Misoprostol

Examples

Generic Name
misoprostol

How It Works

Misoprostol:

• Softens and opens (dilates) the cervix.
• Causes uterine contractions.
• Starts (induces) labour.

Note: Many doctors are only giving misoprostol by mouth for medical abortion. This is because of recent reports of a very rare, fatal infection that affected a few women after they used vaginal misoprostol.¹

Why It Is Used

Misoprostol is a prostaglandin medicine used to terminate a pregnancy by starting labour. It is more effective when used in combination with methotrexate than when used alone. This is an unlabelled use of misoprostol.

Misoprostol is also used to prevent stomach ulcers (labelled use) and for induction of labour for childbirth (unlabelled use).

How Well It Works

Misoprostol used alone may terminate a pregnancy but is much more effective when used with other medicines, such as methotrexate, in first-trimester abortions.²

• Misoprostol alone, moistened and used vaginally, is over 90% effective in terminating first-trimester pregnancies of less than 8 weeks.³
• Misoprostol alone, dry and used vaginally, is only 50% to 67% effective in terminating first-trimester pregnancies of less than 8 weeks.³

Misoprostol may also be used to:

• Complete a spontaneous missed abortion (incomplete miscarriage).
• Start labour in second-trimester abortions. Misoprostol is over 70% effective in terminating a pregnancy within 48 hours when used for second-trimester labour induction.
• Start labour in third-trimester abortions. Misoprostol is more effective than oxytocin and other prostaglandins for inducing labour within 24 hours.² Third-trimester abortions are not done unless the fetus has died or has severe medical problems and will not survive.
• Dilate the cervix 3 to 4 hours before a surgical abortion procedure.
• Soften the cervix for induction of labour.
• Soften the cervix for special gynecologic tests.

Side Effects

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.

• Nausea.
• Vomiting.
• Diarrhea.
• Headache.
• Dizziness.
• Chills or hot flushes (sweating and feeling overly hot).
• Shivering.
• Fatigue.

Signs of complications

Less than 1% of all women who have an abortion have serious problems afterward.⁴

Call your health professional immediately if you have any of these symptoms after an abortion:

• Severe bleeding. Both medical and surgical abortions usually cause bleeding that is different from a normal menstrual period. Severe bleeding can mean:
  • Passing clots that are bigger than a golf ball, lasting 2 or more hours.
  • Soaking more than 2 large sanitary pads in an hour, for 2 hours in a row.
  • Bleeding heavily for 12 hours in a row.
• Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
• Severe pain in the abdomen that is not relieved by pain medicine, rest, or heat
• Hot flushes or a fever of 38°C (100.5°F) or higher that lasts longer than 4 hours
• Vomiting lasting more than 4 to 6 hours
• Sudden abdominal swelling or rapid heart rate
• Vaginal discharge that has increased in amount or smells bad
• Pain, swelling, or redness in the genital area

Call your health professional for an appointment if you have had any of these symptoms after a recent abortion:

• Bleeding (not spotting) for longer than 2 weeks
• New, unexplained symptoms that may be caused by medicines used in your treatment
• No menstrual period within 6 weeks after the procedure
• Signs and symptoms of depression. Hormonal changes after a pregnancy can cause postpartum depression that requires treatment.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Many studies have shown that misoprostol is a safe and effective medicine in abortions.² Misoprostol has been shown to be more effective when the tablets are used vaginally than when taken by mouth. But many doctors are only giving misoprostol by mouth. This is because of recent reports of a very rare, fatal infection after using vaginal misoprostol.

Choosing a medical or surgical procedure for an abortion will depend on your medical history, how many weeks pregnant you are, what options are available where you live, and your personal preferences.

Misoprostol is not used in women with any of the following conditions:

• Glaucoma
• Sickle cell anemia
• Mitral valve narrowing (stenosis)
• Uncontrolled seizure disorder
• Allergy to misoprostol or other prostaglandins

Misoprostol can cause fetal abnormalities, so a follow-up surgical abortion will be done to prevent a fetus from developing abnormally.

Use of misoprostol for medical abortion is an unlabelled use. Misoprostol is approved (labelled) for preventing and treating stomach ulcers in people taking non-steroidal 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 bronchospasm.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Author:	Healthwise Medical Writer	Last Updated: March 5, 2008
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Lori A. Boardman, MD, ScM - Obstetrics and Gynecology Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
© 1995-2008 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.