Misoprostol

Brand names of misoprostol

  • Arthrotec [CD]
  • Cytotec

Misoprostol is a synthetically prepared prostaglandin (a group of powerful compounds like hormones made up of essential fatty acids and present in all mammalian tissues) that diminishes stomach acid and substitutes protective substances in the stomach that are restrained by non-steroidal anti-inflammatory drugs (NSAIDs), for instance ibuprofen, aspirin and others. Precisely speaking, this medication is generally used to lessen the hazards of gastric ulcers in patients who are undergoing treatment with NSAIDs for conditions that are associated with pain and inflammation, such as arthritis. In fact, misoprostol is basically prescribed for patients who are at high risk of having gastric ulcers when undergoing treatment with NSAIDs. Such patients include the elderly people, those having a history of ulcers as well as patients suffering from associated diseases that incapacitate or weaken them.

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It may be mentioned here that prostaglandins are basically compounds produced inside several organs of the body, together with the stomach. It is thought that prostaglandins shield the inner lining of the stomach from the impacts of using NSAIDs that tend to cause ulcers in the stomach. In fact, scientists are of the view that the use of NSAIDs causes gastric ulcers as they put off the production of prostaglandins inside the stomach. Hence, people suffering from stomach ulcers owing to use of NSAIDs that inhibit the production of prostaglandins are administered medications like misoprostol orally to protect the stomach lining. Oral administration of misoprostol, which is prepared synthetically, helps to reinstate the prostaglandins which the stomach has stopped producing owing to the action of the NSAIDs. The Food and Drug Administration (FDA) had approved the sale and use of the synthetic drug misoprostol in 1988 (December) and it has been found to be effective in shielding the inner lining of the stomach walls from the ulcerating effects of NSAIDs.

Things you need to tell your physician before taking misoprostol

As in the case of taking any other medication, before you start taking misoprostol you ought to take a few precautions. For instance, before you start taking misoprostol you need to tell your physician about all your other medical conditions, medical history and also if you are allergic to this medication or any other drugs. In addition, you should also tell your physician about all the prescription, over-the-counter and herbal medication you may be taking. If you want to start taking misoprostol for avoiding gastric ulcers caused by the effects of taking NSAIDs, you should tell your physician about the precise medications you may be taking for arthritis. At the same time, you need to specify if you take aspirin, antacids, any vitamins, minerals or dietary supplements.

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Nursing mothers should consult their physician before taking misoprostol for this medication has the potential to pass on to breast milk and harm the breast feeding infants.

Prior to using misoprostol, it is important that you inform your physician or healthcare provider regarding your complete medical history, especially if you are or had been suffering from any stomach/ intestine problems, such as inflammatory bowel syndrome or risks for the uterine being ruptured when it is used vaginally - before any uterine surgery or a Cesarean delivery.

People using misoprostol to prevent gastric ulcer, ought to quit smoking or reduce smoking tobacco drastically for smoking tobacco enhances the risk of internal bleeding in the stomach. The same is true for alcoholic beverages. It is important to restrict drinking alcoholic beverages and quit smoking if you want the medication to be effective. It is advisable that such people should consult their physician or healthcare providers regarding the risks of smoking tobacco and drinking alcoholic beverages while taking misoprostol. They would be able to provide you with more information and also suggest ways and means to handle your smoking and drinking habits.

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Women taking misoprostol in combination with mifepristone for abortion/ending pregnancy, find this medication very effective as there has seldom been any case of incomplete abortion while using the two medications concurrently. Close monitoring by physician is essential for women taking this medication for abortion. Thus, they need to be cautious about keeping their regular appointments with their physician. In addition, such women should receive clear instructions from their physician regarding what to do and whom to consult in the instance of any emergency. While vaginal bleeding is quite normal in women who take misoprostol in combination with mifepristone, they should seek immediate medical help if they notice any unusual symptoms, for instance, acute or prolonged vaginal blood loss, becoming unconscious, or any sign of infection, such as, chills and fever.

It is important to remember that pregnant women should never use misoprostol to avoid gastric ulcers since this medication has the potential to cause harm to the fetus. Women who are in the childbearing age ought to use an effectual contraceptive method if they are taking misoprostol. In fact, such women should continue using the birth control method for a minimum of one month or at least one completed menstrual cycle even after they stop taking misoprostol. In case women taking misoprostol become pregnant, they should immediately consult their physician and seek necessary medical help.

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Usage

Misoprostol is a synthetically prepared prostaglandin that is used to avoid gastric ulcers caused by the effects of using NSAIDs, for instance, ibuprofen, aspirin, naproxen and the likes. This medication is especially beneficial for people who take NSAIDs and are at high risk of developing gastric ulcers or people who have a medical history of ulcers. In effect, using misoprostol helps to diminish the risks of the more serious symptoms of ulcers, such as internal stomach hemorrhages. Misoprostol works by protecting the inner lining of the stomach as it reduces the amount of secretion of stomach acid. When the stomach comes in contact with lesser amount of acid, it is less susceptible to ulceration due to use of NSAIDs. Misoprostol is also used for abortion or end pregnancy. In this case, this medication is used in combination with another drug called mifepristone. In addition, misoprostol is also used to ease childbirth and several healthcare providers recommend its use during delivery since it aids in the start of labor as well as cervical ripening. Another advantage of using misoprostol during delivery is that this medication helps to cure relentless bleeding soon after childbirth. If this medication is being used for facilitating the childbirth or inducing labor, the healthcare provider inserts misoprostol inside the vagina just before delivery. In this case, misoprostol works to contract the muscles of the womb.

