Labor induction (in unfavorable cervical conditions) & in the prevention & treatment of Post Partum Hemorrhage (PPH)
Drugs Acting on the Uterus / Antacids, Antireflux Agents & Antiulcerants
Misoprostol is extensively absorbed, and undergoes rapid de-esterification to its free acid, which is responsible for its clinical activity and, unlike the parent compound, is detectable in plasma. Maximum plasma concentrations of Misoprostol acid are diminished when the dose is taken with food and total availability of Misoprostol acid is reduced by use of concomitant antacid. Misoprostol has both antisecretory (inhibiting gastric acid secretion) and (in animals) mucosal protective properties. NSAIDs inhibit prostaglandin synthesis, and a deficiency of prostaglandins within the gastric mucosa may lead to diminishing bicarbonate and mucus secretion and may contribute to the mucosal damage caused by these agents. Misoprostol can increase bicarbonate and mucus production, but in man this has been shown at doses 200 meg and above that are also antisecretory. It is therefore not possible to tell whether the ability of Misoprostol to reduce the risk of gastric ulcer is the result of its antisecretory effect, its mucosal protective effect, or both.
Induction of Labor: 25 mcg vaginally 6 hourly or, 50 mcg orally 4 hourly. Postpartum Hemorrhage (PPH) prophylaxis: 400 mcg to 600 mcg orally or rectally immediately following delivery of the child. Postpartum Hemorrhage (PPH) treatment: 1000 mcg rectally or, 200 mcg orally with 400 mcg sublingually.
There is no evidence of clinically significant interaction between Misoprostol and cardiac, pulmonary, CNS drugs and NSAID's. The bioavailability of Misoprostol is decreased with high doses of antacid.
Precaution should be taken in conditions where hypertension might precipitate severe complications (e.g. Cerebrovascular & cardiovascular disease).
Spotting, cramps, hypermenorrhea, menstrual disorder & dysmenorrhea. Postmenopausal vaginal bleeding may be related to Misoprostol administration
Because of the abortifacient property of the Misoprostol component, it is contraindicated in women who are pregnant.
The toxic dose of Misoprostol in human has not been determined. Clinical signs that may indicate an overdose are a sedation, tremor, convulsions, dyspnea, abdominal pain, diarrhea and fever. Symptoms should be treated with supportive therapy.
Store in a cool and dry place, protected from light and moisture. Keep out of the reach of the children.
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