Prevents NSAID-induced gastro-duodenal ulcers and reduce the incidence of life-threatening ulcer complications.

Prostaglandin E1 effective agent for cervical ripening as part of labor induction.

Vaginally administered misoprostol is more efficacious than oral-plus-vaginal or oral-only route administration for cervical ripening and induction of labor.

Associated with a greater incidence of spontaneous rupture of membranes.

PROBAAT-II study show oral misoprostol is as safe as foley catheterization for labor induction.

A medication used to prevent and treat stomach ulcers, start labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus.

Sold under the brandname Cytotec.

Used to prevent and treat stomach ulcers, start labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus.

It is used by itself and with mifepristone or methotrexate for abortions.

Singularly, its effectiveness for abortion is between 66% and 90%.

It is used to prevent gastric ulcers in persons taking NSAIDs.

To induce labor or an abortion it is taken by mouth, dissolved in the mouth, or placed in the vagina.

For postpartum bleeding it may be administered rectally.

Pregnancy category US: X (Contraindicated)

Used for terminating pregnancy

Etensively absorbed.

Protein binding 80-90% .

Metabolism Liver.

Elimination half-life 20–40 minutes.

Excretion by Urine 80%.

Common side effects include diarrhea and abdominal pain.

It is pregnancy category X.

It is known to result in negative outcomes for the baby if taken during pregnancy.

In rare cases, uterine rupture may occur.

It is a prostaglandin analogue.

It is used for the prevention of NSAID-induced gastric ulcers, acting upon gastric parietal cells.

It inhibits the secretion of gastric acid by G-protein coupled receptor-mediated inhibition of adenylate cyclase, which leads to decreased intracellular cyclic AMP levels and decreased proton pump activity at the apical surface of the parietal cell.

H2-receptor antagonists and proton pump inhibitors, are more effective for the treatment of acute peptic ulcers, so that misoprostol is only indicated for use by people who are both taking NSAIDs and are at high risk for NSAID-induced ulcers, including the elderly and people with ulcer complications.

It is sometimes coprescribed with NSAIDs to prevent their common adverse effect of gastric ulceration.

Misoprostol is not be considered a first-line treatment for NSAIDs.

It is commonly used for labor induction, causing uterine contractions and the effacement or thinning of the cervix.

It may be used in conjunction with oxytocin.

It is used either alone or in conjunction with another medication, mifepristone or methotrexate, for medical abortions as an alternative to surgical abortion.

It is most effective when it is used with methotrexate or mifepristone.

Used alone it is effective 88% of the time up to eight-weeks gestation.

Approximately 1% of women will have heavy bleeding requiring medical attention as a complication.

Some women may have ectopic pregnancy.

The 12% of pregnancies that continue after misoprostol failure are more likely to have birth defects and are usually followed up with a more effective method of abortion.

The use of misoprostol in combination with mifepristone is the usual protocol.

The combination is effective in around 95% for early pregnancies.

Alone it may be more effective in earlier gestation.

It is recommended for pregnancies up to 12 weeks to use 12 tablets of 200 mcg.

Four tablets of misoprostol are placed under the tongue or far up the vagina and let dissolved for 30 minutes.

The process is repeated at 3 and 6 hours.

The process It works in 90% after first attempt and, in case of failure, the attempt may be repeated after a minimum of 3 days.

It can also be used to dilate the cervix in preparation for a surgical abortion, particularly in the second trimester.

By mouth it is the least effective mode of administration treatment for producing complete abortion in a period of 24 hours due to the liver’s first-pass effect which reduces the bioavailability of the misoprostol.

Vaginal and sublingual routes result in greater efficacy and extended duration of action because they are directly absorbed into circulation by bypassing the liver first-pass effect.

Testing before using for abortion confirmation of pregnancy: hematocrit or Hb tests, and Rh testing.

If used for treatment of complete abortion, a pregnancy test, physical examination of the uterus, and ultrasound should be performed to ensure success of treatment.

It is also used to prevent and treat post-partum bleeding, with orally administered misoprostol being marginally less effective than oxytocin.

The use of rectally administered misoprostol is associated with lower rates of side effects compared to other routes for vaginal postpartum bleeding.

Oxytocin must also be given by injection, while misprostol can be given orally or rectally for this use.

Can be use for cervical ripening in advance of an endometrial biopsy to reduce the need for use of a tenaculum or cervical dilator.

Adverse effects: taking misoprostol by mouth for the prevention of stomach ulcers is associated with diarrhea.

An average 13% of people reported diarrhea, which was dose-related and self-limiting, when taken orally for the prevention of stomach ulcers.

Fever is almost universal when multiple doses are given every 4 to 6 hours.

Side effects are increased by sublingual or oral misoprostol administered drug, compared to a low dose (400 ug) vaginal misoprostol.

Low dose vaginal misoprostol is linked with low complete abortion rate.

Sublingually administered misoprostol dosed at 400-600 ug has greater likelihood of fever and diarrhea due to its quicker onset of action, higher peak concentration and bioavailability in comparison to vaginal or oral misoprostol.

Bleeding and cramping is commonly experienced after administration of misoprostol for abortion.

Should not be taken by pregnant women with wanted pregnancies to reduce the risk of NSAID-induced gastric ulcers.

May cause cervical ripening and uterine hyperstimulation, which can negatively affect the blood supply to the fetus and increases the risk of complications such as uterine rupture.

It is a prostaglandin analogue that binds to myometrial cells to cause myometrial contractions leading to expulsion of tissue.

Binds to and stimulates prostaglandin EP2 receptors, prostaglandin EP3 receptor and prostaglandin EP4 receptor but not Prostaglandin EP1 receptor.

Failed misoprostol abortions are associated with birth defects in some cases.

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