Misoprostol

miso-kare® (MSOPROSTOL 200mcg)

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miso-kare® (MSOPROSTOL 200mcg)

MISO-KARE tablets contains 200mcg of Misoprostol, a synthetic prostaglandin E1 (PGE1) analogue.

Misoprostol belongs to a group of hormones called prostaglandins which can cause uterine contractions and opening (ripening) of the cervix. Although prostaglandins are highly effective, their efficacy depends on the number of prostaglandins receptors in the uterus and this varies according to whether the woman is pregnant and at what stage of pregnancy is she.

Misoprostol

At the end of pregnancy: there are many receptors and small dose of misoprostol leads to strong contractions. Special attention is required in women with a liver fetus (who may hyperstimulate). Not for use by women with previous caesarean sections-it may cause a ruptured uterus. Uterine ruptures have also been reported occasionally in unscarred uteruses

In early pregnancy: there are few receptors and large doses of misoprostol may need to be given repeatedly in order to have an effect. No problems have been reported in the first trimester of pregnancy with women who have had previous caesarean sections.

Pharmacokinetics

Misoprostol is readily absorbed and undergoes rapid de-esterification to its free acid, it bound to plasma protein and its metabolites include prostaglandin F analogues. The compound is lipophilic methyl ester pro drug and is readily metabolized to the free acid, which is biologically active. When administered orally peak plasma concentration is attained within 30 minutes and rapidly declines by 120 minutes. 80% of the drug is excreted through renal route and 15% through fecal route

Indications

For the treatment of

  • Postpartum Hemorrhage
  • Post abortion care

Warnings and precautions

The patient may require immediate medical attention for cramps and gastrointestinal disturbances after administration of Misoprostol. Also the patient should be given instructions on what to do if significant discomfort, excessive bleeding or other adverse reactions occurs. Intra Uterine Device (IUD) should be removed before the treatment of misoprostol. Patients who have an ongoing pregnancy at last visit have a risk of foetal malformation resulting from the treatment. Oxytocin should not be used after 6 hours of administration of last dose of misoprostol. There may be increased risk of uterine tachysystole, uterine rupture, meconium passage, meconium staining of amniotic fluid and cesarean delivery due to uterine hyper stimulation with the use of higher doses of Misoprostol.

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Contraindications

Misoprostol is contraindicated if the patient has

  • Hypersensitivity to prostaglandins
  • Confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass
  • Intra Uterine Device (IUD) in place
  • Chronic adrenal failure
  • Hemorrhagic disorders or concurrent anticoagulant therapy
  • Inherited porphyria
  • Cervical ripening

Adverse reactions

  • Patient may experience pain due to uterine contractions
  • Severe genital bleeding
  • Shock
  • Pelvic pain
  • Uterine rupture
  • Gastrointestinal side effects like diarrhea, abdominal pain, nausea, flatulence, dyspepsia, headache, vomiting and constipations, shivering, dizziness

Drug interactions

Misoprostol does not interfere with the beneficial effects of aspirin on signs and symptoms of rheumatoid arthritis. Misoprostool does not exert clinically significant effects on the absorption, blood levels and antiplatelet effects on therapeutic doses of aspirin. Misoprostol has no clinically significant effect on the kinetics of diclofenac or ibuprofen. The most common side effect of Misoprostol is diarrhea and abdominal pain. These side effects may be increased if misoprostol is taken concurrently with antacids.

Dosage and administration

600mcg orally for the treatment of postpartum Hemorrhage and Post abortion care.

Overdosage

The symptom of a misoprostol overdose are not well known but might include stomach upset, stomach pain, diarrhea, drowsiness, tremor, seizures, difficulty in breathing, fever, low blood pressure and irregular heart beat

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