Misoprostol

Misoprostol is a prostaglandin e1 analogue medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Prevention of gastric ulcers caused by non-steroidal anti-inflammatory drugs (NSAIDs) in patients at high risk, when prescribed.
• Medical termination of intrauterine pregnancy in combination with mifepristone where legally permitted and clinically appropriate.
• Medical management of miscarriage or incomplete abortion under medical supervision.
• Cervical ripening and induction of labour in selected patients under specialist supervision.
• Prevention or treatment of postpartum haemorrhage where appropriate according to clinical protocols.

The dose, route, and timing of Misoprostol vary greatly depending on the reason for use. For stomach-ulcer prevention it is commonly taken by mouth with food and at bedtime as prescribed. For pregnancy-related or labour-related uses, the exact regimen must be decided and supervised by a trained doctor or authorised healthcare professional. Do not use extra doses or repeat treatment unless specifically instructed.

• Common: diarrhoea, abdominal pain or cramps, nausea, vomiting, indigestion, flatulence, headache, chills, shivering, and fever.
• Gynecological effects: uterine cramping, vaginal bleeding, spotting, and menstrual changes.
• Serious: heavy or prolonged bleeding, severe abdominal pain, fainting or dizziness from blood loss, high fever or signs of infection, allergic reaction, uterine hyperstimulation, uterine rupture in susceptible patients, and incomplete abortion or retained tissue.

Use extra caution in people with a history of uterine surgery including caesarean section, suspected ectopic pregnancy, significant anaemia, bleeding disorders, severe cardiovascular disease, dehydration from diarrhoea or vomiting, or when reliable follow-up is not available. Seek urgent care for very heavy bleeding, severe pain, fainting, or fever that persists. Use Misoprostol only under the guidance of a registered doctor or pharmacist.

• Magnesium-containing antacids may worsen misoprostol-related diarrhoea; ask a pharmacist before combining.
• Other prostaglandins or oxytocic medicines such as oxytocin can increase uterine contractions and require close medical supervision.
• NSAIDs are often the reason misoprostol is prescribed for ulcer prevention, but stomach symptoms should still be monitored.
• Food may reduce stomach upset when Misoprostol is used orally for ulcer prevention; follow the prescribed route and instructions for other uses.

• Known allergy to misoprostol, other prostaglandins, or any tablet ingredient.
• Use for gastric-ulcer prevention in a person who is pregnant or may become pregnant, unless pregnancy has been excluded and effective contraception is used.
• Pregnancy-related use without appropriate medical indication, assessment, and supervision.
• Suspected ectopic pregnancy when being considered for medical abortion management.
• Use for labour induction when vaginal delivery is contraindicated, such as certain abnormal fetal positions, placenta previa, or other serious obstetric risks as judged by a doctor.

Misoprostol can cause uterine contractions, bleeding, miscarriage, birth defects if pregnancy continues after exposure, and serious obstetric complications if misused. It should not be used in pregnancy except for a clearly indicated, legally permitted, doctor-supervised obstetric or gynecological purpose. Small amounts may pass into breast milk; breastfeeding guidance should be taken from the treating doctor, especially after pregnancy-related use.

Store tablets in the original blister or container at room temperature, protected from moisture, heat, and direct sunlight. Keep out of reach of children and do not use after the expiry date.