Dosing & Uses
Dosage Forms & Strengths
tablet
- 200mg (Mifeprex)
- 300mg (Korlym)
Pregnancy Termination
Mifeprex: Indicated for the medical termination of intrauterine pregnancy through 70 days gestation in combination with misoprostol
Day 1: 200 mg of mifepristone PO as a single dose
Days 2-3: 800 mcg of misoprostol buccally once as a single dose; must be administered a minimum of 24-hr and a maximum of 48-hr following mifeprostone dose on day 1 (see Administration)
Follow up with healthcare provider 7-14 days after taking Mifeprex
Days 7-14
- Must return for follow-up visit to confirm complete termination has occurred by medical history, clinical examination, hCG testing, or ultrasonographic scan
- If complete expulsion has not occurred, but the pregnancy is not ongoing, women may be treated with another dose of misoprostol 800 mcg buccally with follow-up in ~7 days
- Lack of bleeding following treatment usually indicates failure; however, prolonged or heavy bleeding is not proof of a complete abortion
- Surgical evacuation is recommended to manage ongoing pregnancies after medical abortion
Dosing considerations
- Pregnancy is dated from the first day of the last menstrual period
- Duration of pregnancy may be determined from menstrual history and clinical examination
- Assess the pregnancy by ultrasonographic scan if the duration of pregnancy is uncertain or if ectopic pregnancy is suspected
- Remove any intrauterine device (IUD) before treatment
- Because most women will expel the pregnancy within 2-24 hr of taking misoprostol, discuss with the patient an appropriate location for her to be when she takes the misoprostol, taking into account that expulsion could begin within 2 hr of administration
Cushing Syndrome
Korlym: Indicated to control hyperglycemia secondary to hypercortisolism in adults with endogenous Cushing syndrome who have type 2 diabetes mellitus or glucose intolerance and have failed surgery or are not candidates for surgery
300 mg PO qDay initially; may dose to a maximum of 1200 mg/day, but should not exceed 20 mg/kg/day
Increase in dose should not occur more frequently than every 2-4 weeks and should be based on assessment of glucose control, antidiabetic medication requirements, insulin levels and psychiatric symptoms
Dosage Modifications (Korlym)
Coadministration with strong CYP3A inhibitors: Not to exceed 300 mg/day
Renal impairment: No change in initial dose; limit maximum dose to 600 mg PO qDay
Hepatic impairment
- Mild-to-moderate: No change in initial dose; limit maximum dose to 600 mg PO qDay
- Severe: Do not use
Ovarian Cancer (Orphan)
Korlym: Orphan designation for treatment of ovarian cancer
Sponsor
- Corcept Therapeutics, Inc; 149 Commonwealth Drive; Menlo Park, California 94025
Safety and efficacy not established
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (64)
- alfuzosin
mifepristone will increase the level or effect of alfuzosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- antithrombin alfa
mifepristone, antithrombin alfa. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- antithrombin III
mifepristone, antithrombin III. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- apixaban
mifepristone increases toxicity of apixaban by anticoagulation. Contraindicated.
- argatroban
mifepristone, argatroban. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- aspirin
aspirin, mifepristone. Other (see comment). Contraindicated. Comment: Aspirin induced antiplatelet activity may induce excessive bleeding after an abortion w/mifepristone (RU 486).
- aspirin rectal
aspirin rectal, mifepristone. Other (see comment). Contraindicated. Comment: Aspirin induced antiplatelet activity may induce excessive bleeding after an abortion w/mifepristone (RU 486).
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate, mifepristone. Other (see comment). Contraindicated. Comment: Aspirin induced antiplatelet activity may induce excessive bleeding after an abortion w/mifepristone (RU 486).
- bemiparin
mifepristone, bemiparin. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- bivalirudin
mifepristone, bivalirudin. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- budesonide
mifepristone, budesonide. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.
- cisapride
mifepristone, cisapride. QTc interval. Contraindicated.
- conivaptan
mifepristone will increase the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- cortisone
mifepristone, cortisone. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.
- cyclosporine
mifepristone increases levels of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index .
- dabigatran
mifepristone, dabigatran. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- dalteparin
mifepristone, dalteparin. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- deflazacort
mifepristone, deflazacort. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.
- dexamethasone
mifepristone, dexamethasone. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.
- dihydroergotamine
mifepristone increases levels of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index .
- dihydroergotamine intranasal
mifepristone increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index .
- dronedarone
mifepristone, dronedarone. QTc interval. Contraindicated.
- eletriptan
mifepristone will increase the level or effect of eletriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- enoxaparin
mifepristone, enoxaparin. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- eplerenone
mifepristone will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- ergoloid mesylates
mifepristone will increase the level or effect of ergoloid mesylates by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- ergonovine
mifepristone will increase the level or effect of ergonovine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- ergotamine
mifepristone increases levels of ergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index .
- finerenone
mifepristone will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- fludrocortisone
mifepristone, fludrocortisone. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.
- fondaparinux
mifepristone, fondaparinux. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- gepirone
mifepristone will increase the level or effect of gepirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- goserelin
goserelin increases toxicity of mifepristone by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- heparin
mifepristone, heparin. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- hydrocortisone
mifepristone, hydrocortisone. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.
- isavuconazonium sulfate
mifepristone will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- lefamulin
lefamulin will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.
- lepirudin
mifepristone, lepirudin. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- leuprolide
leuprolide increases toxicity of mifepristone by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- lonafarnib
mifepristone will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lonafarnib is a sensitive CYP3A4 substrate. Coadministration with strong or moderate CYP3A4 inhibitors is contraindicated.
- lovastatin
mifepristone increases levels of lovastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated due to increased risk of rhabdomyolysis.
- mavacamten
mifepristone will increase the level or effect of mavacamten by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Strong CYP3A4 inhibitors may increase mavacamten systemic exposure, resulting in heart failure due to systolic dysfunction.
- methylergonovine
mifepristone will increase the level or effect of methylergonovine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- methylprednisolone
mifepristone, methylprednisolone. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.
- mometasone topical
mifepristone, mometasone topical. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Mifepristone is contraindicated in patients on long-term corticosteriod treatment due to increase risk of adrenal insufficiency.
- naloxegol
mifepristone will increase the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- norethindrone
mifepristone will increase the level or effect of norethindrone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- pacritinib
mifepristone will increase the level or effect of pacritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- phenindione
mifepristone, phenindione. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- pimozide
mifepristone increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index; combination may prolong QT interval .
- prednisolone
mifepristone, prednisolone. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.
- prednisone
mifepristone, prednisone. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.
- protamine
mifepristone, protamine. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- quinidine
mifepristone increases levels of quinidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index; combination may prolong QT interval .
- rivaroxaban
mifepristone increases toxicity of rivaroxaban by anticoagulation. Contraindicated.
- simvastatin
mifepristone increases levels of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated due to increased risk of rhabdomyolysis.
mifepristone increases toxicity of simvastatin by Other (see comment). Contraindicated. Comment: OATP1B1 inhibitors may increase risk of myopathy. - sirolimus
mifepristone increases levels of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index .
- tacrolimus
mifepristone increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index .
- thioridazine
mifepristone, thioridazine. QTc interval. Contraindicated.
- tinzaparin
mifepristone, tinzaparin. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.
- triamcinolone acetonide injectable suspension
mifepristone, triamcinolone acetonide injectable suspension. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.
- triazolam
mifepristone will increase the level or effect of triazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- voclosporin
mifepristone will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- warfarin
mifepristone increases effects of warfarin by anticoagulation. Contraindicated.
Serious - Use Alternative (192)
- adagrasib
mifepristone will increase the level or effect of adagrasib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a CYP3A4 substrate, with strong CYP3A4 inhibitors until adagrasib concentrations have reached steady-state (after ~8 days). If steady state is not reached, concomitant use of strong CYP3A4 inhibitors will increase adagrasib concentrations and risk of its toxicities
adagrasib, mifepristone. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients. - afatinib
mifepristone increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.
- alfentanil
mifepristone will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- alfuzosin
mifepristone and alfuzosin both increase QTc interval. Avoid or Use Alternate Drug. Use alternatives if available
alfuzosin and mifepristone both increase QTc interval. Contraindicated. - amiodarone
mifepristone will increase the level or effect of amiodarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- amisulpride
amisulpride and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- anagrelide
anagrelide and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- apalutamide
apalutamide will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
mifepristone will increase the level or effect of apalutamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. No initial dose adjustment - aprepitant
mifepristone will increase the level or effect of aprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- aripiprazole
aripiprazole and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- armodafinil
mifepristone will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- artemether/lumefantrine
mifepristone will decrease the level or effect of artemether/lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- aspirin
aspirin will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- atorvastatin
mifepristone increases toxicity of atorvastatin by Other (see comment). Avoid or Use Alternate Drug. Comment: OATP1B1 inhibitors may increase risk of myopathy.
- avanafil
mifepristone will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- avapritinib
mifepristone will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of avapritinib with strong CYP3A4 inhibitors.
- benzhydrocodone/acetaminophen
mifepristone will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration with strong CYP3A4 inhibitors may increase hydrocodone (benzhydrocodone is prodrug of hydrocodone) plasma concentrations and can result in potentially fatal respiratory depression.
- bosentan
mifepristone will increase the level or effect of bosentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- bromocriptine
mifepristone will increase the level or effect of bromocriptine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- budesonide
mifepristone will increase the level or effect of budesonide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- buprenorphine
mifepristone will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
buprenorphine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. - buprenorphine buccal
buprenorphine buccal and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
mifepristone will increase the level or effect of buprenorphine transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
buprenorphine transdermal and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. - buprenorphine, long-acting injection
buprenorphine, long-acting injection and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- calcitriol
mifepristone will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- capivasertib
mifepristone will increase the level or effect of capivasertib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration of capivasertib with strong CYP3A inhibitors, reduce capivasertib dose and monitor for adverse effects.
