Saturday, June 09, 2007

Vaginal vs. Oral Misoprostol

Interesting report on misoprostol regimens. I don't have access to the study on the computer I'm on, but according to the article:

In this study, Dr. Helena von Hertzen, of the Department of Reproductive Health and Research at the World Health Organization, and her colleagues studied 2,046 women who were divided into four groups that received misoprostol either vaginally at three- and 12-hour intervals, or under the tongue at three or 12-hour intervals.

Among women who took misoprostol at 12-hour intervals, pregnancy continued in 9 percent of those who took the drug orally and in 4 percent of those who took it vaginally. Among those who took the drug at three-hour intervals, pregnancy continued in 6 percent of those who took it orally and in 4 percent of those who took it vaginally.

Side effects such as nausea and vomiting were more common among women who took misoprostol under the tongue and vaginally at three-hour intervals than among those who took the drug at 12-hour intervals. Side effects such as pain, diarrhea, chills and shivering were slightly higher among women who took the drug orally.

"Administration interval can be chosen between three hours and 12 hours when misoprostol is given vaginally. If administration is [oral], the intervals between misoprostol doses need to be short, but side effects are then increased. With 12-hour intervals, vaginal route should be used, whereas with three-hour intervals either route could be chosen," the study authors concluded.


A couple of points.

1. You could use misoprostol (Cytotec) alone, but you shouldn't (for now, anyway. Once abortion is outlawed, we'll revisit the recommendation.). Adding mifepristone (RU-486, Mifeprex) to the regimen improves efficacy and reduces side effects.

Note: I'll have more on the misoprostol/mifepristone (RU-486) drug regimen in Part II of my post exposing Senator Jim DeMint (R-SC) lies in support of his amendment to regulate mifepristone (RU-486). [Part I, here.]

In the interim, and without looking it up, try to answer this question: Why do the two drugs work better together? What's more likely: A) the drugs have different actions, or B) the drugs have similar actions, and one potentiates the other?

2. Vaginal misoprostol is not part of the FDA-approved regimen. FDA approved 600 mg mifepristone (RU-486) and 400 mcg misoprostol, both administered orally.

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11 Comments:

At 8:02 PM, Anonymous Anonymous said...

As another of-label use, I recently heard that Cytotec is often used to jump-start labor, in the way that Pitocin is usually prescribed. Seems ill guided to me... any thoughts, or verification of whether this is true?

 
At 2:14 AM, Blogger ema said...

Both PGE2 (Prepidil and Cervidil) and PGE1 (Cytotec) are used to induce cervical ripening/labor:

Two forms of PGE2 (dinoprostone) are available commercially. In randomized trials, the 2 forms are equivalent in efficacy. The first is Prepidil, which is formulated as a gel and is placed inside the cervix, but not above the internal os. The application (3 g gel/0.5 mg dinoprostone) can be repeated in 6 hours, not to exceed 3 doses in 24 hours. The second is Cervidil, which contains 10 mg of dinoprostone embedded in a mesh and is placed in the posterior fornix of the vagina. This allows for controlled release of dinoprostone over 12 hours, after which it is removed.

Prostaglandin E1 analog (misoprostol) use was described recently in a series of articles. This is a synthetic prostaglandin, which is marketed as an antiulcer agent under the trade name Cytotec. One quarter of a tablet (25 mcg), which can be crushed and placed on the cervix, has been shown in several studies to be quite effective in inducing cervical ripening and labor. The application of the medication can be repeated every 4 hours.

Misoprostol has also been administered orally (100 mcg, which can be repeated every 4 h), but vaginal administration seems to be more efficacious. Vaginally administered misoprostol has been used for cervical ripening and labor induction in pregnancies complicated by oligohydramnios. In these patients, the risk for adverse perinatal outcomes was not increased compared with patients with normal amniotic fluid volumes. Note that the US Food and Drug Administration classifies Cytotec as a pregnancy category X drug. The manufacturer has been ambivalent about this off-label use of the medication, and the Food and Drug Administration only acknowledges that misoprostol is being used in pregnancy.

 
At 8:38 AM, Anonymous Anonymous said...

i have a question rather than a comment.. by vaginally do you mean that the tablet is placed deep within the vaginal cavity or is it placed in the endocervical region?

 
At 4:38 PM, Anonymous Anonymous said...

Anonymous, usually, taken vaginally, means to place it at the opening of the cervix, as to dissolve on the cervix, to "ripen", therefore dilate the cervix, for induction of labor. Hope this helps.

 
At 3:34 PM, Anonymous Anonymous said...

I'd wanna ask hw many milligram is 2 b placed in d cervix?

 
At 4:41 PM, Anonymous Anonymous said...

Pls hw many miligrams is to b inserted in d cervix

 
At 2:37 AM, Anonymous Anonymous said...

To induce abortion or soften the cervix prior to a procedure? 400mcg (more than once) for abortion, and 400mcg once to soften prior to a procedure when inserted vaginally in tablet form.

 
At 12:04 PM, Anonymous Anonymous said...

i missed my period for 5 days now.
how many and how to use it?need help pls.

 
At 12:09 PM, Anonymous Anonymous said...

pls i need an answer.
help.

 
At 1:18 PM, Anonymous Anonymous said...

I missed mine by a month. Im going to insert 2 vaginally. 2 100 mg tablets

 
At 12:23 PM, Anonymous Anonymous said...

Will there be a delay in my periods if i take Misoprostol–Mifepristone (mtp Kit) ? & my periods will not be regular like before?

 

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