Misoprostol is a
prostaglandin medicine used to terminate a pregnancy
by starting labor. It is more effective when used in combination with
methotrexate or mifepristone than when used alone. This is an
unlabeled use of misoprostol.
is also used to prevent stomach ulcers (labeled use) and for induction of labor
for childbirth (unlabeled use).
Misoprostol may also be used to:
Misoprostol used alone may terminate
a pregnancy. But it is more often used with other medicines, such as
mifepristone or methotrexate, in first-trimester
Misoprostol alone, moistened and used
vaginally, is effective in over 90 out of 100 cases in terminating first-trimester pregnancies of
less than 8 weeks.1
Misoprostol can be given orally, buccally (dissolved between the gums and cheek), or vaginally. Misoprostol
is slightly more effective when taken vaginally than when taken by
mouth.1 But many doctors are only giving misoprostol by mouth because of reports of a rare, fatal infection that affected a few women after using vaginal misoprostol. Some studies have shown that taking misoprostol buccally works as well as when it is given vaginally or orally.2, 3
This method of abortion causes symptoms
similar to a
miscarriage (such as severe cramping and vaginal
bleeding) as tissue and clots pass from the uterus. Symptoms may
The U.S. Food
and Drug Administration (FDA) has reported that a few women have died from a
severe infection (sepsis) after having an abortion using
mifepristone and vaginal misoprostol.4 Signs of serious infection include
weakness, nausea, and diarrhea with or without belly pain. This rare
infection may not cause a fever. Call your doctor or go to the hospital if you
have any of these signs of a serious infection after having a medical
Call your doctor immediately if you have any of these symptoms after an abortion:
Call your doctor for an appointment if you have had any of these symptoms after a recent
See Drug Reference for a full list of side effects.
(Drug Reference is not available in all systems.)
Choosing a medical or surgical
procedure for an abortion will depend on your past health, how many weeks
pregnant you are, what options are available where you live, and your personal
Misoprostol is not used in women who have an allergy
to misoprostol or other prostaglandins.
Misoprostol can cause
fetal abnormalities, so a follow-up surgical abortion will be done if the medical abortion did not work.
The use of misoprostol for medical
abortion is an unlabeled use. Misoprostol is approved (labeled) for preventing
stomach ulcers in people taking nonsteroidal
anti-inflammatory drugs (NSAIDs) on a long-term schedule.
Misoprostol does not have any known drug interactions.
Unlike other prostaglandins, misoprostol does not increase the risk of a
heart attack or
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
CitationsAmerican College of Obstetricians and Gynecologists
(2005, reaffirmed 2009). Medical management of abortion. ACOG Practice Bulletin
No. 67. Obstetrics and Gynecology, 106(4):
871–882.Middleton T, et al. (2005). Randomized trial of
mifepristone and buccal or vaginal misoprostol for abortion through 56 days of
last menstrual period. Contraception, 72(5):
328–332.Winikoff B, et al. (2008). Two distinct oral routes of misoprostol in mifepristone medical abortion: A randomized controlled trial. Obstetrics and Gynecology, 112(6): 1303–1310.U.S. Food and Drug Administration (2006). Public health advisory: Sepsis and medical abortion with mifepristone (Mifeprex). Available online: http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm051298.htm.
August 31, 2012
Sarah Marshall, MD - Family Medicine & Rebecca H. Allen, MD, MPH - Obstetrics and Gynecology & Kirtly Jones, MD - Obstetrics and Gynecology
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