Pharm
Misoprostol
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Misoprostol
, Cytotec, PGE1 Gel
See Also
Peptic Ulcer Disease
Cervical Ripening
Early Pregnancy Loss
Mechanism
Misoprostol is a
Prostaglandin E1
Analog
Misoprostol is a pro-drug, that when taken orally is de-esterified to its active acid
Effects
Gastric Mucosa Protection by
Prostaglandin
replacement
Cervical Ripening
and uterine contractions
Indications
Peptic Ulcer Disease Prevention
See
NSAID Gastrointestinal Adverse Effects
Prevents ulcers in those on
NSAID
s chronically
Cervical Ripening
agent in Pregnancy
Labor Induction
Early Pregnancy Loss
(<84 days)
Termination of Pregnancy
(<77 days)
Medications
Misoprostol (Cytotec)
Dosing
Prevention of
NSAID
-induced
Peptic Ulcer Disease
See
NSAID Gastrointestinal Adverse Effects
Option 1: 100 to 200 mcg four times daily with food
Option 2: 200 mcg orally twice daily with food
Better tolerated than four times per day dosing
Dosing
Obstetrics and Gynecology
Cervical Ripening
See
Cervical Ripening
for pregnancy dosing
Misoprostol 50 mcg per vagina every 6 hours (or 25 mcg every 3 hours)
Monitor for uterine hyperstimulation and
Fetal Heart Rate
Avoid after prior
Cesarean Section
,
Multigravida
(>=5 prior pregnancies)
Risk of
Uterine Rupture
Early Pregnancy Loss
(<84 days) or
Termination of Pregnancy
(<77 days)
See
Early Pregnancy Loss
(includes precautions and monitoring protocol)
Misoprostol Dosing Protocol
Vaginal (or rectal)
Place 800 mcg (4 tablets) intravaginally at 24-48 hours after
Mifepristone
Lie supine for 30 minutes after dose
Buccal Dosing may be used in place of vaginal dosing
Place two of the 200 mcg Misoprostol tablets on each side of the mouth (total 800 mcg)
Allow tablets to dissolve over 30 minutes
Efficacy improves if followed by second dose Misoprostol 800 mcg 4 hours after first
Strong uterine cramping and heavier
Vaginal Bleeding
follows Misoprostol dose
Onset within several hours
Persists for 3-5 hours
Lighter
Vaginal Bleeding
may persist for 9-16 days
Adjunctive medications
NSAID
s
Heating pad
Safety
Pregnancy Category X
Avoid in
Lactation
Adverse Effects
When used orally (poorly tolerated)
Diarrhea
Nausea
Vomiting
Abdominal cramping
Flatulence
Gynecologic symptoms (800 mcg dosing)
Strong uterine cramping
Vaginal Bleeding
heavier than typical
Menses
Efficacy
Peptic Ulcer Disease
reduction
Dosing qid: 4%
Peptic Ulcer Disease
recurrence
Dosing bid: 8%
Peptic Ulcer Disease
recurrence
Placebo
: 16%
Peptic Ulcer Disease
recurrence
Reference
Raskin (1995) Ann Intern Med 123:344-50 [PubMed]
Resources
Misoprostol (DailyMed)
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f15b41bd-ed36-4908-aba5-f0a019b7a26e
References
MacNaughton (2021) Am Fam Physician 103(8) 473-80 [PubMed]
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