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The success rate of misoprostol alone for terminating pregnancy (93%) is nearly the same as the mifepristone-misoprostol combination (96%). However, 15% of the women using misoprostol alone required a surgical follow-up procedure, which is significantly more than the mifepristone-misoprostol combination. [38]
Misoprostol may be used to complete a miscarriage or missed abortion when the body does not expel the embryo or fetus on its own. Compared to no medication or placebo, it could decrease the time to complete expulsion. [44] Use of a single dose of misoprostol vaginally or buccally is preferred, with additional doses as needed.
The American College of Rheumatology and a Canadian consensus report both recommend GI-protective agents such as misoprostol be combined with long term NSAID therapy and a review concluded that diclofenac/misoprostol is a cost effective treatment in patients requiring long term NSAID therapy who are at increased risk of developing gastropathy. [4]
Mifepristone combined with misoprostol is the preferred medication regimen for management of early pregnancy loss. While misoprostol alone can be used, the addition of a dose of mifepristone twenty-four hours before misoprostol administration improves treatment efficacy. [30]
Vaginally administered misoprostol had improved outcomes of inducing labor within twenty four hours compared to oxytocin, but was associated with uterine hyperstimulation. [15] Misoprostol is an agonist of EP1 and EP3 receptors, and can cause a greater stimulation at lower concentrations.
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Prostaglandin analogues such as misoprostol are used in treatment of duodenal and gastric ulcers. [2] Misoprostol and other prostaglandin analogues protect the lining of the gastrointestinal tract from harmful stomach acid and are especially indicated for the elderly on continuous doses of NSAIDs.
Rank Brand Name(s) Generic Name Sales Q1 2014 Sales ($000) Change from Q4 2013 Company(ies) Disease/Medical Use First Approval Date Patent Expiration Date [6] [7]; 1: Abilify
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