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misoprostol (mi soh PROH stohl)
What is misoprostol?
Prostaglandins are chemicals in the body that have many beneficial functions, one of which is to protect the lining of the stomach. Misoprostol is a synthetic prostaglandin which enhances the ability of the stomach lining to resist the harmful effects of certain types of arthritis and pain medications called NSAIDs (non-steroidal anti-inflammatory drugs). NSAIDs include ibuprofen, Advil, Motrin, Naprosyn and many others.
What is it used for?
Misoprostol is used to prevent the development of stomach ulcers which can occur from the use of any of the NSAID drugs (see above for definition). This drug does not prevent duodenal (intestinal) ulcers or other harmful effects of NSAIDs that may occur in the GI tract.
How do I take it?
Follow your physician’s instructions carefully. Take with food or milk. This drug is usually taken three or four times a day with meals and at bedtime with food. Tablets may be crushed. Keep all medications away from children. Never share your medications with anyone else.
What do I do for a missed dose?
If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and return to your regular schedule. Do not double up on this medicine.
Are there interactions with food or beverages?
There are no interactions with misoprostol and food or alcohol. However, alcohol and tobacco should be avoided or limited because they can aggravate stomach ulcers and reduce this drug’s effectiveness.
Are there interactions with other drugs?
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction. Interactions with misoprostol may occur with antacids containing magnesium. Some arthritis medications (ibuprofen, Motrin, Naprosyn) drug dosages may need to be adjusted.
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease. If you have a disorder such as irritable bowel syndrome or inflammatory bowel disease which causes significant diarrhea, misoprostol likely will make the diarrhea worse. As outlined elsewhere, a woman of childbearing age should use this drug only when effective contraception is practiced. THIS DRUG CAN CAUSE A SPONTANEOUS ABORTION.
What about allergies?
People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient’s allergy history. Signs of an allergic reaction are skin rash or hives. Of course, a person should not take misoprostol if there has been a previous reaction to this or a similar drug.
What if I’m pregnant, considering pregnancy or breast-feeding?
Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Misoprostol is ranked X. THIS DRUG CAN CAUSE ABORTION AND SHOULD NOT BE TAKEN IF YOU ARE PREGNANT OR IF YOU ARE TRYING TO BECOME PREGNANT. START TAKING THIS DRUG ONLY ON THE SECOND OR THIRD DAY OF A NORMAL MENSTRUAL PERIOD AND INITIATE EFFECTIVE CONTRACEPTIVE MEASURES AT THIS TIME. IF PREGNANCY SHOULD OCCUR WHILE ON THIS DRUG, DISCONTINUE IT IMMEDIATELY AND CONTACT YOUR PHYSICIAN.
What are the effects on sexual function?
This drug can cause uterine contractions that produces uterine bleeding. It has no known adverse effect on sexual function.
Are there other precautions?
Misoprostol may cause dizziness so use caution when driving or operating hazardous equipment until the effect of this drug has been determined.
How long is it safe to take misoprostol?
The primary purpose of misoprostol is to prevent stomach ulcers. Therefore, continual use is recommended for the entire period of arthritis drug (NSAID) use. Of course, long-term use requires medical supervision and periodic reevaluation. If a stomach ulcer has occurred, it is almost always necessary to stop the arthritis drug. If necessary, there are other highly effective drugs available to heal ulcers. The physician can decide the best method of healing ulcers.
How about side effects?
Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately. Diarrhea is by far the most common side effect of misoprostol. Increasing the dose gradually may prevent diarrhea. This means taking one tablet once a day for several days, then one tablet twice a day and so forth. Also, a total reduced dosage such as 100 mcg rather than 200 mcg, four times a day, may prevent diarrhea.
For misoprostol, the following are the observed side effects:
- ringing in the ears
- abdominal discomfort
- vaginal bleeding
- uterine cramps
- menstrual irregularity
- blood in urine
A physician’s comment…
The NSAIDs are arthritis drugs which can cause horrendous, even fatal, stomach ulcers and bleeding problems. These drugs, even over-the-counter ibuprofen, should not be used for prolonged periods of time. People most at risk are the elderly, those with a history of ulcers or other serious illness and those taking steroids (prednisone, cortisone) or blood thinners (Coumadin). Misoprostol can prevent stomach ulcers in most people taking NSAIDs, but they should be taken only with careful follow-up by your physician. There is a new class of NSAID drugs called COX 2 which appear to provide arthritis relief without serious intestinal disorders. This would be a very welcomed development in the treatment of arthritis.