Misoprostol (Cytotec)
Cytotec
Synthetic prostaglandin E1 analog (uterotonic + cytoprotective)
Synthetic PGE1 analog. Binds prostaglandin E receptors on uterine smooth muscle → contraction. Also: cytoprotective gastric mucosa (original indication for NSAID-induced ulcers); cervical ripening; GI motility.
Indications
- •Postpartum hemorrhage from uterine atony — used when carboprost contraindicated (asthma)
- •Cervical ripening + labor induction (low-dose 25-50 mcg)
- •Medical abortion (combined with mifepristone)
- •NSAID-induced ulcer prophylaxis (original indication, rarely used now with PPIs)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Postpartum hemorrhage | 800-1000 mcg per rectum (PR) — fast absorption + sustained effect; 600 mcg sublingual is alternative | — |
| Cervical ripening (term) | 25-50 mcg PV q3-6 h; off-label use | — |
| Medical abortion (with mifepristone) | 800 mcg PV at 24-48 h after mifepristone | — |
Pharmacokinetics
Onset PR 10-20 min. Duration ~4 h. Hepatic metabolism + biliary excretion.
Hemodynamic effects
Generally hemodynamically neutral. Less ↑BP than methylergonovine; no bronchospasm like carboprost.
Side effects
- !Diarrhea (most common)
- !Fever + chills
- !Nausea + vomiting
- !Hyperthermia (high dose; can mimic MH temperature rise — context distinguishes)
- !Uterine rupture (rare — high-dose with prior uterine surgery)
Contraindications
- ×Pregnancy (Category X — except for OB indications above)
- ×Hypersensitivity
Clinical pearls
- ★PPH stepwise alternative: when CARBOPROST is contraindicated (ASTHMA), use MISOPROSTOL 800-1000 mcg PR.
- ★PR route preferred for PPH — fastest + most reliable absorption when patient has uterus full of blood (oral absorption variable).
- ★Hyperthermia 38-40°C is COMMON within 30 min of high-dose PR — distinguish from MH (no hypercarbia, no rigidity, normal CK).
- ★CHEAP + WIDELY AVAILABLE globally — backbone of PPH management in resource-limited settings.
- ★Cervical ripening: 25 mcg PV is ENOUGH — higher doses → uterine hyperstimulation + fetal compromise.
Education only — confirm against current package inserts and institutional protocols. Doses assume normal organ function unless otherwise noted.