UPDATE ON MISOPROSTOL

Abstract

Misoprostol, a drug primarily developed for the treatment of peptic ulcer is now being widely used for ever increasing indications in obstetrics and gynaecology due to its uterotonic action. The drug has come a long way following off label use and warning from manufacturers and FDA. Initially introduction of drug led to a flurry of adverse reports due to publication bias and also the fact that optimal dose and route was yet to be determined. There are more randomized controlled trials on use of this novel drug compared to any other drug in obstetrics and gynaecology. Finally after federal drug agency (FDA) approval in USA and recommendation the drug is used widely.  Due to low cost, ease of storage and multiple routes of administration – oral, sublingual, vaginal and rectal uptake was very rapid. Misoprostol has changed the face of 1st trimester medical termination an also 2nd trimester induction. As an alternative to dinoprostone the safety of the drug has been validated along with great cost savings.  Except for prophylaxis of post partum haemorrhage where the drug was less effective compared to counterparts there is evidence in favour of misoprostol for all other indications.