Misoprostol

CYTOTEC

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

BOXED WARNING Can cause birth defects, abortion, premature birth, or uterine rupture; must not be used in pregnancy.

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

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.

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

Pregnancy Contraindicated — causes uterine contractions, bleeding, abortion, and congenital anomalies.

Lactation Undefined

⚠ BOXED WARNING

Cost, est. cash$10–$300/month

Generic entry2002

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk4 / 4

Legacy pregnancy categoryX

Defining liabilityLong-term infection, magnesium/B12 and bone risks; selected agents have clinically important CYP interactions.