MISOPROSTOL

MISOPROSTOL
(my-so-prost'ole)
Cytotec
Classifications: prostaglandin;
Therapeutic:prostaglandin

Pregnancy Category: X

Availability

100 mcg, 200 mcg tablets

Action

Synthetic prostaglandin E1 analog, with both antisecretory (inhibiting gastric acid secretion) and mucosal protective properties. Increases bicarbonate and mucosal protective properties. Inhibits basal and nocturnal gastric acid secretion and acid secretion in response to a variety of stimuli, including meals, histamine, pentagastrin, and coffee. Produces uterine contractions that may endanger pregnancy and cause a miscarriage.

Therapeutic Effect

Inhibits basal and nocturanal gastric acid secretion.

Uses

Prevention of NSAID (including aspirin-induced) gastric ulcers in patients at high risk of complications from a gastric ulcer (e.g., the older adult and patients with a concomitant debilitating disease or a history of ulcers). Drug is taken for the duration of NSAID therapy and does not interfere with the efficacy of the NSAID.

Unlabeled Uses

Short-term treatment of duodenal ulcers; cervical ripening and induction of labor.

Contraindications

History of allergies to prostaglandins; Topical Use: abnormal fetal position, caesarean section, ectopic pregnancy; fetal disease, incomplete abortion multiparity, placenta previa, vaginal bleeding; pregnancy (category X), lactation.

Cautious Use

Renal impairment; inflammatory bowel disease. Safety in children <18 y is not established.

Route & Dosage

Prevention of NSAID-Induced Ulcers
Adult: PO 100–200 mcg q.i.d. p.c. and h.s. or 200 mcg b.i.d. or t.i.d.

Administration

Oral
  • Give with food to minimize GI adverse effects (manufacturer recommendation).
  • Store away from heat, light, and moisture.

Adverse Effects (≥1%)

CNS: Headache. GI: Diarrhea, abdominal pain, nausea, flatulence, dyspepsia, vomiting, constipation. Urogenital: Spotting, cramps, dysmenorrhea, uterine contractions.

Interactions

Drug: magnesium-containing antacids may increase diarrhea.

Pharmacokinetics

Absorption: Readily from GI tract; extensive first pass metabolism. Onset: 30 min. Peak: 60–90 min. Duration: At least 3 h. Metabolism: In liver. Elimination: Primarily in urine; small amount in feces. Half-Life: 20–40 min.

Nursing Implications

Assessment & Drug Effects

  • Monitor for diarrhea; may be minimized by giving drug after meals and at bedtime. Diarrhea is a common adverse effect that is dose related and usually self-limiting (often resolving in 8 d).

Patient & Family Education

  • Avoid using concurrent magnesium-containing antacids because of increased incidence of diarrhea.
  • Report postmenopausal bleeding to physician; it may be drug related.
  • Avoid pregnancy during misoprostol therapy; use an effective contraception method while taking drug.
  • Drug has abortifacient property. Contact physician and immediately discontinue drug if you become pregnant.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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