Precautions and warnings

Misoprostol should not be used to prevent or treat NSAID-induced stomach or duodenal ulcers in pregnant women. It should only be used in women who could become pregnant if they really need NSAID treatment. These women must make sure they are not pregnant before starting Misoprostol and should use reliable birth control while taking it.

Misoprostol should also be used with caution in some people, including:

- Those who could have serious problems if their blood pressure drops (for example, people with heart or brain blood vessel diseases)
- People with inflammatory bowel disease
- People who are easily dehydrated
- Elderly patients
- Those with kidney problems

Drug Interactions

May make the effects of oxytocin stronger. Using magnesium-containing antacids together with misoprostol can increase the risk of diarrhea.

Contraindications

Misoprostol should not be used by anyone who is allergic to prostaglandins. It is also not recommended for women who are pregnant, breastfeeding, or could become pregnant.

Mode of actions

Misoprostol is a man-made version of prostaglandin E1. It works by attaching to certain receptors on stomach cells, which helps reduce acid production. Misoprostol also protects the stomach lining by providing prostaglandins that are lost when people take medicines like NSAIDs that block the body’s natural prostaglandins.

Dosage & Administration

Adult: Benign gastric and duodenal ulceration and NSAID associated ulceration: 800 mcg daily (in 2-4 divided doses) with breakfast or main meals and at bedtime; treatment should be continued for at least 4 weeks and may be continued for up to 8 weeks if required.

Prophylaxis of NSAID induced gastric and duodenal ulcer: 200 mcg 2-4 times daily taken with NSAID. If this dose cannot be tolerated, a dose of 100 mcg can be used. Misoprostol should be taken for the duration of NSAID therapy as prescribed by the physician.

Induction of labor: Place 25 mcg in the posterior fornix of the vagina. Repeat after every 6 hours if necessary until the maximum dosage of 200 mcg total misoprostol is reached. Fetal heart rate and uterus contractions should be monitored. Alternatively, 100 mcg taken orally. If cervical ripening or active labor does not occur, repeated dose of 100- 200 mcg of oral misoprostol is given every 4 hourly until labor is established (as evidenced by a Bishop score of 7 or more). Maximum number of dose is 6.

Maternal vital signs, fetal heart rate and contractions should be monitored. Oxytocin can be started 4 hours after last dose of misoprostol. Physician should be notified for signs of fetal distress or tetanic uterine contractions. Oral misoprostol therapy should be monitored by Physician.

Prevention of postpartum haemorrhage: 600 mcg orally immediately following delivery. Treatment of postpartum haemorrhage: 600 mcg orally or 1000 mcg per rectally.

Termination of pregnancy (

Pregnancy & Lactation

This medicine must not be used during pregnancy. It can be absorbed through the skin and lungs caused can damage your unborn child’s organs and cause congenital disabilities. Strict two effective types of birth control starting one month before and during treatment and for three years after stopping this medicine. Discuss with your doctors if you are not sure which types of birth control are effective for you. You must need to take pregnancy tests regularly during your treatment with this medicine and for at least three years after taking this medicine. If it seems that you do become pregnant stop taking this medicine and call your doctor immediately. If you really become pregnant, miss a menstrual period, or have sex without using two forms of birth control. In some cases, your doctor can prescribe emergency contraception to prevent pregnancy. People on this medicine should not donate blood during the treatment and for three years afterward.

This medicine is also contraindicated breast milk. Breastfeeding is not recommended while using this medication and for three years afterward.

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