User:Sarahchongrx/sandbox

Misoprostol

 * Medical uses
 * Monitoring parameters
 * Studies suggest that all women be advised to contact their physician in case of heavy bleeding or signs of infection. Following administration of misoprostol, it is recommended that patients attend a follow-up visit 2 weeks after treatment. To confirm the status of abortion, a pregnancy test, physical examination of the uterus, and ultrasound should be performed. Surgical management is possible in the case of failed treatment.
 * Pharmacology
 * Mechanism of action
 * Efficacy
 * A systematic review found that 400 ug oral misoprostol is the least effective treatment for producing complete abortion within about 24 hours due to the liver first-pass effect which significantly reduces the bioavailability of the drug. Vaginal and sublingual routes of administration allow misoprostol to be directly absorbed into circulation by bypassing the liver first-pass effect.
 * Contraindications
 * It is recommended that medical treatment for missed abortion with misoprostol should only be considered in women without the following contraindications: suspected ectopic pregnancy, unstable hemodynamics, signs of pelvic infections or sepsis, known allergy to misoprostol, previous caesarean section, mitral stenosis, hypertension, glaucoma, bronchial asthma, use of non-steroidal drugs, and remote areas without a hospital nearby.
 * Dosing
 * Interactions
 * Adverse Effects
 * A systematic review reported increased side effects associated with sublingually or orally administered misoprostol while low dose (400 ug) vaginal misoprostol was found to have the fewest reported adverse effects. However, low dose vaginal misoprostol was linked with low complete abortion rate. The study concluded that, compared with vaginally or orally administered misoprostol, sublingual misoprostol dosed at 600 ug or 400 ug had greater instances of fever and diarrhea due to its shorter onset of action, higher peak concentration and bioavailability.