Formulary
Misoprostol: Indications, Dosing, Side Effects and Interactions
Misoprostol is a synthetic prostaglandin analogue that has antisecretory and protective properties, promoting healing of gastric and duodenal ulcers.
MedNext Academy | 3 min read
Misoprostol: Indications, Dosing, Side Effects and Interactions
Misoprostol is a synthetic prostaglandin analogue that has antisecretory and protective properties, promoting healing of gastric and duodenal ulcers.
Drug action
Misoprostol is a synthetic prostaglandin analogue that has antisecretory and protective properties, promoting healing of gastric and duodenal ulcers. It also acts as a potent uterine stimulant.
Indications and dose
**Termination of pregnancy following mifepristone (gestation up to 49 days)**
- **Adult** (By Mouth): 400 micrograms for 1 dose, dose to be given 24-48 hours after mifepristone.
**Induction of labour (specialist supervision in hospital)**
- **Adult** (By Mouth): 25 micrograms every 2 hours, alternatively 50 micrograms every 4 hours, to be given in accordance with local protocols; maximum 200 micrograms per day.
**Benign gastric ulcer,Benign duodenal ulcer,NSAID-induced peptic ulcer**
- **Adult** (By Mouth): 400 micrograms twice daily, alternatively 200 micrograms 4 times a day continued for at least 4 weeks or may be continued for up to 8 weeks if required, dose to be taken with breakfast (or main meals) and at bedtime.
**Prophylaxis of NSAID-induced peptic ulcer**
- **Adult** (By Mouth): 200 micrograms 2-4 times a day.
Cautions
When used for Termination of pregnancy Established cardiovascular disease; risk factors for cardiovascular disease (e.g. over 35 years of age with chronic smoking, hyperlipidaemia, or diabetes) Cautions For Angusta Before 37 weeks' gestation (limited information available); chorioamnionitis; modified Bishop score greater than 6 (limited information available) Cautions For Cytotec Conditions where hypotension might precipitate severe complications (e.g. cerebrovascular disease, cardiovascular disease); conditions which predispose to diarrhoea (e.g. inflammatory bowel disease)
Contraindications
For Angusta Active labour; fetal malpresentation; placenta praevia; suspicion or evidence of fetal compromise; unexplained vaginal bleeding after 24 weeks gestation; uterine abnormality; uterine scar
Side effects
Common or very common Chills; constipation; diarrhoea; dizziness; fever; flatulence; gastrointestinal discomfort; haemorrhage; headache; muscle cramps; nausea; post abortion infection; skin reactions; uterine cramps; vomiting Uncommon Menstrual cycle irregularities; postmenopausal haemorrhage Rare or very rare Angioedema; erythema nodosum; malaise; toxic epidermal necrolysis; uterine rupture Frequency not known Back pain; cardiac arrest; cardiovascular event; coronary vasospasm; hypotension; myocardial infarction Side-effects, further information With oral use Diarrhoea may occasionally be severe and require withdrawal, reduced by giving single doses not exceeding 200 micrograms and by avoiding magnesium-containing antacids.
Interactions
**Other interactions (1):**
- Antacids containing magnesium may worsen misoprostol induced diarrhoea.
Pregnancy
Termination of pregnancy following mifepristone (gestation up to 49 days) for misoprostol By mouth Adult 400 micrograms for 1 dose, dose to be given 24-48 hours after mifepristone.
Breast feeding
Manufacturer advises avoid-present in milk, and may cause diarrhoea in nursing infants. Tertiary sources state present in milk but amount probably too small to be harmful; to further reduce risk following termination of pregnancy, consider interrupting breastfeeding for 5 hours after a dose. D Breast feeding For Angusta Avoid for 4 hours after administration of the last dose. M
Hepatic impairment
For Angusta Caution in impairment-risk of increased exposure. M Dose adjustments Consider dose reduction and/or prolonged dosing interval in impairment. M
Renal impairment
For Angusta Caution in impairment-risk of increased exposure; avoid if eGFR less than 15 ml/min/1.73 m 2 . M See Prescribing in renal impairment . Dose adjustments Consider dose reduction and/or prolonged dosing interval in impairment. M
Medicinal forms
Tablet,Tablet
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Misoprostol in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary

