Misoprostol , sold under the trademark of Cytotec among others, is a drug used to initiate labor, cause abortion, prevent and treat heartburn, and treat postpartum hemorrhage due to poor contractions of uterus. For abortion it is often used with mifepristone or methotrexate. By itself the effectiveness for this purpose is between 66% and 90%. It is taken either on the cheek, under the tongue, or placed in the vagina.
Common side effects include diarrhea and abdominal pain. This is the category of pregnancy X which means known to produce negative results for infants if taken during pregnancy. In rare cases, uterine rupture may occur. This is a prostaglandin-specific analog, synthetic prostaglandin E 1 (PGE 1 ).
Misoprostol was developed in 1973. It is a List of Essential Medicines of the World Health Organization, the most effective and safe medicines needed in the health system. It is available as a generic drug. Wholesale costs in developing countries are around.36 to 2.00 USD per dose. The one month supply for treating ulcer pain in the United States is between 100 and 200 USD. The cost is the same between 30 and 55 EUR in Europe.
Video Misoprostol
Medical use
Ulcer prevention
Misoprostol is used for prevention of gastric ulcers caused by NSAIDs. It acts on gastric parietal cells, inhibiting gastric acid secretion by a paired G-protein paired adenilate-cyclase inhibitor, which causes decreased intracellular cyclic AMP levels and decreased proton pump activity on the apical surfaces of parietal cells. Because other classes of drugs, especially H-receptor antagonists and proton pump inhibitors, are more effective for the treatment of acute peptic ulcers, misoprostol is only indicated for use by people taking NSAIDs and is at high risk for NSAID-induced ulcers. , including the elderly and people with ulcer complications. Misoprostol is sometimes coupled with NSAIDs to prevent common adverse effects of gastric ulceration (eg by diclofenac in Arthrotec ).
However, even in the treatment of NSAID-induced ulcers, omeprazole is shown to be at least as effective as misoprostol, but significantly better tolerated, so misoprostol should not be considered first-line treatment. Misoprostol-induced diarrhea and the need for multiple daily doses (usually four) are major problems that interfere with treatment adherence.
Induction of labor
Misoprostol is commonly used for labor induction. This causes uterine contractions and maturation (thinning or thinning) of the cervix. This can be cheaper than the other commonly used maturation, dinoprostone.
Oxytocin has long been used as a standard agent for labor induction, but it does not work well when the cervix is ​​immature. Misoprostol can also be used in conjunction with oxytocin.
Between 2002 and 2012, vaginal misoprostol inserts were studied, and approved in the European Union. It is not approved for use in the United States, and the US FDA still considers cervical ripening and labor induction beyond the approved use for misoprostol.
Abortion
Misoprostol is used either alone or in conjunction with other drugs (mifepristone or methotrexate) for medical abortion as an alternative to surgical abortion. Medical abortion has the advantage of being less invasive, and more autonomous, independent, and wise. This is better for some users because it feels more "natural", because drugs trigger a miscarriage. It is also more accessible in places where abortion is illegal. The World Health Organization provides clear guidelines on the use, benefits and risks of misoprostol for abortion.
Misoprostol is most effective when used with methotrexate or mifepristone (RU-486). Misoprostol alone is less effective (usually 88% to eight weeks' gestation). It is not inherently unsafe if it is medically supervised, but 1% of women will experience severe bleeding requiring medical attention, some women may have ectopic pregnancy, and 12% of pregnancies that continue after misoprostol failure are more likely to have birth defects and are usually followed- more effective abortion methods.
Most major studies recommend protocols for the use of misoprostol in combination with mifepristone. Together they are effective at around 95% for early pregnancy. Misoprostol alone may be more effective in previous pregnancies. WHO guidelines recommend for pregnancy up to 12 weeks to use 12 tablets 200 mcg (microgram). Women should place 4 tablets of misoprostol under the tongue or deep into the vagina and allow them to dissolve for 30 minutes. He should wait 3 hours and repeat with 4 pills under his tongue or in his vagina for 30 minutes. He must wait 3 hours and repeat once again. It works in 90% after the first attempt and, in case of failure, attempts can be repeated after at least 3 days.
Misoprostol may also be used to dilate the cervix in preparation for surgical abortion, especially in the second trimester (either alone or in combination with a laminary stent).
Failed failure
Misoprostol can be used to treat the mother in cases of fetal death that do not cause miscarriage. Further research is needed to establish a safe and effective protocol.