- capmatinib
mifepristone will increase the level or effect of capmatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- carbamazepine
mifepristone will increase the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
carbamazepine will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - cariprazine
mifepristone will increase the level or effect of cariprazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If a strong mifepristone initiated, reduce current dosage of cariprazine by half; if patient is already taking the CYP3A4 inhibitor and initiating cariprazine, follow manufacturer?s recommendation
- ceritinib
ceritinib and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
ceritinib will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - chloramphenicol
chloramphenicol will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cilostazol
mifepristone will increase the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cisapride
mifepristone will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- clarithromycin
mifepristone will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
clarithromycin and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. - colchicine
mifepristone will increase the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use of colchicine with strong CYP3A4 inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with strong CYP3A4 inhibitors is contraindicated in patients with renal or hepatic impairment.
- copanlisib
mifepristone will increase the level or effect of copanlisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- crizotinib
mifepristone will increase the level or effect of crizotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Increase in crizotinib levels may result in QT prolongation
- dabrafenib
mifepristone will increase the level or effect of dabrafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- daridorexant
mifepristone will increase the level or effect of daridorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- dasatinib
mifepristone will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration necessary, concomitant use of mifepristone not recommended in patients receiving dasatinib 40-60 mg daily; consider a dasatinib dose reduction to 40 mg PO daily if original dose was 140 mg daily, 20 mg PO daily if original dose was 100 mg daily, or 20 mg PO daily if original dose was 70 mg daily; If dasatinib is not tolerated after dose reduction, consider alternative therapies; if mifepristone stopped, wait approximately 1 week before increasing dasatinib dose
- deflazacort
mifepristone will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Decrease dose by one third if combination cannot be avoided
- desflurane
desflurane and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- dexamethasone
mifepristone will increase the level or effect of dexamethasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- diazepam
mifepristone will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- disopyramide
mifepristone will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- dofetilide
dofetilide increases toxicity of mifepristone by QTc interval. Avoid or Use Alternate Drug.
- dronedarone
mifepristone will increase the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- efavirenz
mifepristone will increase the level or effect of efavirenz by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
efavirenz will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
efavirenz and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. - elacestrant
mifepristone will increase the level or effect of elacestrant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- eliglustat
mifepristone will increase the level or effect of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
eliglustat and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. - eluxadoline
mifepristone increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .
- elvitegravir
mifepristone will increase the level or effect of elvitegravir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
mifepristone will increase the level or effect of elvitegravir/cobicistat/emtricitabine/tenofovir DF by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- encorafenib
mifepristone will increase the level or effect of encorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concomitant use of a strong CYP3A4 inhibitor is unavoidable, reduce encorafenib dose to one-third of the dose (eg, reduce from 450 mg/day to 150 mg/day). After discontinuing the inhibitor for 3-5 elimination half-lives, resume previous encorafenib dose.
encorafenib and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval. - entrectinib
mifepristone and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
mifepristone will increase the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of strong CYP3A4 inhibitors with entrectinib, a CYP3A4 substrate. If coadministration unavoidable, reduce entrectinib dose to 100 mg/day for patients aged 12 y or older with BSA >1.50m2. Resume previous entrectinib dose after discontinuing strong CYP3A inhibitor for 3-5 elimination half-lives. - enzalutamide
mifepristone will increase the level or effect of enzalutamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
enzalutamide will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - erdafitinib
mifepristone will increase the level or effect of erdafitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with strong CYP3A4 inhibitors, monitor closely for adverse reactions and consider decreasing dose accordingly. If strong CYP3A4 inhibitor is discontinued, consider increasing erdafitinib dose in the absence of any drug-related toxicities.
- eribulin
eribulin and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin base
mifepristone will increase the level or effect of erythromycin base by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
mifepristone will increase the level or effect of erythromycin ethylsuccinate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- erythromycin lactobionate
mifepristone will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- erythromycin stearate
mifepristone will increase the level or effect of erythromycin stearate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- eszopiclone
mifepristone will increase the level or effect of eszopiclone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ethinylestradiol
mifepristone will increase the level or effect of ethinylestradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ethosuximide
mifepristone will increase the level or effect of ethosuximide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- etrasimod
mifepristone will increase the level or effect of etrasimod by Other (see comment). Avoid or Use Alternate Drug. Increased exposure of etrasimod expected in patients who are CYP2C9 poor metabolizers if coadministered with moderate to strong CYP2C8 inhibitors.
- everolimus
mifepristone will increase the level or effect of everolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- fedratinib
mifepristone will increase the level or effect of fedratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid fedratinib coadministration with strong CYP3A4 inhibitors, decrease fedratinib dose to 200 mg/day. If CYP3A4 inhibitor discontinued, increase fedratinib dose to 300 mg/day for 2 weeks, and then 400 mg/day thereafter as tolerated.
- felbamate
mifepristone will increase the level or effect of felbamate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- felodipine
mifepristone will increase the level or effect of felodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- fentanyl intranasal
mifepristone will increase the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor patients for respiratory depression and sedation at frequent intervals if coadministration of CYP3A4 inhibitors with fentanyl is necessary, and consider fentanyl dose adjustments until stable drug effects achieved
- fentanyl transdermal
mifepristone will increase the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor patients for respiratory depression and sedation at frequent intervals if coadministration of CYP3A4 inhibitors with fentanyl is necessary, and consider fentanyl dose adjustments until stable drug effects achieved
- fentanyl transmucosal
mifepristone will increase the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor patients for respiratory depression and sedation at frequent intervals if coadministration of CYP3A4 inhibitors with fentanyl is necessary, and consider fentanyl dose adjustments until stable drug effects achieved
- fexinidazole
mifepristone will decrease the level or effect of fexinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration, monitor fexinidazole for decreased efficacy owing to decreased plasma concentrations of active M1 and M2 metabolites.
fexinidazole and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
fexinidazole will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates. - fingolimod
fingolimod and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- flurazepam
mifepristone will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- fluvastatin
mifepristone increases toxicity of fluvastatin by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor; OATP1B1 inhibitors may increase risk of myopathy.
- fosamprenavir
mifepristone will increase the level or effect of fosamprenavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- fosaprepitant
mifepristone will increase the level or effect of fosaprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- gilteritinib
mifepristone will increase the level or effect of gilteritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Consider alternatives to any strong CYP3A4 inhibitor when coadministered with gilteritinib. If such a combination cannot be avoided, closely monitor for gilteritinib-related adverse effects. Interrupt and reduce gilteritinib dosage in patients with serious or life-threatening toxicity.
gilteritinib and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. - glasdegib
mifepristone will increase the level or effect of glasdegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Consider alternate therapies that are not strong CYP3A inhibitors or monitor for increased risk of adverse effects, including QTc interval prolongation.
mifepristone and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation. - granisetron
granisetron and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- guanfacine
mifepristone will increase the level or effect of guanfacine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- haloperidol
mifepristone will increase the level or effect of haloperidol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- histrelin
histrelin increases toxicity of mifepristone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxyprogesterone caproate (DSC)
mifepristone will increase the level or effect of hydroxyprogesterone caproate (DSC) by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- hydroxyzine
hydroxyzine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- ibrutinib
mifepristone will increase the level or effect of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- idelalisib
idelalisib will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- imatinib
mifepristone will increase the level or effect of imatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- infigratinib
mifepristone will increase the level or effect of infigratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- inotuzumab
inotuzumab and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.
- irinotecan
mifepristone will increase the level or effect of irinotecan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration and for at least 1 week prior to initiating therapy unless no therapeutic alternatives
- irinotecan liposomal
mifepristone will increase the level or effect of irinotecan liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. UGT1A1 inhibitors decrease irinotecan metabolism
- isoflurane
isoflurane and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- itraconazole
mifepristone will increase the level or effect of itraconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
itraconazole and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. - ivosidenib
mifepristone will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of strong CYP3A4 inhibitors with ivosidenib or replace with alternate therapies. If coadministration of a strong CYP3A4 inhibitor is unavoidable, reduce ivosidenib dose to 250 mg qDay. If the strong inhibitor is discontinued, increase ivosidenib dose (after at least 5 half-lives of the strong CYP3A4 inhibitor) to the recommended dose of 500 mg qDay. Monitor for increased risk of QTc interval prolongation.
ivosidenib and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
ivosidenib will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs. - ixabepilone
mifepristone will increase the level or effect of ixabepilone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor patients receiving CYP3A4 inhibitors during treatment with ixabepilone for acute toxicities (eg, frequent monitoring of peripheral blood counts between cycles of ixabepilone); consider, a dose reduction of ixabepilone in some patients
- ketamine
mifepristone will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ketoconazole
ketoconazole will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- larotrectinib
mifepristone will increase the level or effect of larotrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of larotrectinib with strong CYP3A4 inhibitors is unavoidable, reduce larotrectinib dose by 50%. Resume prior larotrectinib dose once CYP3A4 inhibitor discontinued for 3-5 half-lives.
- lefamulin
mifepristone will increase the level or effect of lefamulin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of lefamulin with strong CYP3A inhibitors.
- lemborexant
mifepristone will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of lemborexant with moderate or strong CYP3A inhibitors.
- leniolisib
mifepristone will increase the level or effect of leniolisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- levoketoconazole
levoketoconazole will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- levomilnacipran
mifepristone will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- levonorgestrel intrauterine
mifepristone will increase the level or effect of levonorgestrel intrauterine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- levonorgestrel oral
mifepristone will increase the level or effect of levonorgestrel oral by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- lithium
lithium and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- lorlatinib
mifepristone will increase the level or effect of lorlatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministering lorlatinib with strong CYP3A inhibitors. If unavoidable, reduce lorlatinib dose by 25 mg/day. If strong CYP3A inhibitor discontinued, increase to previous lorlatinib (dose after 3 plasma half-lives of strong CYP3A inhibitor). See monograph for further details.
lorlatinib will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - lurbinectedin
lurbinectedin will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
mifepristone will increase the level or effect of lurbinectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce lurbinectedin dose by 50%. After strong CYP3A inhibitor discontinued for 5 half-lives, increase lurbinectedin to dose used before coadministration. - macimorelin
macimorelin and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.
mifepristone will increase the level or effect of macimorelin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - medroxyprogesterone
mifepristone will increase the level or effect of medroxyprogesterone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- mefloquine
mefloquine increases toxicity of mifepristone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
mifepristone will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - mestranol
mifepristone will increase the level or effect of mestranol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- methadone
mifepristone will increase the level or effect of methadone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- methylprednisolone
mifepristone will increase the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- midazolam intranasal
mifepristone will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of strong CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation.
