Misoprostol

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Misoprostol Brand Name– Cytotec

What is Misoprostol

Misoprostol is a synthetic, oral prostaglandin E1 (PGE1) analog. Misoprostol is effective for prevention of gastric ulcers secondary to use of nonsteroidal antiinflammatory drugs (NSAIDs) and should be taken for the duration of NSAID therapy.

The drug may produce uterine contractions, uterine bleeding, and abortifacient effects and the products carry a boxed warning regarding the reproductive risks; adequate contraception is required in females of childbearing potential during oral use for prevention of NSAID-induced ulcers.

Due to its ability to ripen the cervix and stimulate uterine contractions, misoprostol is used widely off-label in various obstetric protocols for cervical ripening and labor induction; these uses are not FDA-approved but are recommended in obstetric guidelines and are discussed in the oral product label.

Misoprostol is a recognized component of the FDA-approved mifepristone-regimen for early pregnancy termination.

Misoprostol was initially approved by the FDA in December 1988.

Indications

  1. cervical ripening induction
  2. duodenal ulcer
  3. early pregnancy failure
  4. gastric ulcer
  5. intrauterine fetal death
  6. kidney transplant rejection prophylaxis
  7. labor induction
  8. NSAID-induced ulcer prophylaxis
  9. postpartum bleeding
  10. pregnancy termination

For NSAID-induced ulcer prophylaxis in patients receiving NSAIDs and at high risk for gastric ulceration (e.g., elderly, past history of ulcer, concomitant debilitating disease, or concomitant systemic corticosteroid use)

NOTE: Misoprostol is indicated to prevent NSAID-induced gastric ulcers but has not been shown to prevent duodenal ulcers.

Side Effects

  1. abdominal pain
  2. agitation
  3. anaphylactoid reactions
  4. breakthrough bleeding
  5. cervical laceration
  6. chest pain (unspecified)
  7. chills
  8. constipation
  9. diaphoresis
  10. diarrhea
  11. dysmenorrhea
  12. dyspepsia
  13. edema
  14. fetal bradycardia
  15. fetal death
  16. fever
  17. flatulence
  18. headache
  19. hypertension
  20. hyperthermia
  21. hypotension
  22. infection
  23. lethargy
  24. leukocytosis
  25. menstrual irregularity
  26. myocardial infarction
  27. nausea
  28. pelvic pain
  29. phlebitis
  30. pulmonary embolism
  31. rash
  32. shivering
  33. sinus tachycardia
  34. stroke
  35. syncope
  36. teratogenesis
  37. thrombosis
  38. uterine contractions
  39. uterine pain
  40. uterine rupture
  41. vaginal bleeding
  42. vertigo
  43. vomiting
  44. weakness

Monitoring Parameters

  • pregnancy testing
  • stool guaiac

Contraindications

  • abnormal fetal position
  • breast-feeding
  • caesarean section
  • cardiac disease
  • children
  • contraception requirements
  • dehydration
  • diarrhea
  • ectopic pregnancy
  • fetal distress
  • fever
  • herpes infection
  • incomplete abortion
  • infection
  • infertility
  • inflammatory bowel disease
  • labor
  • multiparity
  • obstetric delivery
  • placenta previa
  • pregnancy
  • pregnancy testing
  • renal disease
  • reproductive risk
  • sepsis
  • ulcerative colitis
  • vaginal administration
  • vaginal bleeding
  • vasa previa

Interactions

  • Aluminum Hydroxide; Magnesium Hydroxide
  • Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
  • Calcium Carbonate; Magnesium Hydroxide
  • Magnesium Hydroxide
  • Oxytocin

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