Misoprostol, a synthetic methyl ester analogue of pro staglandin E1, was approved by the FDA(USA) in December 1988 and has

 gained regulatory approval for more than 50 co untries.

More than 30 million people in the world take NSAID's everyday. Many of them will develop gastric ulcers and related complications. As it differs from classic peptic ulcer disease in many ways, Misoprostol has been the drug-of-choice for preventing NSAID-induced gastropathy in addition to its cytoprotective effects on treatment of peptic ulcer.

Globally, healthcare policy makers and players are realizing trade-offs between the clinical and economical implication of p reventive medical intervention. And, misoprostol can surely meet the challanging requirements, esp ecially as the call intensifies for more efficient al location of the health care resources. There are also positive conclusions regarding cost-effectiveness could be reached in reviews of studies of misoprostol in the prevention of NSAID-induced gastropathy.1, 2, 11

In addition, vaginal administration of misoprostol has been found as a safe and effective alternative for cervical ripening and labor induction. 5-10

Applications

□ Prevention of NSAIDs-induced Ulcers.

□ Healing of Gastric Ulcer and Duodenal Ulcer

□ Conjunction with Diclofenac Sodium for Treatment of Osteoarthritis or Rheumatoid Arthritis (ArthrotecR )3

□ Conjunction with Naproxen for Treatment of Arthritis (CondretecR )

□ Induction of Labor

Pharmacology4

Misoprostol is a gastric antisecretory agent with protective effectiveness on the gastroduodenal mucosa. It inhibits gastric acid secretion and protects the mucosa from the irritant and/or other (e.g. pharmacological) effects of certain drugs, such as NSAIDs, and may have similar antisecretory and muscosal effects in patients with gastric or duodenal ulcer.

 

Because prostaglandins can affect many tissues, other actions of misoprostol have been identified. Misoprostol may increase the frequency of uterine contractions, which is responsible for its abortifacient capability. In addition, misoprostol has been shown to improve renal function in renal transplant patients treated with cyclosporine and prednisone. Misoprostol may offset cyclosporine-induced intrarenal vasoconstriction.

Proprietary Names

CytotecR; ArthrotecR

 

References

1. Lanas A. et al. Toxicity of NSAIDs in the stomach and duodenum. Eur J Gastroenterol Hepatol 1999 Apr;11(4):375-81

 

2. Agrawal NM et al. Comparison of the upper gastrointestinal safety of Arthrotec 75 in osteoarthritis patients at high risk for developing NSAID-induced gastrointestinal ulcers. Clin Ther 1999 Apr;21(4):659-74

 

3. Morgan D. Arthrotec: the evidence speaks for itself. Scand J Rheumatol Suppl 1999;109:13-8

 

4. AHFS Drug InformationR 96

 

5. Blanchette HA et al. Comparison of the safety efficacy of intravaginal misoprostol with those of dinoprostone for cervical ripening and induction of labor in a community hospital. Am J Obstet Gynecol 1999 Jun; 180(6 Pt 1):1551-9.

 

6. Goldberg AB et al. Induction of labor: the misoprostol controversy. J Midwifery Womens Health. 2003 Jul-Aug;48(4):244-8.

 

7. Hofmeyr GJ et al. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2003;(1):CD000941. Update of: Cochrane Database Syst Rev. 2001;(3):CD000941.

 

8. Wing DA. A benefit-risk assessment of misoprostol for cervical ripening and labour induction. Drug Saf.2002;25(9):665-76.

 

9. Blanchard K et al. Misoprostol for women's health: a review. Obstet Gynecol. 2002 Feb;99(2):316-32.

 

10. Glodberg AB et al. Misoprostol and Pregnancy. NEJM 2001; 344 (1): 38-47.

 

11. Morant SV et al. A pharmacoeconomic comparison of misoprostol/diclofenac with diclofenac. Pharmacoepidemiol Drug Saf. 2002 Jul-Aug;11(5):393-400.

 

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