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Misoprostol: A Quarter Century of Use, Abuse, and Creative Misuse

Chong, Yap-Seng MMed (O&G), MRACOG*; Su, Lin-Lin MMed (O&G), MRCOG; Arulkumaran, Sabaratnam FRCOG, PhD

Obstetrical & Gynecological Survey: February 2004 - Volume 59 - Issue 2 - p 128-140
doi: 10.1097/01.OGX.0000109168.83489.66
CME PROGRAM: CATEGORY 1 CME REVIEW ARTICLES 3, 4, 5, AND 6: CME REVIEW ARTICLE
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Misoprostol is a prostaglandin E1 analog originally intended for use to prevent NSAID-induced gastric ulcers. However, because of its cervical ripening and uterotonic property, misoprostol has become one of the most useful drugs in obstetrics and gynecology. Misoprostol has proven to be a very convenient and flexible drug because of its formulation as a tablet that is stable and that can be administered orally, rectally, vaginally and by the sublingual route. Beginning with its abuse for illegal abortion in the late 1980s, misoprostol has quickly become established as one of the most effective drugs for terminating pregnancies in the first and second trimesters, as well as for inducing labor in the third trimester. Its use for routine prevention of postpartum hemorrhage has not been so successful, partly as the high doses required for this indication often result in troublesome side effects. Despite the large body of medical evidence about its efficacy and relative safety, the use of misoprostol in pregnant women remained off-label until the spring of 2002.

Target Audience Obstetricians & Gynecologists, Family Physicians

Learning Objectives After completion of this article, the reader should be able to outline the pharmacologic properties of the misoprostol, to list the adverse effects of misoprostol, and to summarize the off-label uses of misoprostol.

*Assistant Professor, †Senior Resident, Department of Obstetrics & Gynaecology, National University of Singapore, Singapore; and the ‡Professor and Head, Department of Obstetrics & Gynaecology, St. George’s Hospital Medical School, London, United Kingdom

CHIEF EDITOR’S NOTE: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credit hours can be earned in 2004. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

Reprint requests to: Sabaratnam Arulkumaran, FRCOG, PhD, Department of Obstetrics & Gynaecology, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, U.K. E-mail: sarulkum@sghms.ac.uk

The authors have disclosed no significant financial or other relationship with any commercial entity.

© 2004 Lippincott Williams & Wilkins, Inc.