Ask Your Pharmacist

June 03, 2022
Q:

How do I access medical abortion in New Brunswick?

A:

Medication abortion was approved by Health Canada in 2015 and is known as the abortion medication RU-486 or mifepristone. Mifepristone is considered a safe and effective treatment for a woman to have a medical abortion according to the World Health Organization. 

Mifepristone is appropriate to use up to 63 days after the last menstrual period according to Health Canada. The combination product available to New Brunswickers is called mifepristone/misoprostolol (Mifegymiso). Mifepristone blocks the effect of progersterone, a hormone needed to maintain pregnancy. Misoprostolol is a prostaglandin and causes contractions and relaxation of the cervix. The two medications work together to end pregnancy.  

Mifegymiso is available as a prescription by physicians and nurse practitioners in New Brunswick. This medication is covered at no cost to you if you have a valid New Brunswick Medicare number. 

A prescription for Mifegymiso may be presented to any pharmacy in New Brunswick. Your pharmacy team will work with you to find timely access to the medication, and your pharmacist will provide counselling about what to expect and how to manage side effects.

Most pharmacies have a private counselling area, and discretion will be used to protect your personal health information as we discuss with you the safest way to take the medication and what to expect. You pharmacist will treat you with professionalism. She or he will confirm that you intend a medical abortion. Your pharmacist will answer any questions you may have.

It is important to have a plan in place should you require assistance before you take the medication. Help includes personal support during and around the time of medication administration and transportation should medical follow-up be needed. Access to a telephone is a must. It is important that you have access to emergency medical care should it be needed.

It is important to go over the directions for appropriate administration with your pharmacist.

In Canada, mifepristone is packaged in a combination box containing one mifepristone 200 mg tablet and four 0.2 mg misoprostolol tablets. Day one of treatment involves taking (from the green box label) one tablet of mifepristone orally and swallowing the tablet with a full glass of water. Twenty-four to 48 hours after this, place (from the orange label box) four tablets of misoprostolol between the cheek and the gum (two on each side of the mouth). The tablets are to remain in place for 30 minutes, after which time swallow the remaining tablet pieces with water.

It is very important to always take the misoprostolol even if bleeding has already started. Bleeding generally starts one to 48 hours after ingestion of mifepristone. Heavier bleeding than a normal menstrual period is expected, sometimes with clots, lasting two to four hours. Pain and cramping begin within four hours and maybe persist up to 48 hours. Talk to your pharmacist about ways to manage this pain. Over-the-counter pain relievers such as ibuprofen, naproxen, acetaminophen, and codeine-containing product are options. In some cases, there may be stomach upset, nausea, vomiting, and diarrhea.  

Knowing when to ask for help is important. Heavy vaginal bleeding that saturates more than two sanitary pads per hour for two or more hours is a reason to seek medical attention. Dizziness, increased heart rate, heavy bleeding for more than 16 days, or foul-smelling vaginal discharge should be attended to by a primary care provider. If you develop a temperature greater than 38.3 C for more than six hours and have weakness, nausea, vomiting, diarrhea, this is medical urgency and needs attention.

If you are not comfortable being counselled at the pharmacy, call your pharmacist and an approach which meets your needs will be planned out with you. If you do not have a primary care prescriber or feel more comfortable discussing this matter with another health care professional, you can access treatment through the province of New Brunswick https://www2.gnb.ca/content/gnb/en/departments/health/MedicarePrescriptionDrugPlan/NBDrugPlan/ForHealthCareProfessionals/medical_abortion_program_qa.html

Dr Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Shoppers Drug Mart in Quispamsis, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.

Quispamsis pharmacist Kevin Duplisea dispenses information and advice on a wide range of pharmacy questions in a regular column published in several newspapers.

If you have a question you’d like to see answered in his column, you can send it to him at AskYourNBPharmacist@gmail.com