- midostaurin
mifepristone will increase the level or effect of midostaurin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- mirtazapine
mirtazapine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- nicardipine
mifepristone will increase the level or effect of nicardipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- nilotinib
mifepristone will increase the level or effect of nilotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- nirogacestat
mifepristone will increase the level or effect of nirogacestat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- nisoldipine
mifepristone will increase the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- norgestrel
mifepristone decreases effects of norgestrel by pharmacodynamic antagonism. Contraindicated. Backup contraceptive method recommended.
- olaparib
mifepristone will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concomitant use necessary, reduce dose of olaparib to 100 mg twice daily; original dose may be resumed 3 to 5 elimination half-lives after mifepristone is discontinued
- omaveloxolone
mifepristone will increase the level or effect of omaveloxolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unavoidable, reduce omaveloxolone dose to 50 mg/day. Closely monitor and discontinue if adverse effects emerge.
- ombitasvir/paritaprevir/ritonavir
mifepristone will increase the level or effect of ombitasvir/paritaprevir/ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)
mifepristone will increase the level or effect of ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ondansetron
mifepristone will increase the level or effect of ondansetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- osimertinib
mifepristone will increase the level or effect of osimertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- oxaliplatin
oxaliplatin and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- paclitaxel
mifepristone will increase the level or effect of paclitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- paclitaxel protein bound
mifepristone will increase the level or effect of paclitaxel protein bound by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- palbociclib
mifepristone will increase the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- palovarotene
mifepristone will increase the level or effect of palovarotene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- panobinostat
mifepristone and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.
mifepristone will increase the level or effect of panobinostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - pazopanib
mifepristone will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- pemigatinib
mifepristone will increase the level or effect of pemigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pemigatinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pemigatinib dose.
- pexidartinib
mifepristone will increase the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pexidartinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pexidartinib dose.
- pimavanserin
mifepristone and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.
mifepristone will increase the level or effect of pimavanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - pirtobrutinib
mifepristone will increase the level or effect of pirtobrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration is unavoidable, reduce pirtobrutinib by 50 mg. If current pirtobrutinib dose is 50 mg qDay, discontinue pirtobrutinib for duration of strong CYP3A inhibitor use. Once strong CYP3A inhibitor discontinued for 5 half-lives, resume pirtobrutinib at the dose taken before initiating the strong CYP3A inhibitor.
- pitolisant
mifepristone and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- ponatinib
mifepristone will increase the level or effect of ponatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- pralsetinib
mifepristone will increase the level or effect of pralsetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- primaquine
mifepristone will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
primaquine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. - quetiapine
mifepristone will increase the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- quinine
mifepristone will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- rabeprazole
mifepristone will increase the level or effect of rabeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ranolazine
mifepristone will increase the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- regorafenib
mifepristone will increase the level or effect of regorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- repotrectinib
mifepristone will increase the level or effect of repotrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Discontinue strong or moderate CYP3A inhibitors and wait 3-5 elimination half-lives before initiating repotrectinib.
- ribociclib
ribociclib and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
mifepristone will increase the level or effect of ribociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - rifabutin
mifepristone will increase the level or effect of rifabutin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- rimegepant
mifepristone will increase the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- riociguat
mifepristone will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed
- romidepsin
mifepristone will increase the level or effect of romidepsin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- rosuvastatin
mifepristone increases toxicity of rosuvastatin by Other (see comment). Avoid or Use Alternate Drug.
- saquinavir
mifepristone will increase the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- selumetinib
mifepristone will increase the level or effect of selumetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors cannot be avoided, reduce selumetinib dosage (refer to selumetinib monograph for further information). After discontinuation of the strong or moderate CYP3A4 inhibitor for 3 elimination half-lives, resume selumetinib dose that was taken before initiating the inhibitor.
- sevoflurane
sevoflurane and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- sildenafil
mifepristone will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- siponimod
mifepristone will increase the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with a moderate or strong CYP3A4 inhibitor PLUS a moderate or strong CYP2C9 inhibitor is not recommended.
siponimod and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. - sonidegib
mifepristone will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- sparsentan
mifepristone, sparsentan. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. If unavoidable, interrupt treatment with sparsentan. When resuming sparsentan, consider dose titration. .
- stiripentol
mifepristone will increase the level or effect of stiripentol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- suvorexant
mifepristone will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tazemetostat
mifepristone will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tazemetostat with strong CYP3A4 inhibitors.
- tetrabenazine
tetrabenazine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- tezacaftor
mifepristone will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tiagabine
mifepristone will increase the level or effect of tiagabine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tipranavir
tipranavir will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tolterodine
mifepristone will increase the level or effect of tolterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration necessary in chronic mifepristone therapy, reduce dose of tolterodine IR to 1 mg twice daily and tolterodine ER to 2 mg once daily; monitor for QT prolongation
- tolvaptan
mifepristone will increase the level or effect of tolvaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- toremifene
mifepristone will increase the level or effect of toremifene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- trabectedin
mifepristone will increase the level or effect of trabectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- trazodone
mifepristone will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- triptorelin
triptorelin increases toxicity of mifepristone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.
- tucatinib
mifepristone will increase the level or effect of tucatinib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of tucatinib (a CYP2C8 substrate) with a strong or moderate CYP2C8 inhibitors increases tucatinib plasma concentrations and risk of toxicities.
tucatinib will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling. - ubrogepant
mifepristone will increase the level or effect of ubrogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- ulipristal
mifepristone will increase the level or effect of ulipristal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- umeclidinium bromide/vilanterol inhaled
mifepristone increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- valbenazine
mifepristone will increase the level or effect of valbenazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- vandetanib
mifepristone will increase the level or effect of vandetanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- vemurafenib
mifepristone will increase the level or effect of vemurafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- venetoclax
mifepristone will increase the level or effect of venetoclax by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- vilanterol/fluticasone furoate inhaled
mifepristone increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
mifepristone will increase the level or effect of vilanterol/fluticasone furoate inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - voriconazole
mifepristone will increase the level or effect of voriconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- voxelotor
voxelotor will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
Monitor Closely (315)
- abemaciclib
mifepristone will increase the level or effect of abemaciclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Patients who have had dose reduction to 100 mg twice daily due to adverse reactions, may further reduce dose of abemaciclib to 50 mg PO twice daily; discontinue abemaciclib for patients unable to tolerate 50 mg twice daily; if mifepristone is discontinued, increase dose of abemaciclib to original dose after 3 to 5 half-lives of mifepristone
- acalabrutinib
mifepristone will increase the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If mifepristone use necessary, limit dose of acalabrutinib to 100 mg once daily and monitor closely for drug-related toxicity and need for further adjustment or interruption of acalbrutinib therapy
- ado-trastuzumab emtansine
mifepristone will increase the level or effect of ado-trastuzumab emtansine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If coadministration necessary, closely monitor patients for ado-trastuzumab emtansine-related adverse reactions
- albuterol
albuterol and mifepristone both increase QTc interval. Use Caution/Monitor.
- alprazolam
mifepristone will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- amiodarone
mifepristone will increase the level or effect of amiodarone by Other (see comment). Modify Therapy/Monitor Closely. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor; combination may increase QT interval. Use alternatives if available
- amitriptyline
mifepristone, amitriptyline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- amlodipine
mifepristone will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- amobarbital
amobarbital will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- amoxapine
mifepristone, amoxapine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- apixaban
mifepristone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce apixaban dose by 50% when mifepristone used for treatment of Cushing's disease or other hormonal conditions; if patients are already receiving 2.5 mg twice daily, avoid coadministration
- apomorphine
mifepristone, apomorphine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- aprepitant
aprepitant will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- arformoterol
mifepristone, arformoterol. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- aripiprazole
mifepristone will increase the level or effect of aripiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If these drugs must be used together, follow manufacturer recommendations
- arsenic trioxide
mifepristone, arsenic trioxide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- artemether
mifepristone, artemether. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- artemether/lumefantrine
mifepristone, artemether/lumefantrine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- asenapine
mifepristone, asenapine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- atazanavir
atazanavir will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors. Potential for increased toxicity
mifepristone will increase the level or effect of atazanavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. - atogepant
mifepristone will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Recommended atogepant dosage is 10 mg PO qDay when coadministered with strong CYP3A4 inhibitors.
- atomoxetine
atomoxetine and mifepristone both increase QTc interval. Use Caution/Monitor.
- atorvastatin
mifepristone will increase the level or effect of atorvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose of atorvastatin should not exceed 40 mg/day, when administered with a strong CYP3A4 inhibitor
- avatrombopag
mifepristone will increase the level or effect of avatrombopag by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. When treating ITP, reduce starting dose of avatrombopag to 20 mg PO 3 times weekly when used concomitantly with mifepristone; in patients starting mifepristone while receiving avatrombopag, monitor platelet counts and adjust avatrombopag dose as necessary; coadministration of avatrombopag with a moderate or strong dual CYP2C9/3A4 inhibitor requires a decreased avatrombopag starting dose. Refer to manufacturer recommendations.
- axitinib
mifepristone increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- azithromycin
mifepristone, azithromycin. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- bedaquiline
mifepristone and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
mifepristone will increase the level or effect of bedaquiline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid concurrent use of bedaquiline for more than 14 days unless benefits justify risks - boceprevir
boceprevir will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors
- bortezomib
mifepristone will increase the level or effect of bortezomib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- bosentan
bosentan will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- brentuximab vedotin
mifepristone will increase the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- brexpiprazole
mifepristone will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- brigatinib
mifepristone will increase the level or effect of brigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use necessary, reduce dose of brigatinib by approximately 50% without breaking tablets (ie, from 180 mg to 90 mg; from 90 mg to 60 mg); after discontinuation of mifepristone, resume brigatinib dose that was tolerated prior to initiation of mifepristone
- bupropion
mifepristone will increase the level or effect of bupropion by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
- buspirone
mifepristone will increase the level or effect of buspirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If buspirone needs to be administered concurrently, a low dose of buspirone (ie, 2.5 mg PO twice daily) recommended initially; base subsequent dosage adjustments on clinical response
- cabozantinib
mifepristone will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use necessary, reduce dose of cabozantinib; for patients taking cabozantinib tablets, reduce dose by 20 mg (eg, 60 mg/day to 40 mg/day; 40 mg/day to 20 mg/day); for patients taking cabozantinib capsules, reduce dose by 40 mg (eg, 140 mg/day to 100 mg/day or 100 mg/day to 60 mg/day); resume cabozantinib dose that was used prior to initiating treatment with mifepristone 2 to 3 days after discontinuation of mifepristone
- calcifediol
mifepristone will increase the level or effect of calcifediol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cannabidiol
mifepristone will increase the level or effect of cannabidiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a strong CYP3A4 inhibitor.
- carbamazepine
carbamazepine, mifepristone. Other (see comment). Use Caution/Monitor. Comment: Carbamazepine may decrease mifepristone levels via CYP3A4 induction; additionally, mifepristone may increase carbamazepine levels by inhibiting CYP2C8/2C9.
- cenobamate
cenobamate will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
- ceritinib
mifepristone increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
mifepristone, ceritinib. Either increases toxicity of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. May increase QT prolongation. - chloroquine
mifepristone will increase the level or effect of chloroquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- chlorpromazine
mifepristone, chlorpromazine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- cholic acid
mifepristone increases toxicity of cholic acid by decreasing elimination. Modify Therapy/Monitor Closely. Avoid concomitant use of inhibitors of the bile salt efflux pump (BSEP). May exacerbate accumulation of conjugated bile salts in the liver and result in clinical symptoms. If concomitant use is necessary, monitor serum transaminases and bilirubin.
- ciclesonide inhaled
mifepristone will increase the level or effect of ciclesonide inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ciprofloxacin
ciprofloxacin will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available.
- citalopram
mifepristone, citalopram. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concurrent therapy considered essential, ECG monitoring recommended - clarithromycin
clarithromycin will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors; combination may also prolong QT interval. Use alternatives if available
- clomipramine
mifepristone, clomipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- clonazepam
mifepristone will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- clozapine
mifepristone, clozapine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- cobicistat
cobicistat will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If coadministration necessary, administer 300 mg mifepristone initially; not to exceed 600 mg; if cobicistat initiated in patient receiving 600 mg mifepristone, reduce mirepristone dose to 300 mg; if cobicistat initiated in patient receiving 900-1200 mg mifepristone, reduce mifepristone dose to 600 mg; if initiated in patient receiving 300 mg mifepristone, no change in dose necessary
- cobimetinib
mifepristone will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If short-term coadministration (14 days or less) of mifepristone necessary, reduce dose of cobimetinib to 20 mg once daily for patients normally taking 60 mg daily; after discontinuation of mifepristone, resume cobimetinib at previous dose; use alternative to mifepristone in patients who are already taking a reduced dose of cobimetinib (20-40 mg daily)
- conivaptan
conivaptan will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors
- conjugated estrogens
mifepristone will increase the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- crizotinib
mifepristone, crizotinib. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- cyclophosphamide
mifepristone will increase the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
mifepristone will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - daclatasvir
mifepristone will increase the level or effect of daclatasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- daprodustat
mifepristone will increase the level or effect of daprodustat by Other (see comment). Modify Therapy/Monitor Closely. Moderate CYP2C8 inhibitors increase daprodustat exposure. If coadministered with moderate CYP2C8 inhibitors, reduce daprodustat starting dose by half (except if starting dose is already 1 mg). Monitor hemoglobin and adjust daprodustat dose when initiating or stopping therapy with moderate CYP2C8 inhibitors during treatment
- dapsone
mifepristone will increase the level or effect of dapsone by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- darifenacin
mifepristone will increase the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. In adults receiving mifepristone chronically for treatment of hormonal conditions, daily dose of darifenacin should not exceed 7.5 mg/day PO
- darunavir
darunavir will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors
mifepristone will increase the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. - dasatinib
mifepristone, dasatinib. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- degarelix
mifepristone, degarelix. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- delavirdine
mifepristone will increase the level or effect of delavirdine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- desipramine
mifepristone, desipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- desogestrel
mifepristone decreases effects of desogestrel by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- deutetrabenazine
mifepristone and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- diazepam intranasal
mifepristone will increase the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.
- dichlorphenamide
dichlorphenamide and mifepristone both decrease serum potassium. Use Caution/Monitor.
- diclofenac topical
mifepristone will increase the level or effect of diclofenac topical by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- dienogest/estradiol valerate
mifepristone will increase the level or effect of dienogest/estradiol valerate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for potential adverse effects such as nausea, irregular uterine bleeding, breast tenderness and headache.
mifepristone decreases effects of dienogest/estradiol valerate by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended. - diltiazem
diltiazem will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration of mifepristone, CYP3A4 inhibitor with diltiazem, CYP3A4 substrate may increase plasma concentrations of diltiazem. Discontinuation or dose reduction of diltiazem may be necessary with mifepristone coadministration.
mifepristone will increase the level or effect of diltiazem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - disopyramide
mifepristone, disopyramide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- docetaxel
mifepristone will increase the level or effect of docetaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Closely monitor for docetaxel-related adverse reactions and consider 50% dose reduction of docetaxel if concomitant use of docetaxel with chronic mifepristone necessary; clinical significance of this interaction with short-term use of mifepristone for termination of pregnancy unknown
- dofetilide
mifepristone, dofetilide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- dolasetron
mifepristone, dolasetron. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- donepezil
donepezil and mifepristone both increase QTc interval. Use Caution/Monitor.
- doravirine
mifepristone will increase the level or effect of doravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of doravirine and CYP3A4 inhibitors may increase plasma concentrations and toxicities of doravirine.
- doxepin
doxepin and mifepristone both increase QTc interval. Use Caution/Monitor.
- doxepin cream
mifepristone will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- doxorubicin
mifepristone will increase the level or effect of doxorubicin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- doxorubicin liposomal
mifepristone will increase the level or effect of doxorubicin liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dronabinol
mifepristone will increase the level or effect of dronabinol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- droperidol
mifepristone, droperidol. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- drospirenone
mifepristone decreases effects of drospirenone by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- duvelisib
mifepristone will increase the level or effect of duvelisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with a strong CYP3A4 inhibitor increases duvelisib AUC, which may increase the risk of duvelisib toxicities. Reduce duvelisib dose to 15 mg BID when coadministered with a strong CYP3A4 inhibitor.
duvelisib will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate. - efavirenz
efavirenz, mifepristone. Other (see comment). Use Caution/Monitor. Comment: Efavirenz shown in vitro to induce CYP3A4 and CYP2B6, but in vitro has been shown to inhibit CYP3A4 and therefore may affect mifepristone levels/effect; mifepristone inhibits CYP2B6, therefore increasing exposure of efavirenz.
- elagolix
mifepristone will increase the level or effect of elagolix by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration of elagolix 200 mg BID with strong CYP3A inhibitors for >1 month is not recommended. Limit elagolix dose to 150 mg qDay and CYP3A inhibitor duration of use to 6 months if coadministered.
elagolix decreases levels of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed. - elbasvir/grazoprevir
mifepristone will increase the level or effect of elbasvir/grazoprevir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- encorafenib
encorafenib, mifepristone. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- enfortumab vedotin
mifepristone increases toxicity of enfortumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Enfortumab vedotin is an antibody-drug conjugate that releases monomethylauristatin E (MMAE) via proteolytic cleavage. MMAE is primarily metabolized by CYP3A4 in vitro. Coadministration with strong CYP3A4 inhibitors may increase free MMAE exposure, which may increase the incidence or severity of toxicities.
- erlotinib
mifepristone will increase the level or effect of erlotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce dose of erlotinib by 50 mg decrements If concomitant use necessary and severe reactions occur; clinical significance of this interaction with short-term use of mifepristone for termination of pregnancy unknown
- erythromycin base
erythromycin base will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
mifepristone, erythromycin base. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available. - erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
mifepristone, erythromycin ethylsuccinate. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available. - erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
mifepristone, erythromycin lactobionate. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available. - erythromycin stearate
erythromycin stearate will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
mifepristone, erythromycin stearate. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available. - escitalopram
mifepristone, escitalopram. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
escitalopram increases toxicity of mifepristone by QTc interval. Use Caution/Monitor. - eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- estradiol
mifepristone will increase the level or effect of estradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- estrogens conjugated synthetic
mifepristone will increase the level or effect of estrogens conjugated synthetic by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- estrogens esterified
mifepristone will increase the level or effect of estrogens esterified by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- estropipate
mifepristone will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ethinylestradiol
mifepristone decreases effects of ethinylestradiol by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- etoposide
mifepristone will increase the level or effect of etoposide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- etravirine
etravirine will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
mifepristone will increase the level or effect of etravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - etynodiol
mifepristone decreases effects of etynodiol by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- exemestane
mifepristone will increase the level or effect of exemestane by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ezogabine
mifepristone, ezogabine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- famotidine
famotidine, mifepristone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor.
mifepristone, famotidine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. - fedratinib
fedratinib will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
- fentanyl
mifepristone will increase the level or effect of fentanyl by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor patients for respiratory depression and sedation at frequent intervals if coadministration of CYP3A4 inhibitors with fentanyl is necessary, and consider fentanyl dose adjustments until stable drug effects achieved
- ferrous fumarate
mifepristone decreases effects of ferrous fumarate by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- flecainide
mifepristone, flecainide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- flibanserin
mifepristone will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
- fluconazole
fluconazole will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
mifepristone, fluconazole. Either increases toxicity of the other by QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available. - flunisolide inhaled
mifepristone will increase the level or effect of flunisolide inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fluoxetine
mifepristone, fluoxetine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- fluphenazine
mifepristone, fluphenazine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- fluticasone furoate
mifepristone will increase the level or effect of fluticasone furoate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure
- fluticasone inhaled
mifepristone will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure
- formoterol
mifepristone, formoterol. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- fosamprenavir
fosamprenavir, mifepristone. Either increases levels of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors.
