Misoprostol

About Misoprostol

Misoprostol is a synthetic prostaglandin that reduces stomach acid and strengthens the stomach’s protective lining. The label approves it to reduce the risk of gastric ulcers caused by NSAIDs, including aspirin, in people at high risk of ulcer complications, such as older people and those with a debilitating illness, and in people at high risk of developing an ulcer, such as those who have had one before; it has not been shown to reduce the risk of duodenal ulcers. The adult dose is 200 mcg four times a day with food, the last dose at bedtime, for as long as the NSAID is taken; 100 mcg can be used if 200 mcg is not tolerated. Safety and effectiveness in children have not been established.

The boxed warning is about pregnancy: misoprostol can cause abortion, premature birth and birth defects, and uterine rupture has been reported when it was used in pregnant women to induce labor or abortion, so it must not be taken by pregnant women to prevent NSAID ulcers. For a woman who could become pregnant, the label sets conditions: a negative serum pregnancy test within two weeks before starting, the ability to use effective contraception, oral and written warnings about the risks and about not giving the tablets to anyone else, and starting only on the second or third day of a normal menstrual period. If pregnancy occurs, the drug is stopped and the prescriber contacted. Misoprostol is also contraindicated in anyone allergic to prostaglandins. Diarrhea is the most frequent side effect, usually early and usually settling on its own, though rare cases of severe dehydration have occurred; abdominal pain, nausea, gas, headache and indigestion are also reported.

What is distinctive is the counseling that comes with it: the Patient Information leaflet is given with each prescription, and MedlinePlus advises asking for the maker’s patient information and reading it carefully. Antacids that contain magnesium are avoided because they worsen the diarrhea, and the label advises caution in people with heart or blood vessel disease. Misoprostol acid passes into breast milk. Hospital use of misoprostol in obstetrics is outside the approved labeling and is not covered by this guide. Misoprostol is not a controlled substance.

Taking Misoprostol

How to take it

Take it by mouth four times a day, after meals and at bedtime with food, for as long as you take the NSAID it is protecting you from. It works only if taken regularly. Read the Patient Information leaflet that comes with each fill.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

In the original container at or below room temperature in a dry place, away from heat and moisture (not in the bathroom), out of reach of children, and never shared with anyone else.

Interactions to know about

Avoid antacids that contain magnesium, which make the diarrhea worse. Misoprostol does not change how aspirin, ibuprofen or diclofenac are handled by the body. Tell the pharmacist about every medicine, including antacids, aspirin and arthritis medicines.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Misoprostol differs from pharmacy to pharmacy

Misoprostol is a generic, though fewer makers list the 100 mcg tablet than the 200 mcg tablet, so stocking of the lower strength varies more. Quotes depend on which maker the pharmacy buys from, the pack it stocks (bottles of 60 or 100, or blister packs), and whether the drug is on a flat-price generic list.

The approved dose is four tablets a day for as long as the NSAID is taken, so a month is a sizable count and the quote should match the exact quantity written; a long-term prescription can be filled for ninety days once the dose is settled.

Ways to pay less for Misoprostol without insurance

• Ask the prescriber to write misoprostol generically and allow substitution; both strengths have rated generics.
• Once you tolerate the dose, ask the prescriber whether a ninety-day supply suits you, so you pay fewer dispensing fees.
• Ask whether misoprostol is on the pharmacy’s flat-price generic list, and compare more than one pharmacy for the exact count written.
• Ask the prescriber whether a proton pump inhibitor, several of which are generics, would protect your stomach as well; do not switch on your own.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Misoprostol

1. 1.Should I take my misoprostol with my meals and at bedtime, and what if the diarrhea does not settle?
2. 2.Which antacids should I avoid while I take misoprostol?
3. 3.What should I do if I think I might be pregnant while taking it?
4. 4.Can my prescription be filled with a generic, and does the pharmacy stock my strength?

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