New York, California shops misoprostol

Misoprostol pills, used to terminate early pregnancies, are on display at a pharmacy in Provo, Utah on May 12, 2022.

George Frey | Reuters

New York and California are stockpiling massive amounts of an alternative abortion drug in case a federal judge’s order suspending the Food and Drug Administration’s approval of the lead drug mifepristone goes into effect later this week.

New York Gov. Kathy Hochul on Tuesday ordered the state health department to immediately begin purchasing 150,000 doses of misoprostol, a five-year supply of the pill. Hochul’s announcement comes a day after Gov. Gavin Newsom said California had secured 2 million pills of misoprostol.

Medication-related abortions are the most common way of terminating a pregnancy in the United States. Patients typically use a two-drug regimen, taking mifepristone first, followed by misoprostol. The second pill is used as a standalone abortion drug in parts of the world.

Misoprostol is FDA-approved to treat stomach ulcers, so it will remain on the market when U.S. District Judge Matthew Kacsmaryk’s order suspending mifepristone goes into effect at 12:00 p.m. ET on Saturday.

“One judge in Amarillo, Texas, thinks he knows better than thousands of doctors, scientists and pundits. And not to mention the countless women who have been using this drug safely for decades,” Hochul said during a news conference with the New York chapter of Planned Parenthood Tuesday.

“This is not just an attack on abortion, it is an attack on democracy. Courts have never overturned a science-based FDA decision,” the governor said.

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Hochul said she is working with the New York Legislature to require private insurers to cover misoprostol when it is prescribed off-label for abortions.

The Justice Department and Danco Laboratories, the distributor of mifepristone, have asked the US Circuit Court of Appeals to block Kacsmaryk’s decision until noon Thursday.

The World Health Organization and the American College of Obstetricians and Gynecologists recommend misoprostol as a standalone abortion drug when the two-drug regimen is unavailable. However, according to obstetricians and gynecologists, misoprostol is not as effective when used alone.

The FDA has approved the two-drug abortion regimen up to 10 weeks gestation. Mifepristone stops the pregnancy from progressing further by blocking a hormone called progesterone. Misoprostol triggers contractions that empty the uterus.

Patients take 200 milligrams of mifepristone by mouth on the first day and 800 micrograms of misoprostol by the cheek pouch 24 to 48 hours later, according to the FDA label.

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