- fosaprepitant
fosaprepitant will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- foscarnet
mifepristone, foscarnet. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- fosphenytoin
fosphenytoin will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- fostamatinib
mifepristone will increase the level or effect of fostamatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Strong CYP3A4 inhibitors may increase exposure to R406 (fostamatinib major active metabolite). Monitor for toxicities that may require fostamatinib dose reduction.
- fostemsavir
mifepristone and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gefitinib
mifepristone will increase the level or effect of gefitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- gemifloxacin
mifepristone, gemifloxacin. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- gemtuzumab
mifepristone and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- gepirone
gepirone and mifepristone both increase QTc interval. Modify Therapy/Monitor Closely.
- glecaprevir/pibrentasvir
mifepristone will increase the level or effect of glecaprevir/pibrentasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- grapefruit
grapefruit will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- haloperidol
mifepristone, haloperidol. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- hydrocodone
mifepristone will increase the level or effect of hydrocodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ibuprofen/famotidine
ibuprofen/famotidine, mifepristone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor.
mifepristone, ibuprofen/famotidine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. - ibutilide
mifepristone, ibutilide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- idelalisib
mifepristone will increase the level or effect of idelalisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- ifosfamide
mifepristone will decrease the level or effect of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of CYP3A4 inhibitors may decrease the metabolism of ifosfamide to its active alkylating metabolites and decrease the efficacy of ifosfamide.
mifepristone will decrease the level or effect of ifosfamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor. Coadministration of ifosfamide with CYP2B6 inhibitors may decrease metabolism of ifosfamide to its metabolite, potentially reducing ifosfamide therapeutic effects. - iloperidone
mifepristone, iloperidone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- imatinib
imatinib will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- indapamide
mifepristone, indapamide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- indinavir
indinavir, mifepristone. Either increases levels of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors.
mifepristone will increase the level or effect of indinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. - irinotecan
mifepristone will increase the level or effect of irinotecan by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
- irinotecan liposomal
mifepristone will increase the level or effect of irinotecan liposomal by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
- isotretinoin
mifepristone will increase the level or effect of isotretinoin by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- isradipine
mifepristone, isradipine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of isradipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor closely for toxicities if coadministration necessary, (eg, frequent monitoring of peripheral blood counts between cycles of ixabepilone); consider dose reduction of ixabepilone in some patients - istradefylline
mifepristone will increase the level or effect of istradefylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Do not exceed istradefylline 20 mg/day if coadministered with strong CYP3A4 inhibitors.
istradefylline will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates. - itraconazole
itraconazole, mifepristone. Either increases levels of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors. Monitor for increased concentrations/toxic effects, during and 2 weeks following treatment with mifepristone.
- ivacaftor
mifepristone will increase the level or effect of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce ivacaftor dose if coadministered with strong CYP3A4 inhibitors. See specific ivacaftor-containing product for precise dosage modification.
- ketamine
mifepristone will increase the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
- lacosamide
mifepristone will increase the level or effect of lacosamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lapatinib
mifepristone will increase the level or effect of lapatinib by Other (see comment). Modify Therapy/Monitor Closely. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor; combination may increase QT interval. Use alternatives if available
mifepristone will increase the level or effect of lapatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If coadministration necessary, decrease dose of lapatinib to 500 mg PO once daily; use lowest effective dose of mifepristone to reduce risk of QT prolongation; monitor ECGs for QT prolongation and monitor electrolytes; correct electrolyte abnormalities prior to treatment; if mifepristone discontinued, increase lapatinib to indicated dose after a period of approximately 1 week - lenacapavir
lenacapavir will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
- lenvatinib
mifepristone and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.
- letermovir
mifepristone increases levels of letermovir by decreasing metabolism. Use Caution/Monitor. Coadminstration of letermovir, an OATP1B1/3 substrate, with OATP1B1/3 inhibitors may increase letermovir plasma concentrations.
letermovir increases effects of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - levamlodipine
mifepristone will increase the level or effect of levamlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate and strong CYP3A inhibitors results in increased systemic exposure to amlodipine and may require dose reduction. Monitor for symptoms of hypotension and edema when amlodipine is coadministered with CYP3A inhibitors to determine the need for dose adjustment.
- levofloxacin
mifepristone, levofloxacin. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- levonorgestrel intrauterine
mifepristone decreases effects of levonorgestrel intrauterine by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- levonorgestrel oral
mifepristone decreases effects of levonorgestrel oral by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- linagliptin
mifepristone will increase the level or effect of linagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lofexidine
mifepristone and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.
- lomitapide
mifepristone increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.
- lopinavir
lopinavir, mifepristone. Either increases levels of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors.
mifepristone, lopinavir. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of lopinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If coadministration necessary, obtain baseline ECG to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs; correct electrolyte abnormalities; monitor patients for lopinavir-related adverse effects (eg, nausea, vomiting, diarrhea, hypokalemia, fast irregular heartbeat, pancreatic or hepatic dysfunction) - losartan
mifepristone will increase the level or effect of losartan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lumacaftor/ivacaftor
mifepristone will increase the level or effect of lumacaftor/ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If coadministration necessary, monitor efficacy and adjust dosages as necessary
- lumateperone
mifepristone will increase the level or effect of lumateperone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce lumateperone dose to 10.5 mg/day if coadministered with strong CYP3A4 inhibitors.
- lumefantrine
mifepristone, lumefantrine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - lurasidone
mifepristone, lurasidone. Either increases levels of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- maprotiline
mifepristone, maprotiline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- maraviroc
mifepristone will increase the level or effect of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- mefloquine
mifepristone, mefloquine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- mestranol
mifepristone decreases effects of mestranol by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- metaxalone
mifepristone will increase the level or effect of metaxalone by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- methadone
mifepristone will increase the level or effect of methadone by Other (see comment). Modify Therapy/Monitor Closely. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor; combination may increase QT interval. Use alternatives if available
- mirtazapine
mifepristone will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- mirvetuximab soravtansine
mifepristone will increase the level or effect of mirvetuximab soravtansine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with strong CYP3A4 inhibitors may increase unconjugated DM4 (a CYP3A4 substrate and the cytotoxic component of the antibody drug conjugate for mirvetuximab soravtansine) exposure, which may increase the risk of adverse reactions.
- mitotane
mitotane decreases levels of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
- modafinil
mifepristone will increase the level or effect of modafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- mometasone, intranasal
mifepristone will increase the level or effect of mometasone, intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- moxifloxacin
mifepristone, moxifloxacin. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- nafcillin
nafcillin will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- naldemedine
mifepristone will increase the level or effect of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nefazodone
nefazodone will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors
mifepristone will increase the level or effect of nefazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. - nelfinavir
nelfinavir, mifepristone. Either increases levels of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors.
mifepristone will increase the level or effect of nelfinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - nevirapine
nevirapine will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nifedipine
mifepristone will increase the level or effect of nifedipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nilotinib
mifepristone, nilotinib. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- nimodipine
mifepristone will increase the level or effect of nimodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- norelgestromin
mifepristone decreases effects of norelgestromin by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- norethindrone
mifepristone decreases effects of norethindrone by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- norethindrone acetate
mifepristone decreases effects of norethindrone acetate by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- norgestimate
mifepristone decreases effects of norgestimate by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- nortriptyline
mifepristone, nortriptyline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- octreotide
mifepristone, octreotide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- ofloxacin
mifepristone, ofloxacin. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- olanzapine
mifepristone, olanzapine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- oliceridine
mifepristone will increase the level or effect of oliceridine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.
- ondansetron
mifepristone, ondansetron. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- osilodrostat
mifepristone will increase the level or effect of osilodrostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce dose of osilodrostat, a CYP3A4 substrate, by half when coadministered with a strong CYP3A4 inhibitor.
osilodrostat and mifepristone both increase QTc interval. Use Caution/Monitor. - osimertinib
osimertinib and mifepristone both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
- ospemifene
mifepristone will increase the level or effect of ospemifene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- oxaliplatin
oxaliplatin will increase the level or effect of mifepristone by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
- oxcarbazepine
oxcarbazepine will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- oxycodone
mifepristone will increase the level or effect of oxycodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ozanimod
ozanimod and mifepristone both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
- paclitaxel
mifepristone will increase the level or effect of paclitaxel by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- paclitaxel protein bound
mifepristone will increase the level or effect of paclitaxel protein bound by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- paliperidone
mifepristone, paliperidone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- paricalcitol
mifepristone will increase the level or effect of paricalcitol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- pasireotide
mifepristone and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
- pazopanib
mifepristone will increase the level or effect of pazopanib by Other (see comment). Modify Therapy/Monitor Closely. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor; combination may increase QT interval. Use alternatives if available
- pentamidine
mifepristone, pentamidine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- pentobarbital
pentobarbital will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- perphenazine
mifepristone, perphenazine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- phenobarbital
phenobarbital will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- phenytoin
phenytoin will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- pioglitazone
mifepristone will increase the level or effect of pioglitazone by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- pitavastatin
mifepristone increases toxicity of pitavastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.
- polatuzumab vedotin
mifepristone will increase the level or effect of polatuzumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Polatuzumab undergoes catabolism to small peptides, amino acids, monomethyl auristatin E (MMAE), and unconjugated MMAE-related catabolites. MMAE is a CYP3A4 substrate. Coadministration of polatuzumab vedotin with a strong CYP3A4 inhibitor may increase unconjugated MMAE AUC, which may increase polatuzumab vedotin toxicities.
- posaconazole
posaconazole will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors; combination may also prolong QT interval. Use alternatives if available
- pravastatin
mifepristone increases toxicity of pravastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.
