The role of pharmacist for medical abortion in Bulgaria


The role of pharmacist for medical abortion in Bulgaria


Dimitar Marinov1, Gergana Josifova2 ,Evgeni Grigorov1,2

1Department of Health Technology Assessment, National Center of Public Health and Analyses

2Department of Pharmaceutical Sciences and Pharmaceutical Management, Faculty of Pharmacy, Medical University “Prof.d-r Paraskev Stoyanov”, Varna


Abortion has been a controversial subject in many societies through history because of the moral, ethical, practical,and political power issues that surround it. It has been banned frequently and otherwise limited by law. However, in the 1970’s, many developed countries legalised abortion. At the same period, Prof Etienne-Emile Baulieu, who was a consultant for Roussel-Uclaf, directed his research in finding a progesterone antagonist.Prof. Baulieu explained that, at the beginning, “it was more a matter of fundamental research than the search for an abortion pill”. He succeeded and first published the clinical effect of the RU-486 in 1982. Further studies by Prof. Bygdeman from Sweden showed that the combination with a prostaglandin was necessary to improve the eficacy of the treatment.

The combination of Mifepristone and Misoprostol, variety of dosages and protocols, is the most common method for medical termination of pregnancy. The decision of dosages and the way of intake is taken by the physician according to the individuality of the patient and the stage of pregnancy. The method is preferred by the women because it is not invasive and with minimum chances for unwanted consequences for any future pregnancies. Unlike surgical interruption of pregnancy, drug abortion occurs in several stages and requires active co-operation with the patient. The effect of the combination drug used may be affected by certain medications, food supplements and foods, which would compromise the success of the method. The role of a pharmacist as a person who provides medicines and best knows the specific needs of patients, their prior or concomitant therapies, chronic diseases is of paramount importance. Only pharmacists have the knowledge for increasing number of nutritional supplements on the market, the variety of drugs, original and generic, in all dosage forms that can affect the action of Mifepristone and Misoprostol. Pharmacists are the medical specialists who are best knowledgeable about the pharmacokinetics and pharmacodynamics of medicines that are essential to the successful outcome of medical termination of pregnancy.

Twenty-five years after the first marketing, mifepristone in combination with prostaglandin is increasingly used as an alternative to classic methods of termination of pregnancy. Since then, millions of women worldwide have used the combination of mifepristone and prostaglandin analogue to terminate pregnancy with impressive safety and efficacy.