Misoprostol 💊
💡 Used in PPH prevention when oxytocin is not available. Always exclude a second twin before administration.
- Check BNF or equivalent for UpToDate prescribing advice.
- Misoprostol is a synthetic prostaglandin E1 analogue.
- Clinical uses include peptic ulcer prophylaxis, postpartum haemorrhage (PPH) prevention and treatment, medical TOP (termination of pregnancy), and miscarriage management.
⚙️ Mode of Action
- Stimulates uterine contractions by binding to myometrial prostaglandin receptors.
- Inhibits gastric acid secretion and increases gastric mucosal protection.
📋 Indications & Example Doses (check BNF/local guidance)
- Peptic ulcer prophylaxis/treatment: 800 micrograms PO daily in divided doses.
- PPH prevention: 400–600 micrograms PO (sublingual/oral).
- PPH treatment: 800 micrograms PO (sublingual or rectal) as a single dose.
- Termination of pregnancy (≤49 days gestation): Following mifepristone, 400 micrograms PO as a single dose, 24–48h later.
- Termination of pregnancy (13–24 weeks): Vaginal 800 micrograms initially, then 400 micrograms every 3h (max 4 doses). If abortion not completed, repeat regimen after further mifepristone dose (see specialist guidance).
- Missed miscarriage: 800 micrograms PO/vaginal/sublingual, usually 48h after mifepristone.
- Incomplete miscarriage: 600–800 micrograms PO/vaginal/sublingual single dose.
🔗 Interactions
⚠️ Cautions
- See BNF.
- Monitor closely for uterine hyperstimulation.
🚫 Contraindications
- Exclude presence of a second twin before administration in obstetric use.
- Absolute contraindications listed in BNF (e.g., hypersensitivity).
💥 Side Effects
- Diarrhoea, abdominal pain
- Pyrexia, shivering, fever
- Rarely uterine rupture if excessive dosing or scarred uterus
📖 References
📝 Revisions
- Reviewed for consistency – August 2025
