Misoprostol
CYTOTEC
Pronunciation: mye-soe-PROST-oel
What it isProstaglandin E1 analog; NSAID ulcer prevention, labor induction, and medical abortion.
Why this oneIt replaces the gastric prostaglandin suppressed by NSAIDs and also provides a heat-stable uterotonic.
What limits itDiarrhea and cramping commonly limit GI use. Obstetric use can cause tachysystole or uterine rupture.
FDA-approved for
- NSAID ulcer prevention (1988)
Off-label
- labor induction
- medical abortion (with mifepristone)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Prevention of NSAID-induced gastric ulcers | Adult | 200 mcg QID |
Renal No routine adjustment; may reduce dose if 200 mcg not tolerated.
Hepatic Undefined
Instructions
- Take with meals; last dose of the day at bedtime.
- If 200 mcg not tolerated, 100 mcg may be used.
- Avoid coadministration with magnesium-containing antacids.
- In women of childbearing potential: negative serum pregnancy test within 2 weeks, effective contraception, and begin only on the 2nd–3rd day of the next menstrual period.
Available strengths
- tab 100, 200 mcg
- sol 10 g/100 mL
Contraindications
- Pregnancy (when used to reduce risk of NSAID-induced ulcers).
Cautions
- Profound diarrhea with severe dehydration (monitor patients with IBD or where dehydration would be dangerous)
- Postmenopausal vaginal bleeding warrants workup
- Abortifacient — warn not to give to others
Adverse reactions
- Diarrhea
- Abdominal pain
- Nausea
- Flatulence
- Headache
- Dyspepsia
- Vomiting
- Gynecologic spotting/cramps
Pregnancy Contraindicated — causes uterine contractions, bleeding, abortion, and congenital anomalies.
Lactation Undefined
Cost
Generic entry2002
⚠ BOXED WARNING
- Abortifacient; uterine rupture in pregnancy
Classes and tags
Clinical profile
Legacy pregnancy categoryX
Defining liabilityLong-term infection, magnesium/B12 and bone risks; selected agents have clinically important CYP interactions.