misoprostol

Misoprostol is a synthetic prostaglandin E1 analogue used to protect the stomach lining and to induce uterine contractions. It is sold under the brand name Cytotec and in generic forms. By acting on the gastric mucosa, misoprostol reduces acid secretion and increases mucus and bicarbonate. It also stimulates uterine contractions, which underpins its obstetric uses.

In gastroenterology, misoprostol is approved to prevent NSAID-induced gastric ulcers in patients at risk and to treat certain gastric or duodenal ulcers where appropriate. It is not a substitute for NSAID cessation and is not suitable for all patients.

In obstetrics and gynecology, misoprostol is used for cervical ripening and induction of labor; for medical abortion when abortion is legally indicated, either alone in some regimens or combined with mifepristone or methotrexate; and for management of postpartum hemorrhage due to uterine atony. Dosing regimens vary by route (oral, sublingual, buccal, vaginal) and indication, and are selected to balance efficacy with safety; regimens are supervised by clinicians.

Adverse effects commonly include diarrhea, abdominal cramps, nausea, and fever. Uterine hyperstimulation and, rarely, uterine rupture can occur with obstetric use. Contraindications include hypersensitivity to misoprostol; caution is advised in pregnancy when gastric ulcer indications are considered and during obstetric use requires medical supervision. Misoprostol is on the World Health Organization list of essential medicines for certain indications and is widely available in generic forms.