This content was published in 2011. We do not recommend that you take any clinical decisions based on this information without first ensuring you have checked the latest guidance.
A. A single oral dose of mifepristone, followed 36 to 48 hours later by a prostaglandin E1 analogue (misoprostol or gemeprost) given orally or intravaginally, is effective for termination of pregnancy at various stages, including in the first trimester.
There are no data on the effect of mifepristone, misoprostol or gemeprost on lactation or on a breastfed infant.
Limited data suggest that the levels of mifepristone in breast milk are low, especially when using the 200mg dose and so breastfeeding can be safely continued in an uninterrupted manner after medical abortion. This does not match the manufacturer’s recommendation to withhold breastfeeding for 26 days after administration.
Misoprostol is excreted into human breast milk in small amounts, which are rapidly eliminated, necessitating only a short interruption of breastfeeding — for five hours after an oral dose.
Gemeprost is expected to pass into breast milk but there are no data to confirm this. The elimination half-life of gemeprost is 24 hours after intravenous administration, and, therefore, interruption of breastfeeding for 24 hours after a vaginal dose would seem appropriate.
Where a surgical method of termination is used, the effects of local or general anaesthetics must be considered when advising on the safety of breastfeeding.
The above recommendations are based on limited clinical evidence supported by pharmacokinetic observations. Any effect on a breastfed infant is unknown.
This FAQ is adapted from a “Medicines Q&A” produced by UK Medicines Information. The full document, including references, is available from www.nelm.nhs.uk (prepared 12 March 2011).