- praziquantel
mifepristone will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- primidone
primidone will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- procainamide
mifepristone, procainamide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- progesterone intravaginal gel
mifepristone will increase the level or effect of progesterone intravaginal gel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- progesterone micronized
mifepristone will increase the level or effect of progesterone micronized by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- progesterone, natural
mifepristone will increase the level or effect of progesterone, natural by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- promethazine
mifepristone will increase the level or effect of promethazine by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
- propafenone
mifepristone, propafenone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- propofol
mifepristone will increase the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
- protriptyline
mifepristone, protriptyline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- quazepam
mifepristone will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- quetiapine
mifepristone, quetiapine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- quinine
mifepristone, quinine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- quizartinib
mifepristone will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.
quizartinib, mifepristone. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs. - ranolazine
mifepristone, ranolazine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- repaglinide
mifepristone will increase the level or effect of repaglinide by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
mifepristone will increase the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - ribociclib
ribociclib, mifepristone. Either increases toxicity of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- rifabutin
rifabutin will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- rifampin
rifampin will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- rifapentine
rifapentine will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- ripretinib
mifepristone will increase the level or effect of ripretinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with a strong CYP3A inhibitor will increase systemic exposure to ripretinib and its active metabolite (DP-5439), which may increase risk of adverse reactions.
- risperidone
mifepristone, risperidone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- ritonavir
ritonavir will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors
mifepristone, ritonavir. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. - rivaroxaban
mifepristone will increase the level or effect of rivaroxaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. These drugs may be coadministered with caution when mifepristone given chronically for conditions, including Cushing's syndrome; increased serum concentrations of rivaroxaban possible
- romidepsin
mifepristone, romidepsin. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- rosiglitazone
mifepristone will increase the level or effect of rosiglitazone by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- rucaparib
rucaparib will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- sacubitril/valsartan
mifepristone will increase the level or effect of sacubitril/valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure
- salmeterol
mifepristone will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- saquinavir
saquinavir will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors; combination may also prolong QT interval. Use alternatives if available
- saxagliptin
mifepristone will increase the level or effect of saxagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. When coadministered, the initial dose of saxagliptin should be limited to 2.5 mg/day
- segesterone/ethinyl estradiol
mifepristone decreases effects of segesterone/ethinyl estradiol by pharmacodynamic antagonism. Use Caution/Monitor. Backup contraceptive method recommended.
- selegiline
mifepristone will increase the level or effect of selegiline by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9/2B6; use smallest recommended dose for substrates and monitor
- selexipag
mifepristone will increase the level or effect of selexipag by decreasing metabolism. Modify Therapy/Monitor Closely. Reduce selexipag dose to once daily if coadministered with moderate CYP2C8 inhibitors.
- selpercatinib
selpercatinib increases toxicity of mifepristone by QTc interval. Use Caution/Monitor.
mifepristone will increase the level or effect of selpercatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If coadministration necessary and original dose selpercatinib was 120 mg twice daily, reduce dose to 40 mg PO twice daily; reduce dose to 80 mg PO twice daily if original dose was 160 mg twice daily; monitor ECGs for QT prolongation more frequently; if mifepristone is discontinued, resume original selpercatinib dose after 3 to 5 elimination half-lives of mifepristone - sertraline
mifepristone, sertraline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- sitagliptin
mifepristone will increase the level or effect of sitagliptin by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- sofosbuvir/velpatasvir
mifepristone will increase the level or effect of sofosbuvir/velpatasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- solifenacin
mifepristone, solifenacin. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - sorafenib
mifepristone, sorafenib. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of sorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - sotalol
mifepristone, sotalol. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- St John's Wort
St John's Wort will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers have not been studied, coadministration not recommended by manufacturer
- stiripentol
stiripentol, mifepristone. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
- sufentanil
mifepristone will increase the level or effect of sufentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. If coadministration necessary, consider reduced dose of sufentanil injection with frequent monitoring for respiratory depression and sedation if concurrent use of mifepristone is necessary; if mifepristone is discontinued, consider increasing sufentanil injection dose until stable drug effects are achieved and monitor for evidence of opioid withdrawal
- sufentanil SL
mifepristone will increase the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of sufentanil SL with any CYP3A4 inhibitor may increase sufentanil plasma concentration, and, thereby increase or prolonged adverse effects, including potentially fatal respiratory depression.
- sunitinib
mifepristone, sunitinib. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use necessary, monitor patients for QT prolongation and consider reducing dose of sunitinib, based on individual safety and tolerability, in 12.5 mg decrements to minimum of 37.5 mg (GIST and RCC) or 25 mg (pNET) daily - tadalafil
mifepristone will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tamoxifen
mifepristone decreases effects of tamoxifen by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ketoconazole, tamoxifen. affecting hepatic/intestinal enzyme CYP3A4 metabolism. CYP3A4 inhibition decreases metabolism of tamoxifen to N-desmethyl tamoxifen (active metabolite with similar biologic activity).
- tamsulosin
mifepristone will increase the level or effect of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tasimelteon
mifepristone will increase the level or effect of tasimelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tazemetostat
tazemetostat will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tecovirimat
tecovirimat will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- telavancin
mifepristone, telavancin. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- temsirolimus
mifepristone will increase the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If coadministration necessary, consider reducing dose of temsirolimus to 12.5 mg/ week; allow a period of approximately 1 week after discontinuing mifepristone before increasing temsirolimus to original dose
- terbinafine
mifepristone will increase the level or effect of terbinafine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- thiothixene
mifepristone, thiothixene. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- ticagrelor
mifepristone will increase the level or effect of ticagrelor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tinidazole
mifepristone will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tipranavir
mifepristone will increase the level or effect of tipranavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- tisotumab vedotin
mifepristone increases levels of tisotumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tisotumab vedotin?s active metabolite (MMAE) is a CYP3A4 substrate. Coadministration with strong CYP3A4 inhibitors may increase unconjugated MMAE systemic exposure and increase risk of adverse effects.
- tofacitinib
mifepristone will increase the level or effect of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If coadministration necessary, reduce dose of tofacitinib if chronic mifepristone therapy used; reduce to 5 mg twice daily in patients receiving 10 mg twice daily; reduce to 5 mg once daily in patients receiving 5 mg twice daily; change to 11 mg XR once daily in patients receiving 22 mg once daily of XR formulation; change to immediate-release formulation at dose of 5 mg once daily in patients receiving 11 mg XR once daily
- toremifene
mifepristone, toremifene. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- tramadol
mifepristone will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- treprostinil
mifepristone will increase the level or effect of treprostinil by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- tretinoin
mifepristone will increase the level or effect of tretinoin by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- tretinoin topical
mifepristone will increase the level or effect of tretinoin topical by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor
- triclabendazole
triclabendazole and mifepristone both increase QTc interval. Use Caution/Monitor.
- trimipramine
mifepristone, trimipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - umeclidinium bromide/vilanterol inhaled
mifepristone will increase the level or effect of umeclidinium bromide/vilanterol inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- upadacitinib
mifepristone will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.
- valbenazine
valbenazine and mifepristone both increase QTc interval. Use Caution/Monitor.
- valsartan
mifepristone will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure
- vamorolone
mifepristone will increase the level or effect of vamorolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce vamorolone starting dose to 4 mg/kg/day; not to exceed 200 mg/day if weight >50 kg.
- vandetanib
mifepristone, vandetanib. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- vardenafil
mifepristone, vardenafil. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
mifepristone will increase the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Vardenafil dose may need to be reduced if coadministered with moderate or strong CYP3A4 inhibitors - velpatasvir
mifepristone will increase the level or effect of velpatasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- vemurafenib
mifepristone, vemurafenib. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- venlafaxine
mifepristone will increase the level or effect of venlafaxine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- verapamil
verapamil will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
mifepristone will increase the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - vilazodone
mifepristone will increase the level or effect of vilazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. If intolerable adverse effects occur when coadministered with moderate CYP3A4 inhibitors, reduce vilazodone to 20 mg/day
- vinblastine
mifepristone will increase the level or effect of vinblastine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- vincristine
mifepristone will increase the level or effect of vincristine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- vincristine liposomal
mifepristone will increase the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- vinorelbine
mifepristone will increase the level or effect of vinorelbine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- voclosporin
voclosporin, mifepristone. Either increases effects of the other by QTc interval. Use Caution/Monitor.
- vorapaxar
mifepristone will increase the level or effect of vorapaxar by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- voriconazole
voriconazole will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Do not exceed mifepristone 300 mg/day for Cushing syndrome when coadministered with strong CYP3A4 inhibitors; combination may also prolong QT interval. Use alternatives if available
- vorinostat
mifepristone, vorinostat. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- vortioxetine
mifepristone will increase the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- zanubrutinib
mifepristone will increase the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce zanubrutinib (a CYP3A4 substrate) to 80 mg PO BID when coadministered with a moderate CYP3A4 inhibitor. Interrupt dose as recommended for adverse reactions. After discontinuing the CYP3A4 inhibitor, resume previous zanubrutinib dose.
- ziprasidone
mifepristone, ziprasidone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- zolpidem
mifepristone will increase the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
Minor (7)
- acetazolamide
acetazolamide will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- chloroquine
chloroquine increases toxicity of mifepristone by QTc interval. Minor/Significance Unknown.
- cyclophosphamide
cyclophosphamide will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ganaxolone
mifepristone, ganaxolone. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Changes in ganaxolone exposures when coadministered with strong, moderate, or weak CYP3A4 inhibitors are not expected to be clinically significant.
