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Misoprostol
Aka: Misoprostol, Cytotec, PGE1 Gel
- Mechanism
- Prostaglandin E1 Analog
- Gastric Mucosa Protection by prostaglandin replacement
- Cervical Ripening and uterine contractions
- 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)
- Preparations
- Misoprostol (Cytotec)
- 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
- 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
- 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
- Adverse Effects
- When used orally
- Diarrhea
- Nausea
- Vomiting
- Poorly tolerated
- 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]
- References
- MacNaughton (2021) Am Fam Physician 103(8) 473-80 [PubMed]