Indications: Misoprostol, a synthetic prostaglandin analogue has antisecretory and protective properties, promoting healing of gastric and duodenal ulcers. It can prevent NSAID-associated ulcers, its use being most appropriate for the frail or very elderly from whom NSAIDs cannot be withdrawn. Misoprostol to induce medical abortion or labour.

Cautions: conditions where hypotension might precipitate severe complications (e.g. cerebrovascular disease, cardiovascular disease).

Contra-indications: pregnancy or planning to be pregnant, important: women of childbearing age, and breast-feeding. Manufacturer advises that misoprostol should not be used in women of childbearing age unless the patient requires non-steroidal anti-inflammatory (NSAID) therapy and is at high risk of complications from NSAID-induced ulceration. In such patients, it is advised that misoprostol should only be used if the patient takes effective contraceptive measures and has been advised of the risks of taking misoprostol if pregnant.

Side Effects: diarrhoea, dyspepsia, abdominal pain, flatulence, nausea and vomiting, abnormal vaginal bleeding, rashes, dizziness.

Dose: Benign gastric and duodenal ulceration and NSAID- associated ulceration, 800 mcg daily (in 2–4 divided doses) with breakfast (or main meals) and at bedtime; treatment should be continued for at least 4 weeks and may be continued for up to 8 weeks if required Prophylaxis of NSAID-induced gastric and duodenal ulcer, 200 mcg 2–4 times daily taken with the NSAID child not recommended.

Breast feeding: Avoid as no information available as advised by manufacturer.