MISOPROSTOL

Misoprostol is a drug that is used for the prevention of non steroidal anti inflammatory drug  induced astric ulcers, for early abortion, to treat missed miscarriage, and to induce labor.

Misoprostol is typically sold in pharmacies in tablets of 200 mcg. Four tablets are recommended to initiate an early abortion, and four (or, rarely, eight) more may be required for its completion.  It is best to use misoprostol within nine weeks since the last menstruation; that is, fewer than 63 days counting from the first day of the last regular period.  The earlier in the pregnancy it is administered the better, because it is safer, more effective and less painful.  Misoprostol can be used later in pregnancy but the risks of complications are higher (see below).  Women with an intrauterine contraceptive device (IUD) in place should have it removed before using misoprostol.

Intended effects and side effects of misoprostol

• Bleeding and uterine contractions (cramping) are the intended effects of using misoprostol for inducing an abortion.
• Cramping will be stronger than for an ordinary menstrual period and may be painful.  Non-steroid anti-inflammatory pain medication such as ibuprofen may be taken without interfering with the misoprostol. 
• Bleeding will be heavier and more prolonged than for a normal period: up to a week, in most cases, often with continued spotting until menstruation resumes in four to six weeks.  These effects will be more pronounced in pregnancies of longer duration.  
• Chills and fever are common side effects but are transient. High fever is less common but can occur and usually disappears within a few hours as do nausea, vomiting, and diarrhea. 

Women should seek medical attention if they experience any of the following side effects after taking misoprostol:

• Very heavy bleeding (soaking more than two large-sized thick sanitary pads each hour for more than two consecutive hours);
• Continuous bleeding for several days resulting in dizziness or light-headedness;
• Bleeding that stops but is followed two weeks or later by a sudden onset of extremely heavy bleeding, which may require manual vacuum aspiration or D&C;
• Scant bleeding or no bleeding at all in the first seven days after using misoprostol, which may suggest that no abortion has occurred and require a repeat round of misprostol or surgical termination; or
• Chills and fever lasting more than 24 hours, which suggest that an infection may be present requiring treatment with antibiotics.