Misoprostol is regularly used in some Canadian hospitals for labor induction for fetal death early in pregnancy, and for cessation of pregnancy for fetal anomalies. Low doses are used initially, then duplicated for the remaining dose until delivery. In the case of previous Cyst sections, however, lower doses are used.
Postpartum haemorrhage
Misoprostol is also used to prevent and treat postpartum hemorrhage. Oral misoprostol is slightly less effective than oxytocin. Use of optimal rectal misoprostol in case of bleeding; it was shown to be associated with lower rates of adverse events compared with other routes. Self-administered misoprostol is reported in case reports and randomized controlled trials. However, it is cheap and thermostable (so it does not require cooling like oxytocin), making it a cost-effective and valuable drug for use in developing countries. A randomized controlled trial of misoprostol use found a 38% reduction in maternal mortality due to post-haemorrhage in resource-poor communities. Misoprostol is recommended because of its cost, effectiveness, stability, and low side effects. Oxytocin should also be administered by injection, while misprostol can be administered orally or rectally for this use, making it much more useful in areas where nurses and doctors are less available.
Maps Misoprostol
Adverse effects
The most commonly reported adverse effects of misoprostol use by mouth for the prevention of heartburn are diarrhea. In clinical trials, on average 13% of patients report diarrhea, which is associated with dosage and is usually developed early in therapy (after 13 days) and is usually self-limiting (often lost within 8 days), but occasionally (in 2% of patients) requires termination of misoprostol.
The most frequently reported side effects of taking misoprostol by mouth for the prevention of peptic ulcers are: abdominal pain, nausea, flatulence, headache, dyspepsia, vomiting, and constipation, but no side effects occur more frequently than when taking placebo. In practice, fever is almost universal when multiple doses are administered every 4 to 6 hours.
Misoprostol should not be taken by pregnant women with the desired pregnancy to reduce the risk of gastric ulcers caused by NSAIDs because it increases uterine tone and contractions in pregnancy, which may cause partial or complete abortion, and because its use in pregnancy has been associated with birth defects.
All cervical ripening and induction agents can cause uterine hyperstimulation, which can adversely affect the blood supply to the fetus and increase the risk of complications such as uterine rupture. Concern has been suggested that uterine hyperstimulation that occurs during misoprostol-induced labor is more difficult to treat than hyperstimulation during labor caused by other drugs. Because complications are rare, it is difficult to determine whether misoprostol causes a higher risk than other cervical ripening agents. One estimate is that it would require about 61,000 people enrolled in a randomized controlled trial to detect differences in serious fetal complications and about 155,000 people to detect differences in serious maternal complications.
Pharmacology
Misoprostol, the prostaglandin analogue, binds to myometrial cells to cause a strong myometrial contraction leading to tissue excision. This agent also causes cervical ripening with softening and widening of the cervix. Misoprostol binds and stimulates prostaglandin E1 receptor, prostaglandin EP3 receptor and prostaglandin EP4 receptor but not Prostaglandin EP1 receptor and is therefore expected to have a more limited range of physiological and potentially toxic actions than prostaglandin E2 or other analogs that activate all four prostaglandin receptors.
Society and culture
A letter from Searle produced some controversy over the use of misoprostol in labor induction. The American College of Obstetricians and Gynecologists argues that substantial evidence supports the use of misoprostol for labor induction, a position reaffirmed in 2000 in response to Searle's letter. Misoprostol is also on the list of essential medicines of WHO for labor induction.
The largest medical malpractice award of nearly $ 70 million was given due to the use of misoprostol to induce labor in California hospitals.
The vaginal form of the drug is sold in the European Union under the name Misodel and Mysodelle for use in induction of labor.
Dark market
Misoprostol is used for self-induced abortion in Brazil, where the black market price exceeds US $ 100 per dose. Illegal misoprostol abortions without medical supervision in Brazil are associated with lower rates of complications than other forms of self-administered abortion, but are still associated with higher rates of complications than medical and medical supervised and controlled surgical abortions. Misoprostol abortion failed to be associated with birth defects in some cases. Low-income residents and immigrants in New York City have also been observed to use self-administered misoprostol to induce abortion, since this method is much cheaper than surgical abortion (about $ 2 per dose). This drug is readily available in Mexico. The use of misoprostol also increased in Texas in response to increased regulation of abortion providers.
References
External links
- Misoprostol.org an independent website containing dosage guidelines and suggestions on the use of misoprostol.
- Mechanism of Action and Pharmacology Mifepristone, Misoprostol, and Methotrexate
Source of the article : Wikipedia
0 Comments