II. Mechanism
- Prostaglandin E1 Analog
- Gastric Mucosa Protection by prostaglandin replacement
- Cervical Ripening and uterine contractions
III. Indication
-
Peptic Ulcer Disease prevention
- See NSAID Gastrointestinal Adverse Effects
- Prevents ulcers in those on NSAIDs chronically
- Cervical Ripening agent in Pregnancy Labor Induction
- Early Pregnancy Loss (<84 days)
- Termination of Pregnancy (<77 days)
IV. Preparations
- Misoprostol (Cytotec)
V. Dosing: Prevention of NSAID-induced Peptic Ulcer Disease
- See NSAID Gastrointestinal Adverse Effects
- Option 1: 100-200 mcg four times daily with food
- Option 2: 200 mcg orally twice daily with food
- Better tolerated than four times per day dosing
VI. Dosing: Obstetrics and Gynecology
-
Cervical Ripening
- See Cervical Ripening for pregnancy dosing
- Misoprostol 25-50 mcg per vagina every 6 hours
-
Early Pregnancy Loss (<84 days) or Termination of Pregnancy (<77 days)
- See Early Pregnancy Loss (includes precautions and monitoring protocol)
- Misoprostol 800 mcg intravaginally at 24-48 hours after Mifepristone
- 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
- NSAIDs
- Heating pad
VII. Technique
- Vagnial Dosing
- Place 4 of the 200 mcg tablets (total 800 mcg) inside the vagina and lie supine for 30 minutes
- 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
VIII. Adverse Effects
- When used orally
- Gynecologic symptoms (800 mcg dosing)
- Strong uterine cramping
- Vaginal Bleeding heavier than typical Menses
IX. 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
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Related Studies
| misoprostol (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MISOPROSTOL 100 MCG TABLET | Generic | $0.42 each |
| MISOPROSTOL 200 MCG TABLET | Generic | $0.80 each |
Ontology: Misoprostol (C0085174)
| Definition (NCI_NCI-GLOSS) | A radioprotective agent that belongs to the family of drugs called prostaglandins. |
| Definition (MSH) | A synthetic analog of natural prostaglandin E1. It produces a dose-related inhibition of gastric acid and pepsin secretion, and enhances mucosal resistance to injury. It is an effective anti-ulcer agent and also has oxytocic properties. |
| Concepts | Pharmacologic Substance (T121) , Eicosanoid (T111) |
| MSH | D016595 |
| SnomedCT | 387242007, 43684009 |
| English | Misoprostol, Prost-13-en-1-oic acid, 11,16-dihydroxy-16-methyl-9-oxo-, methyl ester, (11alpha,13E)-, Methyl (11alpha,13E)-11,16-Dihydroxy-16-methyl-9-oxoprost-13-en-1-oate, (11alpha,13E)-(+-)-11,16-Dihydroxy-16-methyl-9-oxo-prost-13-en-1-oic Acid Methyl Ester, misoprostol, prostaglandins misoprostol, misoprostol (medication), MISOPROSTOL, Misoprostol [Chemical/Ingredient], Misoprostol product, Misoprostol (product), Misoprostol (substance) |
| Swedish | Misoprostol |
| Czech | misoprostol |
| Finnish | Misoprostoli |
| Russian | MIZOPROSTOL, МИЗОПРОСТОЛ |
| Japanese | ミソプロストール |
| Polish | Mizoprostol |
| Spanish | misoprostol (producto), misoprostol (sustancia), misoprostol, Misoprostol |
| French | Misoprostol |
| German | Misoprostol |
| Italian | Misoprostolo |
| Portuguese | Misoprostol |
Ontology: Cytotec (C0591321)
| Concepts | Pharmacologic Substance (T121) , Eicosanoid (T111) |
| MSH | D016595 |
| English | Pfizer Brand of Misoprostol, Misoprostol Pfizer Brand, cytotec, Cytotec |
