II. Mechanism

  1. Prostaglandin E1 Analog
  2. Gastric Mucosa Protection by prostaglandin replacement
  3. Cervical Ripening and uterine contractions

III. Indication

  1. Peptic Ulcer Disease prevention
    1. See NSAID Gastrointestinal Adverse Effects
    2. Prevents ulcers in those on NSAIDs chronically
  2. Cervical Ripening agent in Pregnancy Labor Induction
  3. Early Pregnancy Loss (<84 days)
  4. Termination of Pregnancy (<77 days)

IV. Preparations

  1. Misoprostol (Cytotec)

V. Dosing: Prevention of NSAID-induced Peptic Ulcer Disease

  1. See NSAID Gastrointestinal Adverse Effects
  2. Option 1: 100-200 mcg four times daily with food
  3. Option 2: 200 mcg orally twice daily with food
    1. Better tolerated than four times per day dosing

VI. Dosing: Obstetrics and Gynecology

  1. Cervical Ripening
    1. See Cervical Ripening for pregnancy dosing
    2. Misoprostol 25-50 mcg per vagina every 6 hours
  2. Early Pregnancy Loss (<84 days) or Termination of Pregnancy (<77 days)
    1. See Early Pregnancy Loss (includes precautions and monitoring protocol)
    2. Misoprostol 800 mcg intravaginally at 24-48 hours after Mifepristone
      1. Efficacy improves if followed by second dose Misoprostol 800 mcg 4 hours after first
    3. Strong uterine cramping and heavier Vaginal Bleeding follows Misoprostol dose
      1. Onset within several hours
      2. Persists for 3-5 hours
      3. Lighter Vaginal Bleeding may persist for 9-16 days
    4. Adjunctive medications
      1. NSAIDs
      2. Heating pad

VII. Technique

  1. Vagnial Dosing
    1. Place 4 of the 200 mcg tablets (total 800 mcg) inside the vagina and lie supine for 30 minutes
  2. Buccal Dosing may be used in place of vaginal dosing
    1. Place two of the 200 mcg Misoprostol tablets on each side of the mouth (total 800 mcg)
    2. Allow tablets to dissolve over 30 minutes

VIII. Adverse Effects

  1. When used orally
    1. Diarrhea
    2. Nausea
    3. Vomiting
    4. Poorly tolerated
  2. Gynecologic symptoms (800 mcg dosing)
    1. Strong uterine cramping
    2. Vaginal Bleeding heavier than typical Menses

IX. Efficacy: Peptic Ulcer Disease reduction

  1. Dosing qid: 4% Peptic Ulcer Disease recurrence
  2. Dosing bid: 8% Peptic Ulcer Disease recurrence
  3. Placebo: 16% Peptic Ulcer Disease recurrence
  4. Reference
    1. Raskin (1995) Ann Intern Med 123:344-50 [PubMed]

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Related Studies

Cost: Medications

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