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Misoprostol
💡 Used in PPH prevention when oxytocin is not available. Always exclude a second twin before administration.
About: Always check the BNF link here
- Check BNF or equivalent for UpToDate prescribing advice.
- Misoprostol is a synthetic prostaglandin E1 analogue.
- Clinical uses include peptic ulcer prophylaxis, postpartum haemorrhage (PPH) prevention and treatment, medical TOP (termination of pregnancy), and miscarriage management.
⚙️ Mode of Action
- Stimulates uterine contractions by binding to myometrial prostaglandin receptors.
- Inhibits gastric acid secretion and increases gastric mucosal protection.
📋 Indications & Example Doses (check BNF/local guidance)
- Peptic ulcer prophylaxis/treatment: 800 micrograms PO daily in divided doses.
- PPH prevention: 400–600 micrograms PO (sublingual/oral).
- PPH treatment: 800 micrograms PO (sublingual or rectal) as a single dose.
- Termination of pregnancy (≤49 days gestation): Following mifepristone, 400 micrograms PO as a single dose, 24–48h later.
- Termination of pregnancy (13–24 weeks): Vaginal 800 micrograms initially, then 400 micrograms every 3h (max 4 doses). If abortion not completed, repeat regimen after further mifepristone dose (see specialist guidance).
- Missed miscarriage: 800 micrograms PO/vaginal/sublingual, usually 48h after mifepristone.
- Incomplete miscarriage: 600–800 micrograms PO/vaginal/sublingual single dose.
🔗 Interactions
- See BNF.
⚠️ Cautions
- See BNF.
- Monitor closely for uterine hyperstimulation.
🚫 Contraindications
- Exclude presence of a second twin before administration in obstetric use.
- Absolute contraindications listed in BNF (e.g., hypersensitivity).
💥 Side Effects
- Diarrhoea, abdominal pain
- Pyrexia, shivering, fever
- Rarely uterine rupture if excessive dosing or scarred uterus
📖 References
- BNF – Misoprostol
- NICE guidelines on PPH and medical abortion
📝 Revisions
- Reviewed for consistency – August 2025
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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