Misoprostol

Indications
Oral
Benign gastric and duodenal ulceration
Adult: 800 mcg daily in 2-4 divided doses for at least 4 wk, up to 8 wk if needed.
Elderly: Reduce dose if patients are unable to tolerate usual adult dose.
Renal impairment: Reduce dose if patients are unable to tolerate usual adult dose.
Oral
NSAID-associated ulceration
Adult: 800 mcg daily in 2-4 divided doses for at least 4 wk, up to 8 wk if needed.
Elderly: Reduce dose if patients are unable to tolerate usual adult dose.
Renal impairment: Reduce dose if patients are unable to tolerate usual adult dose.
Oral
Prophylaxis of NSAID-induced ulcers
Adult: 200 mcg 2-4 times daily. Patient not tolerating high dose: Reduce dose to 100 mcg 2-4 times daily.
Elderly: Reduce dose if patients are unable to tolerate usual adult dose.
Renal impairment: Reduce dose if patients are unable to tolerate usual adult dose.
Oral
Cervical ripening before surgical termination of pregnancy in the 1st trimester
Adult: 400 mcg as a single dose 3-4 hr before surgery.
Oral
Termination of pregnancy (49 days or less duration)
Adult: 400 mcg as a single dose 36-48 hr after mifepristone.
Contraindications
Women of childbearing potential. Pregnancy and lactation.
Warnings / Precautions
Conditions where hypotension might precipitate severe complications e.g. cerebrovascular or CV disease. Inflammatory bowel disease. Patients prone to dehydration. Elderly. Renal impairment.
Adverse Reactions
Diarrhoea, abdominal pain, dyspepsia, constipation, flatulence, nausea and vomiting; abnormal vaginal bleeding, cramps, increased uterine contractility, headache.
Overdose Reactions
Symptoms: Sedation, tremor, convulsions, dyspnoea, abdominal pain, diarrhoea, hypotension, bradycardia. Management: Symptom-directed and supportive
Drug Interactions
May increase effects of oxytocin. Increased risk of misoprostol-induced diarrhoea with magnesium-containing antacids.
See Below for More misoprostol Drug Interactions
Mechanism of Actions
Misoprostol, a synthetic prostaglandin E1 analogue, exerts its antisecretory activity by directly acting on specific prostaglandin receptors found on the surface of gastric parietal cells. It exerts its protective effects on the mucosa by replacing the prostaglandins consumed during prostaglandin-inhibiting therapies e.g. NSAIDs.
Absorption: Rapidly absorbed from the GI tract (oral). Peak plasma concentration in 15-30 min.
Metabolism: Rapidly metabolised to misoprostol acid (active form).
Excretion: Mainly via urine. Elimination half-life: 20-40 min.
Administration
Should be taken with food.
Storage Conditions
Oral: Store at or below 25°C (77°F).
ATC Classification
G02AD06 - misoprostol ; Belongs to the class of prostaglandins. Used as an oxytocic.
A02BB01 - misoprostol ; Belongs to the class of prostaglandins. Used in the treatment of peptic ulcer and gastro-oesophageal reflux disease (GERD).
Storage
Oral: Store at or below 25°C (77°F).
Available As
  • Misoprostol 100 mcg
  • Misoprostol 200 mcg
  • Misoprostol 200 mg
  • Misoprostol 25 mcg
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