Download - Misoprostol
MisoprostolTheory & Practice
In Obstetrics
Objectives Be familiar with the nature and
pharmacokinetics of misoprostol.
Establish the difference between different routes of drug adminstration.
Strengthen the self-confidence with erasing the internal worries about the use of misoprostol.
Subjects
Nature & pharmacokinetics of misoprostol.
Adverse reactions. Uses of misoprostol.
Nature
Synthetic PGE1 analog Why?
Pharmacokinetics
Routes of adminstration & absorption:•Oral…..affected by food & antacids•Sublingual•Vaginal•Rectal•Parentral……NO
ORAL VAGINAL
ORALRECTAL
Mainly in the liver……So take care in hepatic patient not renal one.No accumulation.
Metabolism
oDiarrheaoAbdominal painoHeadacheoNausea
oVomitingoFlatulenceoChillsoShiveringofeveroLess common adverse reactionsoDose-dependent
Adverse reactions
2200 g (11 tablets) No serious side effects
Toxicity
Serious side effects:I. HyperthermiaII. RhabdomyolysisIII.HypoxemiaIV.Acid-base balance
disorder
6000 g (30 tablets)
Teratogenicity:
Mobius syndromeCategory “X”
Uses of misoprostol Obstetric uses: Termination of pregnancy 1st trimester 2nd trimester 3rd trimester Postpartum hemorrhage Prevention Treatment Gynecological uses Pre-hysteroscopy Intauterine Insemination (IUI) Cervical pregnancy GIT Prevention & treatment of peptic ulcer induced by NSAIDs
Misoprostol in 1st trimester
mifepristone
misoprostol
methotrexate
misoprostol
misoprostol
3 different regimens
success
91-97% 88-100% 47% ????
Gestational age not more than 49 days (completed 7 weeks)
6 hr 36-48hr 5-7 days
Gestational age more than 56 days (completed 9 weeks)
Misoprostol as cervical –priming agent before vaccum-aspiration of the products of conception
400 g vaginal 3 hours before procedure
Misoprostol PGE2
Misoprostol in 2nd trimester
Misoprostol 400 g vaginal every 3 hours
Misoprostol = PGE2 = extraamniotic PGs
Misoprostol in 3rd trimester
Induction of labor
Living fetus at term Dead fetus at term
Misoprostol 25 g every 6 hours
Misoprostol 50 g every 12 hours
why?
Concerns about misoprostol in induction of labor !!!!!
Uterine tachysystoleUterine hyperstimulationUterine rupture
Misoprostol in postpartum hemorrhage (PPH)
Prevention of PPH Treatment of PPH Insufficient evidence to support its routine use
when oxytocin or methyl-ergometrine
is available
Rectal misoprostol 800 g
Useful 1st line drug for ttt PPH
Why ?
WHO misoprostol multicenter Trial concluded that oral tablets of 600 g was associated with
a higher risk of:
Severe postpartum hemorrhageNeed for additional uterotonicsShivering Pyrexia
This is in comparison to intramuscular or intravenous oxytocin
But Why misoprostol is still evaluated as uterotonic
agent despite its side-effects
1)Ease of use2)Stability in field conditions3)Longer shelf-life4)Less expense
Thank you for your attention!
Any Questions?
