prostaglandin analogue (misoprostol), can also arise from mifepristone or methotrexate. Such conditions as nausea, vomiting, and diarrhea also can be associated with both early pregnancy and the abortion process itself.
In a great amount of medical abortion studies, nausea is the most frequently reported gastrointestinal side effect. Rates of gastrointestinal side effects are approximately the same for mifepristone/misoprostol and methotrexate/misoprostol regimens.
As a rule, nausea, vomiting, and diarrhea are self-limited and of mild severity. Gastrointestinal side effects are originally managed with reassurance but also may be cured with antiemetics or antidiarrheals. On the other hand, no definitive studies prove the benefit of these interventions in medical abortion patients.
Study indicates that the incidence of gastrointestinal side effects is prone to enlarge with higher doses of misoprostol and with advancing gestational age. Nausea and vomiting are considerably more frequent in women with gestations 50 to 63 days than in women with gestations ≤ 49 days. (Note: The FDA-approved regimen is for pregnancies ≤ 49 days.) Creinin and colleagues showed that nausea and vomiting were lower in women who used misoprostol 6-8 hours after mifepristone as compared to those who used it 24 hours after mifepristone.
One possible approach for reducing the incidence of these side effects is to manage misoprostol vaginally rather than orally. El-Refaey and colleagues demonstrated that the incidence of vomiting (31% vs. 44%; p = 0.04) and diarrhea (18% vs. 36%; p = 0.002) was considerably lower in women receiving vaginal misoprostol than among those given oral misoprostol. The usual first dose of vaginal misoprostol in both mifepristone and methotrexate regimens is 800 µg.
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