Misoprostol (Abortion Pill) - Uses, Mechanism Of Action, Adverse Effects, And Contraindications

Misoprostol is a synthetic prostaglandin E1 analog, which is FDA approved only for the treatment and prevention of non-steroidal anti-inflammatory drug induced gastric ulcers. However, it is used in combination with mifepristone for medically induced termination of pregnancy worldwide. Clinicians also use it for the expectant management of missed and incomplete miscarriages. At much smaller doses, it induces cervical ripening, and can be used to induce labor in full term pregnancies. It is also useful in the treatment of postpartum uterine bleeding.
Prostaglandin has several important functions in our body. It secretes protective mucus in the stomach, and reduces acid induced damage to the gastric mucosa. It also enhances uterine contractions, especially during labor. And it reduces gastric acid secretion by the stomach.
Following administration, misoprostol binds to the prostaglandin receptors on gastric parietal cells, and increases the secretion of prostaglandins, which leads to reduced gastric acid secretion. Increased mucus and bicarbonate secretion. And increased mucosal blood flow, all of which reduce the acid induced damage to the gastric mucosa.
In the uterus, it binds to prostaglandin receptors of uterine smooth muscle cells, and induces uterine contractions, which is responsible for its abortifacient properties. It also causes cervical dilation by promoting degradation of collagen and increasing the cervical tone.
Misoprostol is taken per orally. It is best to take the drug at night, to reduce gastric disturbances. And it should not be taken with magnesium containing antacids, as it may cause misoprostol induced diarrhea.
Misoprostol is usually a safe, and well tolerated drug by most individuals. Mild side effects include, gastrointestinal disturbances such as abdominal pain, nausea and vomiting, and diarrhea. Hyperthermia and chills. Headache. Breakthrough bleeding. Menstrual irregularities. Lethargy. And vertigo. Moderate to severe side effects are very rare and can include hypotension. Sinus tachycardia. Vaginal bleeding. Uterine rupture and cervical laceration. Thrombosis and pulmonary embolism. And anaphylaxis.
Finally, misoprostol is contraindicated in any person who has a hypersensitivity to it. Other contraindications include normal pregnancy. And previous cesarean section, as misoprostol can increase the risk of uterine rupture.

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