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MISTOL Generic Name:                                Misoprostol Therapeutic Category:                 Endocrine-Metabolic Agent Pharmacologic Class:                   Prostaglandin Composition: Each uncoated tablet contains Misoprostol 200 mc Pregnancy Category:             X Presentation:  Available in the pack size as 4 tablets X 1 blister
Description
It is a synthetic analog of natural prostaglandin E1. It produces a dose-related inhibition of gastric acid and pepsin secretion, and enhances mucosal resistance to injury. It is an effective anti-ulcer agent and also has oxytocic properties.
Mechanism of Action
At the end of a pregnancy: There are many receptors and a small dose of misoprostol leads to strong contractions. Special attention is required in women with a live fetus [who may hyperstimulate (uterine)*]. Not for use by women with previous caesarean sections – it may cause a uptured uterus. Uterine ruptures have also been reported occasionally in unscarred uterus. In early pregnancy: There are few receptors and large doses of misoprostol may need to be given repeatedly in order to have an effect. For termination of pregnancy: The sensitivity of the uterus to prostaglandins can be increased by giving the progesterone blocker mifepristone to the women 24-48 hours before treatment with misoprostol. This is especially useful in early pregnancy, although it also works in late pregnancy.
Indications
  • Softens and opens (dilates) the cervix.
  • Causes uterine contraction
  • Starts (induces) labor.
  • To prevent postpartum hemorrhage.
  • In combination with mifepristone it cause abortion
Dosage
Route of administration: Vaginally, orally, sub-lingual 400 μg or 800 μg Smaller dose while given vaginally. Pharmacokinetics Absorption: Rapid absorption Protein binding: Approximately 85% Metabolism: Hepatic Route of elimination: Urine Half-life: 20-40 minutes
Adverse Effects
Most common side effect is Diarrhea followed by abdominal pain, nausea, flatulence, headache, dyspepsia, vomiting, and constipation.
Contraindications
MISTOL is contraindicated in the following populations and situations:
  • Should not be taken by pregnant women for gastric ulcers
  • Women with previous cesarean section
Advantages
  • Less force needed for dilatation,
  • makes the intervention safer and easier
  • shortens the time for the procedure
  • reduces blood loss in the case of a subsequent surgical abortion
    *Terminologies
    Uterine hyperstimulation: This may result in fetal heart rate abnormalities, uterine rupture, or placental abruption.