- ruxolitinib
mifepristone will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ruxolitinib topical
mifepristone will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
Adverse Effects
>10% (Mifeprex)
Abdominal pain, cramping (96%)
Uterine cramping (83%)
Nausea (43-61%)
Headache (2-31%)
Vomiting (1-26%)
Diarrhea (12-20%)
Dizziness (1-12%)
>10% (Korlym)
Fatigue (48%)
Nausea (48%)
Headache (44%)
Endometrial hypertrophy (38%)
Hypokalemia (34%)
Arthralgia (30%)
Vomiting (26%)
Peripheral edema (26%)
Hypertension (24%)
Dizziness (22%)
Decreased appetite (20%)
Abnormal thyroid function test (18%)
Xerostomia (18%)
Back pain (16%)
Dyspnea (16%)
Myalgia (14%)
Pain (14%)
Sinusitis (14%)
Nasopharyngitis (12%)
Extremity pain (12%)
Diarrhea (12%)
Postmarketing reports
- Angioedema
1-10% (Mifeprex)
Fatigue (10%)
Back pain (9%)
Decreased hemoglobin >2 g/dL (6%)
Uterine hemorrhage (5%)
Viral infection (4%)
Dyspepsia (3%)
Insomnia (3%)
Rigors (3%)
Vaginitis (3%)
Anemia (2%)
Anxiety (2%)
Fainting (2%)
Leg pain (2%)
Leukorrhea (2%)
Pelvic pain (2%)
Sinusitis (2%)
Weakness (2%)
1-10% (Korlym)
Constipation (10%)
Somnolence (10%)
Anorexia (10%)
Anxiety (10%)
Gastroesophageal reflux (5-10%)
Abdominal pain (5-10%)
Increased triglycerides (5-10%)
Hypoglycemia (5-10%)
Insomnia (5-10%)
Vaginal hemorrhage, metrorrhagia (5-10%)
General disorders: asthenia, malaise, edema, pitting edema, thirst (5-10%)
Musculoskeletal and connective tissue disorders: muscular weakness, flank pain, musculoskeletal chest pain (5-10%)
Adrenal insufficiency (4%)
Rash (4%)
Pruritus (4%)
Warnings
Black Box Warnings
Mifeprex
- Serious and sometimes fatal infections and bleeding occur very rarely following spontaneous, surgical, and medical abortions
- Atypical presentation of infection reported; patients with serious bacterial infections (eg, Clostridium sordellii) and sepsis can present without fever, bacteremia or significant findings on pelvic examination following an abortion; very rarely, deaths have been reported in patients who presented without fever, with or without abdominal pain, but with leukocytosis with a marked left shift, tachycardia, hemoconcentration, and general malaise
- Prolonged heavy bleeding may be a sign of incomplete abortion or other complications that requires prompt medical attention
- Should be used only with strict adherence to recommended dosages by medically trained personnel who can provide immediate intensive care in acute surgical facilities
Korlym
- Potent antiprogestational effects and will result in the termination of pregnancy
- Pregnancy must therefore be excluded before the initiation of treatment with Korlym, or if treatment is interrupted for more than 14 days in females of reproductive potential
- Pregnancy must be prevented during treatment and for 1 month after stopping treatment by the use of a nonhormonal medically acceptable method of contraception unless the patient has had a surgical sterilization
Contraindications
Known hypersensitivity to mifepristone, misoprostol, or other prostaglandins
Mifeprex
- Confirmed or suspected ectopic pregnancy, undiagnosed adnexal mass, or IUD currently in place
- Chronic adrenal failure or concurrent long-term corticosteroid therapy
- Hemorrhagic disorders, inherited porphyrias, or concurrent anticoagulant therapy
- Concurrent long-term corticosteroid therapy
- Hypersensitivity to drug or components
- Inherited porphyrias
- Patients with intrauterine device (IUD) in place if terminating intrauterine pregnancy
Korlym
- Pregnancy
- Coadministration with simvastatin or lovastatin and CYP3A substrates with narrow therapeutic range (eg, cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, tacrolimus)
- Patients requiring systemic corticosteroids for serious medical conditions
- Women with history of unexplained vaginal bleeding
- Women with endometrial hyperplasia with atypia or endometrial carcinoma
Cautions
Mifeprex
- A clinical examination or ultrasonographic scan should be performed approximately 14 days after mifepristone administration to confirm termination of pregnancy
- Preventive measures to suppress formation of anti-Rho(D) antibodies (eg, administration of Rho(D) immune globulin) should be considered in Rho (D)-negative women
- Use with caution in women <35 years who smoke 10 or more cigarettes daily
- Available only through a restricted program under a REMS called the mifepristone REMS Program, because of the risks of serious complications; prescribers must be certified and patients must sign a patient agreement form
- Must be dispensed to patients by or under the supervision of a certified prescriber, or by certified pharmacies on prescriptions issued by certified prescribers
-
Infection and sepsis
- Any termination of pregnancy, including those resulting from mifepristone use, may result in serious, potentially fatal infections and bleeding (see Black Box Warnings)
- As with other types of abortion, cases of serious bacterial infection, including very rare cases of fatal septic shock, reported following the therapy
- Healthcare providers evaluating a patient who is undergoing a medical abortion should be alert to possibility of this rare event; a sustained (> 4 hours) fever of 100.4°F or higher, severe abdominal pain, or pelvic tenderness in the days after a medical abortion may be indication of infection
- A high index of suspicion is needed to rule out sepsis (eg, from Clostridium sordellii) if patient reports abdominal pain or discomfort or general malaise (including weakness, nausea, vomiting, or diarrhea) more than 24 hours after taking misoprostol
- Very rarely, deaths have been reported in patients who presented without fever, with or without abdominal pain, but with leukocytosis with a marked left shift, tachycardia, hemoconcentration, and general malaise
- No causal relationship between drug and misoprostol use and an increased risk of infection or death established
- Clostridium sordellii infections have also been reported very rarely following childbirth (vaginal delivery and caesarian section), and in other gynecologic and non-gynecologic conditions
-
Uterine bleeding
- Uterine bleeding occurs in almost all patients during medical abortion; prolonged heavy bleeding (soaking through two thick full-size sanitary pads per hour for two consecutive hours) may be a sign of incomplete abortion or other complications, and prompt medical or surgical intervention may be needed to prevent development of hypovolemic shock
- Counsel patients to seek immediate medical attention if they experience prolonged heavy vaginal bleeding following a medical abortion
- Women should expect to experience vaginal bleeding or spotting for an average of 9 to 16 days; women report experiencing heavy bleeding for a median duration of 2 days
- Up to 8% of all subjects may experience some type of bleeding for 30 days or more. In general, the duration of bleeding and spotting increased as duration of pregnancy increased
- Decreases in hemoglobin concentration, hematocrit, and red blood cell count may occur in women who bleed heavily
- Excessive uterine bleeding usually requires treatment by uterotonics, vasoconstrictor drugs, surgical uterine evacuation, administration of saline infusions, and/or blood transfusions
- Based on data from several large clinical trials, vasoconstrictor drugs were used in 4.3% of all subjects, there was a decrease in hemoglobin of more than 2 g/dL in 5.5% of subjects, and blood transfusions were administered to < 0.1% of subjects
- Because heavy bleeding requiring surgical uterine evacuation occurs in about 1% of patients, special care should be given to patients with hemostatic disorders, hypocoagulability, or severe anemia
-
Ectopic pregnancy
- Contraindicated in patients with a confirmed or suspected ectopic pregnancy; drug is not effective for terminating ectopic pregnancies
- Healthcare providers should remain alert to possibility that a patient who is undergoing a medical abortion could have an undiagnosed ectopic pregnancy because some of the expected symptoms experienced with a medical abortion (abdominal pain, uterine bleeding) may be similar to those of a ruptured ectopic pregnancy.
- The presence of an ectopic pregnancy may have been missed even if the patient underwent ultrasonography prior to being prescribed drug
- Women who became pregnant with an IUD in place should be assessed for ectopic pregnancy
-
REMS program
- Prescribers must be certified with the program by completing the Prescriber Agreement Form.
- Patients must sign a Patient Agreement Form.
- Drug must be dispensed to patients by or under the supervision of a certified prescriber, or by certified pharmacies on prescriptions issued by certified prescribers
- Further information is available at 1-877-4 Early Option (1-877-432-7596)
Korlym
- Do not use for treatment of hyperglycemia unrelated to Cushing syndrome; patients with endogenous Cushing’s syndrome are at risk for opportunistic infections such as Pneumocystis jiroveci pneumonia during treatment; patients may present with respiratory distress shortly after initiation of therapy; appropriate diagnostic tests should be undertaken and treatment for Pneumocystis jiroveci should be considered
- Drug prolongs QTc interval in a dose-related manner; there is little or no experience with high exposure, concomitant dosing with other QT-prolonging drugs, or potassium channel variants resulting in a long QT interval; to minimize risk, the lowest effective dose should always be used
- Drug does not reduce serum cortisol levels; elevated cortisol levels may activate mineralocorticoid receptors which are also expressed in cardiac tissues; caution should be used in patients with underlying heart conditions including heart failure and coronary vascular disease
- Use of Korlym in patients who receive corticosteroids for other conditions (eg, autoimmune disorders) may lead to exacerbation or deterioration because of Korlym’s glucocorticoid antagonistic effects; for medical conditions in which chronic corticosteroid therapy is life-saving (eg, immunosuppression in organ transplantation), Korlym is contraindicated
- Coadministration with strong CYP3A inhibitors can increase mifepristone plasma levels significantly; use only when necessary and limit mifepristone dose to 300 mg (see Dosage Modification)
-
Endometrial changes
- Being an antagonist of the progesterone receptor, mifepristone promotes unopposed endometrial proliferation that may result in endometrium thickening, cystic dilatation of endometrial glands, and vaginal bleeding
- Drug should be used with caution in women who have hemorrhagic disorders or are receiving concurrent anticoagulant therapy
- Women who experience vaginal bleeding during treatment should be referred to a gynecologist for further evaluation
-
Adrenal insufficiency
- Patients receiving mifepristone may experience adrenal insufficiency
- Because serum cortisol levels remain elevated and may even increase during treatment, serum cortisol levels do not provide an accurate assessment of hypoadrenalism in patients receiving drug
- Patients should be closely monitored for signs and symptoms of adrenal insufficiency, including weakness, nausea, increased fatigue, hypotension, and hypoglycemia
- If adrenal insufficiency is suspected, discontinue treatment with drug immediately and administer glucocorticoids without delay
- High doses of supplemental glucocorticoids may be needed to overcome glucocorticoid receptor blockade produced by mifepristone
- Factors considered in deciding on duration of glucocorticoid treatment should include the long half-life of mifepristone (85 hr).