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How to use misoprostol

The synthetically prepared prostaglandin misoprostol is available with a patient information leaflet. Before you start using this drug either to prevent or treat gastric ulcers due to the impact of NSAIDs, it is important that you go through the leaflet thoroughly. In case you have any queries regarding the usage of this medication, it is advisable that you consult your physician, healthcare provider or pharmacist. The dosage of misoprostol generally depends on the medical condition of the patient as well as his/ her response to the therapy with this medication.

People taking misoprostol to keep off gastric ulcers caused by the effects of using NSAIDs should take this medication orally four times every day. Alternately it may also be taken after meals and before bedtime or according to the recommendation of their physician. On the other hand, women taking this medication for abortion should take it orally strictly as per their doctor's advice. Then again, for women who want to use misoprostol to start labor pain, their nurse or healthcare provider will place the medication in the vagina at the appropriate time.

People taking misoprostol for any of the above reasons ought to keep away from taking antacids enclosing magnesium since doing so may worsen diarrhea. Hence, if such people require taking any antacid, they ought to talk to their physician or pharmacist for they are the best people to suggest the right antacid to be taken while you are using misoprostol. People who are taking this medication to avoid gastric ulcers owing the effects of using NSAIDs should continue taking this synthetically prepared prostaglandin as long as they keep taking the NSAIDs. It is important to use this medication on a regular basis to derive the utmost benefit. If you stop taking it prematurely, you may face certain problems. People who feel that they are having some problem after taking this medication should immediately contact their doctor for help. You should also talk to your physician if your condition remains the same or deteriorates even after taking misoprostol.

How misoprostol works

Any person who has been undergoing treatment with anti-inflammatory medications, such as NSAIDs, for a prolonged period is likely to experience an irritation in the inner lining of the stomach causing it to be damaged. In such a situation, the individual faces high risk of developing ulcers in the stomach and intestine. In fact, scientists are of the view that these anti-inflammatory medications or NSAIDs stop the production of prostaglandins in the stomach causing ulceration. The use of the synthetically prepared prostaglandin misoprostol in such conditions facilitates the prevention of ulcers in the stomach by substituting for the prostaglandins that the stomach has stopped producing. At the same time, misoprostol works to enhance the natural healing ability of the stomach by means of augmenting the production of prostaglandins or the protective mucus in the stomach. In addition, misoprostol also helps in slowing down the discharge of the stomach acid.

Side effects

Serious
There are no serious side effects associated with the use of misoprostol.
Common
Less common

Possible interactions

Other medicaments
As in the case of other medications, misoprostol is also known to interact with certain other drugs. While some of them may dampen the effect of this synthetic prostaglandin, there are few others that may cause adverse after-effects when used concurrently.
  • Misoprostol should never be taken in combination with any antacid that encloses magnesium since it may augment the hazards of diarrhea. Hence, it is advisable to avoid taking misoprostol along with such antacids. In addition, taking any antacid may generally lessen the absorption of misoprostol, thereby, dampening the effect of this medication and delaying the healing process.
  • In addition, people taking misoprostol to prevent or treat gastric ulcers caused by the use of NSAIDs for treating other conditions, such as arthritis, should also avoid taking indomethacin as well as other NSAIDs since they may led to diminished levels of NSAID.
Foods
People taking misoprostol to treat gastric ulcers caused by the effects of using NSAIDs should avoid foods that are rich in fat content. Consuming foods that have high fat content may possibly decrease the peak blood concentration.
Herbal medicines or minerals
People taking the synthetically prepared prostaglandin misoprostol to prevent as well as treat stomach ulceration caused by the use of NSAIDs should exercise caution while using herbal medications and minerals for some of them are known to interact with misoprostol and render it less effective. For instance, such patients should avoid using herbs like kola and ma huang because they augment the production of stomach acids, thereby, lessening the impact of the medication. Even it is advisable not to use other herbs like ginkgo, black cohosh root and squill while taking misoprostol since they aggravate the gastro-intestinal problems. In fact, the herb licorice root also possesses a German Commission E (a remedial guide to herbal medicine with 380 monographs assessing the safety and effectiveness of herbs designed for licensed medical prescribing in Germany) monograph indication for ulcers in the stomach and intestine. Therefore, it is advisable that people taking misoprostol should consult a qualified physician before using any herbal medication concurrently.
Alcohol
Consumption of alcoholic beverages is a strictly prohibited for people enduring gastric ulcers owing to the effects of NSAIDs and taking misoprostol to treat the condition. In fact, drinking alcoholic beverages have the potential to stimulate the development of ulcers in the stomach. At the same time, to a great extent, alcohol also renders misoprostol ineffective retarding the healing process.
Tobacco smoking
Patients taking misoprostol for preventing gastric ulcers should avoid smoking tobacco. This is essential because nicotine contained in tobacco actually facilitates the development of stomach ulcers.

Discontinuation

Patients taking misoprostol with a view to prevent stomach ulceration owing to the effects of using NSAIDs should never stop taking this medication abruptly or before the treatment regimen ends. In case you are facing any problem owing to the use of misoprostol, inform your physician about it at the earliest. Never stop using this medication without consulting your physician or healthcare provider.

Storage instructions

Misoprostol, which is used to prevent gastric ulcers caused by use of NSAIDs, should be stored in the container in which the medication was packaged under tight seal to prevent its exposure to light and moisture. Always store this medication at temperatures below 77°F (25°C) in a dry place. It is important to mention that misoprostol should never be stored in the bathroom - where the conditions are generally moist. This medication ought to be kept out of the reach of children as well as pets. Unless there is any specific instruction in this regard, never try to dispose of this medication by flushing it down the toilet or pouring it into any drain. Always remember to dispose of misoprostol in a proper way when it becomes needless or the validity of the medication has lapsed. It is advisable that you talk to your pharmacist or the waste disposal company in your area regarding the details about proper manner of safely discarding the medication when it is not needed any longer.

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