Misoprostol

1391Misoprostol

(C22H38O5)(15-deoxy-16-hydroxy-16-methyl ProstaglandinE1) :

Brief Information:

:

Misoprostol :

Cytotec Cyprostol Mibetec Prostokos Misotrol Misodex :

E1 :

100 mcg 200 mcg

: NSAIDs Acute Rejection of Renal Replacement 49 ( mifepristone)

Unlabeled:

NSAIDs

: .

:

: . . . 25 .

:

History and Introduction:

. . . 20 600 . . .

E1 . . 1971 (NSAID) . . . 100 200 Sublingual . . Cytotec (Pfizer) 600 . (200-100 ) . - FDA . WHO Incomplete Abortion . - - PPH . off-label . . (Guideline) . E1 :Pharmacologic Effects of Misoprostol and other analogs of PGE1 on Reproductive System:Misoprostol is a Syntetic form of Prostaglandin E1 Analogs and basically is used for the prevention and treatment of Peptic ulcers and in Gyneco-Obstetrics, it combines with the related receptors in uterus and causes uterine contractions through some biochemical changes such as Calcium changes and etc. and thus is used for abortions, Induction of labor and prevention & treatment of PPH

NoTrimestersIndicationsDosageTimes to be usedEffectiveness

1

First TrimesterMissed Abortion 4-12 week800MicGr Vaginally/ OrallyEvery 24 Hours for 2 Days90% effective

Incomplete Abortion 4-12 Week600 MicGr Vaginally /orallySingle dose leave to work for 2 days95% Effective

2Second TrimesterMissed Abortion 12-24 Week400MicGr Orally

200 MicGr vaginally

Maximum 5 doseEvery 4 hours

Every 4 hours

90-100 % deliver in 48 hours

Incomplete Abortion 12-24 Week400MicGr Orally

200 MicGr vaginallyEvery 4 hours

Every 4 hours95% Effective

3Third Trimester*Induction of Labour >24 Week

Alive Fetus25 MicGr Vaginally

Or 50 MicGr OrallyEvery 4-6 hours

Every 4 hours90 % Effective

Induction of Labour > 24 Weeks

Died Fetus100 MicGr VaginallyEvery 12 Hours100 % Effective

4Post PartumPPH Treatment1000Micgr RectallySingle Dose85% Effective

PPH Prevention600-800 MicGr RectallySingle Dose90% Effective

5For RipeningRipening prior Uterine Instrumentation400 MicGr Vaginally or OrallySingle Dose 3 Hours before Procedure95% Effective

*:Generally dosage of Misoprostol is 200MicGr/12Hr in Early third trimester and it is 50MicGr/ 12 Hr in End of Third trimester

Gyneco-Obstetrical Side Effects: Nausea, flatulence, Headache, dyspepsia, vomiting, and constipation

Gyneco-Obstetrical Cautions:Dont use Oxytocine within 6hrs of last Misoprostol administration, if vomiting occurs within 30 minutes of oral administration of drug, please consider virginal administration for the next dosageGyneco-Obstetrical Contra Indications: Hypersensitivity with Prostaglandins, Cephalo- Pelvic Disproportions, Grand Multiparity, fragile uterus, Mal-presentation, total Placenta Previa, and previous C/S or history of Hystrotomy

A. :

Abortion: PGE1 :

: Decidual Break Down Detachment Conceptus .

: .

: (Oxytocic) (Expulsion) .

.

:

... (Vasomotor and Vasovagal) .

.

:

Intra-amniotic Administration:

PGF2 alpha ( ) 40mg .

PGE 2 . :

Intra-vaginal Administration: .

:

Oral Administration: {Mifepristone (RU-486) with Misoprostol) Synthetic .

:

- Breast Cancer

- Ovarian Cancer- Meningiomas

- Cushings Syndrome- Uterine Fibroids

-Endometriosis Early Pregnancies .

:

600 mg 400 microgram . :

Abortion in 1st Trimester: (D&C) . 48 24 4.92% . 90%-80% 800 (94%-95%) . Sublingual Sublingual . 800 12 .

:

Blighted Ovum Abortion: (D&C) . 800 Sublingual . Sublingual 800 (600 ) 86% . 800 600 Sublingual . :

Incomplete Abortion: 600 99%-95% 2-1 . . 600 12 2-1 . 3 ( ):

Abortion in 2nd Trimester (Alive Fetus): D&C (Extraction) . : ... WHO 600-200 . (26-14 ) 400 600 . 400 . . . . :

Intra-Uterine Fetal Death(IUFD): IUFD . IUFD . Sublingual . 400 200 IUFD . : 17 -13 200 .

26 -18 100 . 27 50- 25 . . . :

()

( )

: 4 . . . ( )

. . ( )

9 . Menstrual Period)

IUD . . . . 2 3 Menstrual Period . :

Menstrual Period

: . . 70 . 25 . 25 mg3 . 25 . . 56 . 20 -25 100 200 58% 10% . 200 200 20 12 . . . 12-6% . :

Postpartum Hemorrhage Prevention: (PPH) 25% . .

. 20000 600 10 ( cc1000) ((12% vs4 % PPH . . WHO PPH . . 600 Sublingual . :

Treating Postpartum Hemorrhage: . . . (PPH) . WHO 600 Sublingual PPH . E1 :

B. :

Cervical Ripening prior to cervical surgeries: D&C IUD . D&C . WHO 400 Sublingual . Sublingual Sublingual .C. :

Dysmenorrhea: PGE 2 PGE 2 alpha NSAIDs .

D. :

Male Reproductive System: ( / Intracovernous) 0.2-140 microgram .

E. :

Cardiovascular System: . Ductus Arteriosus .

F. :

Respiratory System:

.

:

Side effects of Misoprostol Usage: : . 600 28% 5.7% . C 40 (800) Sublingual . . : 35% . . . Sublingual . : (Cramp) ( 10 ) . NSAID . . : 25 20 12%- 4%. . : Mobius . 6 7 - club foot 12 11 9 8 5 3 .

: HCG .: - . . :

Contraindications:

1. .

2. - .

3. (Anticoagulants).

4. (PG) .5. .....

References:1. WHO. WHO Recommendations for the Prevention of Postpartum Hemorrhage. 2. WHO. WHO Model List of Essential Medicines, 16th edn. WHO: Geneva, 2009.

3. WHO. Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors.

Mobius Syndrome