- Treatment at a lower dose can be resumed after resolution of adrenal insufficiency; patients should also be evaluated for precipitating causes of hypoadrenalism (infection, trauma, etc)
-
Hypokalemia
- In a study of patients with Cushing’s syndrome, hypokalemia observed
- Hypokalemia should be corrected prior to initiating therapy; during administration, serum potassium should be measured 1-2 weeks after starting or increasing dose and periodically thereafter
- Hypokalemia can occur at any time during treatment; mifepristone-induced hypokalemia should be treated with intravenous or oral potassium supplementation based on event severity
- If hypokalemia persists in spite of potassium supplementation, consider adding mineralocorticoid antagonists
Pregnancy & Lactation
Pregnancy
Drug contraindicated in pregnancy because use results in pregnancy loss; there are no data that assess risk of birth defects in women exposed to drug during pregnancy
Available data limited to exposure following a single dose of mifepristone during pregnancy showed a higher rate of major birth defects compared to the general population comparator
Pregnancy testing
- Due to its anti-presentational activity, drug causes pregnancy loss; perform pregnancy testing before initiation of treatment or if treatment interrupted for more than 14 days in females of reproductive potential
Contraception
- Recommend non-hormonal contraception for duration of treatment and for one month after stopping treatment; drug interferes with effectiveness of hormonal contraceptives
Animal data
- Administered to pregnant mice, rats, and rabbits during organogenesis caused pregnancy loss in all species at clinically relevant doses based on body surface area comparisons; inhibition of both endogenous and exogenous progesterone by mifepristone at progesterone receptor results in pregnancy loss; if used during pregnancy or if patient becomes pregnant while taking drug, patient should be apprised of potential hazard to a fetus
- Estimated risk of fetal loss is elevated in patients with active Cushing’s syndrome (24-30%), and risk of major birth defects is unknown; in the U.S. general population, estimated background risks of major birth defects and miscarriage in clinically recognized pregnancies are 2-4% and 15-20%, respectively
Lactation
Drug is present in human milk, however, there are no data on amount of mifepristone in human milk, effects on breastfed infant, or on milk production during long term use of mifepristone; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for Korlym and any potential adverse effects on breastfed child from drug or from the underlying maternal condition
To minimize exposure to a breastfed infant, women who discontinue or interrupt treatment may consider pumping and discarding milk during treatment and for 18-21 days (5-6 half-lives) after last dose, before breastfeeding
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Stimulate uterine contractility: antiprogestin; also increases prostaglandins by inhibiting prostaglandin dehydrogenase
Blocks cortisol receptor binding, and thereby reduces excess cortisol effects (eg, hyperglycemia) associated with endogenous Cushing syndrome
Absorption
Peak Plasma Time: 1-2 hr (single dose); 1-4 hr (multiple doses)
Peak Plasma Concentration: 2-8 hr
Distribution
Protein Bound: >99% to alpha-1-acid glycoprotein; 96-99% (active metabolites)
Distributed to other tissues including CNS
Metabolism
Extensively metabolized by CYP3A4
Metabolized to 3 active metabolites, of which 2 are the product of demethylation, while a third active metabolite results from hydroxylation
In addition to being a CYP3A4 substrate, it also inhibits and induces CYP3A4
Elimination
Half-life: 20 hr (single dose); 85 hr (parent drug following multiple doses)
Excretion: 90% feces
Administration
Oral Administration (Mifeprex)
200 mg PO once, followed 24-48 hr later by misoprostol buccal administration
Follow up with healthcare provider 7-14 days after taking Mifeprex
Buccal administration (misoprostol)
- Because most women will expel the pregnancy within 2-24 hr of taking misoprostol, discuss with the patient an appropriate location for her to be when she takes the misoprostol, taking into account that expulsion could begin within 2 hr of administration
- Administer misoprostol 800 mcg buccally within 24-48 hr after taking Mifeprex
- The effectiveness of the regimen may be lower if misoprostol is administered <24 hr or >48 hr after mifepristone administration
- Tell the patient to place two 200 mcg misoprostol tablets in each cheek pouch (the area between the cheek and gums) for 30 minutes and then swallow any remnants with water or another liquid
- During the period immediately following the administration of misoprostol, the patient may need medication for cramps or GI symptoms
Oral Administration (Korlym)
Always take with a meal
Must be taken as a single daily dose
Swallow tablet whole, do not split, crush, or chew
Dose reduction or discontinuation may be needed in some clinical situations; if dosage is interrupted, reinitiate at the lowest dose (ie, 300 mg/day)
Images
BRAND | FORM. | UNIT PRICE | PILL IMAGE |
---|---|---|---|
Korlym oral - | 300 mg tablet | ![]() |
Copyright © 2010 First DataBank, Inc.
Patient Handout
mifepristone oral
MIFEPRISTONE - ORAL
(MIF-e-PRIS-tone)
COMMON BRAND NAME(S): Mifeprex
WARNING: Rarely, serious medical problems can occur when a pregnancy ends, including sometimes fatal infections and bleeding. Read the Medication Guide, read and sign the Patient Agreement, and consult your doctor if you have any questions. To receive this medication in the United States, you must understand, agree to, and carefully follow the requirements of the Mifepristone REMS Program. If you live in Canada or any other country, consult your doctor and pharmacist for your country's regulations.Your doctor must give you clear instructions about who to call and what to do in case of an emergency (such as severe bleeding, infection). If you go to the emergency room or visit another health care professional, show them the Medication Guide so they know you are trying to end your pregnancy.Get medical help right away if you experience symptoms such as severe abdominal pain, fainting, fast heartbeat, fever lasting more than 4 hours. You may have a very serious infection even if you do not have a fever. Get medical help right away if you have abdominal pain or feel sick (for example, if you have nausea, vomiting, diarrhea, weakness) more than 24 hours after taking the second drug (misoprostol), even if you do not have a fever. Also get medical help right away if you have continued heavy bleeding, which may be a sign the pregnancy has not ended or other serious medical problem. You may need surgery or other medical care. See also Side Effects section.
USES: Mifepristone (also known as RU 486) is used to end a pregnancy during the early part of a pregnancy. It is used up to week 10 of pregnancy (up to 70 days after the first day of your last menstrual period). Mifepristone blocks a natural substance (progesterone) that is needed for your pregnancy to continue. It is usually used together with another medicine called misoprostol.Mifepristone must not be used if you have a rare abnormal pregnancy that is outside the womb (ectopic pregnancy). It will not end the pregnancy in this case. It may cause an ectopic pregnancy to rupture, resulting in very serious bleeding.
HOW TO USE: Read the Medication Guide provided by your doctor before you start using mifepristone. Keep the guide to reread if needed. Read and sign the Patient Agreement form provided by your doctor. If you have any questions, consult your doctor or pharmacist.You must visit the doctor's office at least 2 times to complete your treatment and important examinations. This treatment is only given under direct medical supervision. Learn about who to call and what to do in case of an emergency.Your doctor may order an ultrasound to make sure your pregnancy is less than 10 weeks and is not outside the womb (ectopic).Take mifepristone by mouth as directed by your doctor, usually as a single dose. After taking mifepristone, your doctor should direct you to wait 24 to 48 hours before taking another medication (misoprostol) by mouth as a single dose. The medications may not work well if you take misoprostol sooner than 24 hours after taking mifepristone or later than 48 hours after taking mifepristone. Follow your doctor's instructions carefully. Heavy vaginal bleeding does not mean that the pregnancy has ended.Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.It is important that you return for a follow-up visit within 7 to 14 days after taking mifepristone, even if you are not having any problems.If the pregnancy has not ended, or there are serious medical problems, surgery may be needed. If the treatment fails and the pregnancy continues until birth, there is a risk of birth defects.
SIDE EFFECTS: See also Warning section.Nausea, vomiting, diarrhea, weakness, or dizziness may occur. If these effects last longer than the first 24 hours after taking the second drug (misoprostol), get medical help right away because they can be signs of a serious medical problem.Bleeding and cramping are expected during this treatment. Usually, the symptoms mean the drugs are working. However, sometimes you can have cramps and bleeding and still be pregnant. You must return for all of your follow-up visits with your doctor. Nausea and cramping may get worse in the 24 hours after you take the second drug (misoprostol). Your doctor may direct you to take other medication to help with these symptoms. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Bleeding and spotting may last up to 30 days and may be much heavier than a normal period. In very few cases, this bleeding will need to be stopped by surgery. Get medical help right away if you bleed enough to soak through 2 thick, full-size sanitary pads each hour for 2 hours in a row, or if you are concerned about heavy bleeding.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Get medical help right away if you have any very serious side effects, including: fever of 100.4 degrees F (38 degrees C) or higher, fainting, fast heartbeat, stomach/abdominal pain or tenderness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking mifepristone, tell your doctor if you are allergic to it; or to misoprostol; or to other progestins (such as norethindrone); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: undiagnosed abdominal growth (adnexal mass), adrenal gland problem, certain blood disorder (inherited porphyrias), bleeding problems, low blood count (anemia).If you are using an IUD (intrauterine birth control device), it should be removed before mifepristone treatment begins.This drug must be used only if you can easily reach adequate emergency medical services in case you have a serious medical problem.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Mifepristone usually causes fetal death. In the unlikely event you have an ongoing pregnancy after treatment, birth defects may result.Another pregnancy can occur after treatment with this medication and before your normal period begins again. Birth control can be started as soon as this treatment is successfully completed. Consult your doctor for more information.This medication passes into breast milk. Since the effects of mifepristone on infants are unknown, breast-feeding women should consult their doctors on whether they should discard their breast milk for a few days following this treatment.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: long-term corticosteroid therapy (such as, prednisone), other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen, "blood thinners" such as warfarin/dabigatran).Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.Other medications can affect the removal of mifepristone from your body, which may affect how mifepristone works. Examples include azole antifungals (such as itraconazole), dexamethasone, macrolide antibiotics (such as erythromycin), rifamycins (such as rifabutin), St. John's wort, drugs used to treat seizures (such as carbamazepine, phenytoin), among others.Mifepristone can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include cyclosporine, ergot alkaloids (such as dihydroergotamine, ergotamine), fentanyl, pimozide, quinidine, some statin drugs (such as fluvastatin, lovastatin, simvastatin), sirolimus, tacrolimus, warfarin, among others.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe vaginal bleeding.
NOTES: Lab and/or medical tests (such as ultrasound) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: You must follow the dosing and appointment schedule as directed by your doctor. If you miss an appointment, contact your doctor right away.
STORAGE: This drug is available only from your doctor. Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised April 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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