II. 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
III. Indications
-
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. Medications
- Misoprostol (Cytotec)
V. 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
VI. 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
- Vaginal (or rectal)
- 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. Safety
- Pregnancy Category X
- Avoid in Lactation
VIII. 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
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
X. Resources
XI. References
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Related Studies
misoprostol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
MISOPROSTOL 100 MCG TABLET | Generic | $0.46 each |
MISOPROSTOL 200 MCG TABLET | Generic | $0.74 each |