Misoprostol: What is it used for? Side effects, interactions, and precautions

 Key takeaways

• Doctors usually prescribe misoprostol along with non-steroidal anti-inflammatory drugs (NSAIDs) for patients at risk of stomach ulcers. This is because NSAIDs, such as diclofenac and ibuprofen, can potentially cause peptic ulcers in certain patients if given alone.
• Misoprostol (Cytotec) is not a contraceptive. But it can cause abortion in the early stages of pregnancy. Its use in clinical abortion is approved, but you need a prescription to get it from your pharmacist. 
• Misoprostol can be used alone to induce labor in pregnant people.

Most people refer to misoprostol as an abortion pill. However, its primary use is in combination with NSAIDs like aspirin and diclofenac to prevent stomach ulcers in high-risk patients. 

NSAIDs are used to treat pain, inflammation, and also lower body temperature. But they can also cause some side effects. One of their significant side effects is the potential to cause stomach ulcers, leading to internal bleeding and anemia. 

NSAIDs are usually given in combination with misoprostol to reduce the side effects. One such combination is Arthrotec, which consists of 75 mg of diclofenac and 200 mcg of misoprostol, used to treat arthritis.

This article will explain how misoprostol works, its uses, side effects, and interactions.

 What is misoprostol, and how does it work?

Misoprostol is a medication usually taken with NSAIDs to prevent stomach ulcers. It is known by its brand name, Cytotec. It usually comes as a 200-mcg tablet and can be taken up to four times within 24 hours to prevent or treat stomach ulcers. 

Misoprostol works by enabling the stomach to protect itself from acid damage and decreasing the level of acid produced by the stomach. It protects the stomach lining, preventing any damage that NSAIDs may cause. Hence its use in treating stomach ulcers.

Misoprostol is a prescription drug, which means you cannot purchase it from a pharmacy without a prescription from a medical doctor. 

Although the U.S. Food and Drug Administration (FDA) initially approved misoprostol for preventing and treating stomach ulcers, it is now used as an abortion pill. When pregnant people ingest it in the early stages of their pregnancy, it causes cramping and bleeding, which leads to the emptying of the uterus. 

 Common uses of misoprostol

Misoprostol has three significant uses: medical abortion, stomach ulcers, and labor induction. 

• Medical abortion

Misoprostol is considered safe and has been approved by the FDA for medical abortions. People use it alone or in combination with mifepristone. When mifepristone is not readily available, they may combine it with methotrexate. 

Misoprostol causes abortion by cramping the uterus, causing it to bleed and empty its contents.

A study shows that a combination of misoprostol and mifepristone is more effective in terminating early-stage pregnancy than misoprostol alone. 

Also, the dose of misoprostol used to cause medical abortion is usually higher (800 mcg every 3 hours) than for treating stomach ulcers.

• Preventing or treating stomach ulcers

Misoprostol was first approved by the FDA for treating and preventing stomach ulcers. It is used in people with stomach ulcers who need to be placed on NSAIDs and are at risk of stomach ulcers.

NSAIDs like diclofenac, ibuprofen, and aspirin can cause stomach ulcers in certain patients. If you have a stomach ulcer or are at risk of developing one, ensure your doctor or pharmacist is aware before placing you on NSAIDS.

When used to prevent or treat ulcers, misoprostol protects the stomach lining, preventing any damage caused by these NSAIDs, and reduces stomach acid.

The usual dose of misoprostol used to prevent or treat stomach ulcers is 200 mg, given four times within 24 hours. 

• Inducing labor 

Another primary use of misoprostol is inducing labor. Misoprostol induces labor by causing the muscles of the uterus to contract. Misoprostol can be given orally or through the vagina to induce labor.

A study[4] showed that vaginal misoprostol is more effective than oral misoprostol for inducing labor. 

When inducing labor, healthcare professionals give misoprostol in 50 mcg doses orally or 25 mcg vaginally.

 Is misoprostol FDA-approved for inducing labor?

Although some studies show that misoprostol can be used to induce labor, the FDA has not approved it for this purpose. This could be due to the high risks associated with its use.

Also, the FDA says no company has sent them scientific proof of misoprostol’s safety and effectiveness in inducing labor. 

 Potential side effects of misoprostol

As with any other drug, misoprostol has potential side effects associated with its use. Some common side effects to expect when using misoprostol are:

• Diarrhea
• Stomach ache
• Vomiting
• Fever 
• Headache
• Nausea 
• Constipation
• Fatigue
• Flatulence 

While some more severe side effects of misoprostol may include:

• Anemia
• Bloody stools
• Severe cramps 
• Heavy bleeding
• Irregular menstruation

 Is misoprostol a contraceptive?

Misoprostol is not a contraceptive.

Contraceptives are drugs or medical devices used for birth control. They include implants and drugs. Most contraceptive drugs are usually taken within 24 to 120 hours after unprotected sexual intercourse.

An important point to note is that contraceptives are used to prevent pregnancy. On the other hand, misoprostol is used to end early-stage unwanted pregnancies. 

Also, you can get most contraceptives, such as Postinor 2 and Postpill, at a nearby pharmacy without a prescription. But you would need a prescription from your doctor to buy misoprostol. 

In summary, misoprostol is not a contraceptive but rather an abortion pill.

 How to use misoprostol

Misoprostol is a small tablet usually taken by mouth to prevent or treat stomach ulcers. It can be taken four times within 24 hours and is best taken with or immediately after a meal. Taking misoprostol with a meal or with milk helps prevent diarrhea. 

When used to induce labor or as an abortion pill, misoprostol can be administered orally or vaginally. 

To ensure you use misoprostol correctly, always speak to a healthcare professional. Also, never take the drug longer than you should, and do not take more doses than recommended. 

 Precautions to take when using misoprostol

While some know that misoprostol can be used as an abortion pill, others are unaware.

Pregnant people who intend to give birth should not use misoprostol, as it might lead to congenital disabilities, premature birth, or even abortion.

Misoprostol can cause fetal defects, miscarriage, early labor, or complete pregnancy loss.

Avoid taking this medication without a doctor’s prescription. And if you notice symptoms like chills, fever, diarrhea, and vomiting when taking it, speak with your doctor as soon as possible.

 Can misoprostol interact with other drugs?

Yes. Misoprostol reacts with antacids containing magnesium, worsening diarrhea, a side effect of misoprostol. 

 Wrap up

Misoprostol is a medication used to prevent or treat NSAIDs, cause abortion, or induce labor. The dose of misoprostol used for each condition differs based on each individual’s needs. Also, there are some common side effects to expect when you are taking misoprostol. If you notice any severe side effects, consider reaching out to a health professional.

Misoprostol can be used alone or with other medications for specific conditions. But before taking it, talk to your doctor.