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misoprostol

misoprostol

see also:

introduction

  • synthetic analogue of prostaglandin E1
  • induces contractions of the smooth muscle fibers in the myometrium and relaxation of the uterine cervix.
  • the uterotonic properties of misoprostol should facilitate cervical opening and evacuation of intrauterine debris and is commonly used in Australia “off-label” to assist in the medical Mx of miscarriage
  • it is also used with mifepristone / RU486 in early termination of pregnancy when it is given 36 to 48 hours after the oral intake of mifepristone

dose for Mx of miscarriage

  • insert intravaginally as either 400ug or 800ug dose
  • repeat in 24 hours if POC not passed
  • advise adequate analgesia such as paracetamol, codeine, and non-steroidal anti-inflammatory drugs (NSAIDs)
  • can avoid surgical Mx of missed miscarriage under 13wks gestation in ~80% of cases but has a 10-20% failure rate

C/I

  • HS to misoprostol
  • gestation > 13wks
    • uterine hyperstimulation and rupture have been reported beyond the first trimester when much lower dosage of misoprosotol may be required
  • suspected coagulopathy
  • IUCD in situ (remove it 1st)
  • viable pregnancies unless termination is being undertaken
    • use has been associated with birth defects
  • lactation
    • may cause diarrhoea in infants

precautions

  • patients with cardiovascular disease as potential rare serious cardiovascular accidents
  • epilepsy - seizures may occur
  • asthma - bronchospasm may occur in susceptible patients
  • avoid subsequent conception until the next normal menses

adverse effects

  • nausea, vomiting, diarrhoea, abdominal pain
  • frequent uterine contractions which may be painful
  • vaginal bleeding
  • headache, dizziness, fever
  • breast tenderness
  • neurogenic tinnitus
  • other very uncommon effects
misoprostol.txt · Last modified: 2013/09/11 17:16 (external edit)