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Misoprostol is a prostaglandin medicine used to terminate a pregnancy by starting labor. It is more effective when used in combination with methotrexate or mifepristone than when used alone. This is an unlabeled use of misoprostol.
Misoprostol is also used to prevent stomach ulcers (labeled use) and for induction of labor for childbirth (unlabeled use).
Misoprostol may also be used to:
Misoprostol used alone may terminate a pregnancy. But it is more often used with other medicines, such as mifepristone or methotrexate, in first-trimester abortions.
Misoprostol alone, moistened and used vaginally, is effective in over 90 out of 100 cases in terminating first-trimester pregnancies of less than 8 weeks.1
Misoprostol can be given orally, buccally (dissolved between the gums and cheek), or vaginally. Misoprostol is slightly more effective when taken vaginally than when taken by mouth.1 But many doctors are only giving misoprostol by mouth because of reports of a rare, fatal infection that affected a few women after using vaginal misoprostol. Some studies have shown that taking misoprostol buccally works as well as when it is given vaginally or orally.2, 3
This method of abortion causes symptoms similar to a miscarriage (such as severe cramping and vaginal bleeding) as tissue and clots pass from the uterus. Symptoms may include:
The U.S. Food and Drug Administration (FDA) has reported that a few women have died from a severe infection (sepsis) after having an abortion using mifepristone and vaginal misoprostol.4 Signs of serious infection include weakness, nausea, and diarrhea with or without belly pain. This rare infection may not cause a fever. Call your doctor or go to the hospital if you have any of these signs of a serious infection after having a medical abortion.
Call your doctor immediately if you have any of these symptoms after an abortion:
Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
Choosing a medical or surgical procedure for an abortion will depend on your past health, how many weeks pregnant you are, what options are available where you live, and your personal preferences.
Misoprostol is not used in women who have an allergy to misoprostol or other prostaglandins.
Misoprostol can cause fetal abnormalities, so a follow-up surgical abortion will be done if the medical abortion did not work.
The use of misoprostol for medical abortion is an unlabeled use. Misoprostol is approved (labeled) for preventing and treating stomach ulcers in people taking nonsteroidal anti-inflammatory drugs (NSAIDs) on a long-term schedule.
Misoprostol does not have any known drug interactions.
- American College of Obstetricians and Gynecologists (2005, reaffirmed 2009). Medical management of abortion. ACOG Practice Bulletin No. 67. Obstetrics and Gynecology, 106(4): 871–882.
- Middleton T, et al. (2005). Randomized trial of mifepristone and buccal or vaginal misoprostol for abortion through 56 days of last menstrual period. Contraception, 72(5): 328–332.
- Winikoff B, et al. (2008). Two distinct oral routes of misoprostol in mifepristone medical abortion: A randomized controlled trial. Obstetrics and Gynecology, 112(6): 1303–1310.
- U.S. Food and Drug Administration (2006). Public health advisory: Sepsis and medical abortion with mifepristone (Mifeprex). Available online: http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm051298.htm.
Last Revised: August 31, 2012
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