Misoprostol

Misoprostol, sold under the brandname Cytotec among others, is 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. For abortions it is used by itself and with mifepristone or methotrexate. By itself, effectiveness for abortion is between 66% and 90%. Misoprostol is taken by mouth when used to prevent gastric ulcers in persons taking NSAIDs. For labor induction or abortion, it is taken by mouth, dissolved in the mouth, or placed in the vagina. For postpartum bleeding it may also be used rectally. Misoprostol, sold under the brandname Cytotec among others, is 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. For abortions it is used by itself and with mifepristone or methotrexate. By itself, effectiveness for abortion is between 66% and 90%. Misoprostol is taken by mouth when used to prevent gastric ulcers in persons taking NSAIDs. For labor induction or abortion, it is taken by mouth, dissolved in the mouth, or placed in the vagina. For postpartum bleeding it may also be used rectally. Common side effects include diarrhea and abdominal pain. It is pregnancy category X meaning that 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 — specifically, a synthetic prostaglandin E1 (PGE1). Misoprostol was developed in 1973. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication. The wholesale cost in the developing world is about 0.36 to 2.00 USD a dose. A month's supply to treat stomach ulcers in the United States is between 100 and 200 USD. The same costs between 30 and 55 EUR in Europe. Misoprostol is used for the prevention of NSAID-induced gastric ulcers. It acts upon gastric parietal cells, inhibiting 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. Because other classes of drugs, especially H2-receptor antagonists and proton pump inhibitors, are more effective for the treatment of acute peptic ulcers, 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. Misoprostol is sometimes coprescribed with NSAIDs to prevent their common adverse effect of gastric ulceration (e.g. with diclofenac in Arthrotec). However, even in the treatment of NSAID-induced ulcers, omeprazole proved to be at least as effective as misoprostol, but was significantly better tolerated, so misoprostol should not be considered a first-line treatment. Misoprostol-induced diarrhea and the need for multiple daily doses (typically four) are the main issues impairing compliance with therapy. Misoprostol is commonly used for labor induction. It causes uterine contractions and the ripening (effacement or thinning) of the cervix. It can be less expensive than the other commonly used ripening agent, dinoprostone. Oxytocin has long been used as the standard agent for labor induction, but does not work well when the cervix is not yet ripe. Misoprostol also may be used in conjunction with oxytocin. Between 2002 and 2012, a misoprostol vaginal insert was studied, and was approved in the EU. It was not approved for use in the USA, and the US FDA still considers cervical ripening and labor induction to be outside of the approved uses for misoprostol. Misoprostol is used either alone or in conjunction with another medication (mifepristone or methotrexate) for medical abortions as an alternative to surgical abortion. Medical abortion has the advantage of being less invasive, and more autonomous, self-directed, and discreet. It is preferable to some users because it feels more 'natural,' as the drugs induce a miscarriage. It is also more easily accessible in places where abortion is illegal. The World Health Organization provides clear guidelines on the use, benefits and risks of misoprostol for abortions.