Examples

Generic Name	Brand Name
misoprostol	Cytotec

How It Works

Misoprostol:

• Softens and opens (dilates) the cervix.
• Causes uterine contractions.
• Starts (induces) labor.

Note: Many doctors are only giving misoprostol by mouth for medical abortion. This is because of recent reports of a very rare, fatal infection that affected a few women after they used vaginal misoprostol. ¹ Some doctors may give misoprostol buccally (dissolved between the gums and cheek).

Why It Is Used

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).

How Well It Works

Misoprostol used alone may terminate a pregnancy but is much more effective when used with other medicines, such as mifepristone or methotrexate, in first-trimester abortions. ²

• Misoprostol alone, moistened and used vaginally, is over 90% effective in terminating first-trimester pregnancies of less than 8 weeks. ³
• Misoprostol alone, dry and used vaginally, is only 50% to 67% effective in terminating first-trimester pregnancies of less than 8 weeks. ³

Misoprostol may also be used to:

• Complete a spontaneous missed abortion (incomplete miscarriage).
• Start labor in second-trimester abortions. Misoprostol is over 70% effective in terminating a pregnancy within 48 hours when used for second-trimester labor induction. It is more effective when used with mifepristone. ²
• Start labor in third-trimester abortions. Misoprostol is more effective than oxytocin and other prostaglandins for inducing labor within 24 hours. ² Third-trimester abortions are not done unless the fetus has died or has severe medical problems and will not survive.
• Dilate the cervix 3 to 4 hours before a surgical abortion procedure.
• Soften the cervix for induction of labor.
• Soften the cervix for special gynecologic tests.

Side Effects

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:

• Nausea.
• Vomiting.
• Diarrhea.
• Headache.
• Dizziness.
• Chills or hot flushes (sweating and feeling overly hot).
• Shivering.
• Fatigue.

Signs of complications

Less than 1% of women who have an abortion have serious problems afterward. ⁴

Call your doctor immediately if you have any of these symptoms after an abortion:

• Severe bleeding. Both medical and surgical abortions usually cause bleeding that is different from a normal menstrual period. Severe bleeding can mean:
  • Passing clots that are bigger than a golf ball, lasting 2 or more hours.
  • Soaking more than 2 large pads in an hour, for 2 hours in a row.
  • Bleeding heavily for 12 hours in a row.
• Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
• Severe pain in the abdomen that is not relieved by pain medicine, rest, or heat
• Hot flushes or a fever of 100.4F or higher that lasts longer than 4 hours
• Vomiting lasting more than 4 to 6 hours
• Sudden abdominal swelling or rapid heart rate
• Vaginal discharge that has increased in amount or smells bad
• Pain, swelling, or redness in the genital area

Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:

• Bleeding (not spotting) for longer than 2 weeks
• New, unexplained symptoms that may be caused by medicines used in your treatment
• No menstrual period within 6 weeks after the procedure
• Signs and symptoms of depression. Hormonal changes after a pregnancy can cause depression that requires treatment.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Many studies have shown that misoprostol is a safe and effective medicine in abortions. ² Misoprostol has been shown to be more effective when the tablets are used vaginally than when taken by mouth. But many doctors are only giving misoprostol by mouth. This is because of recent reports of a very rare, fatal infection after using vaginal misoprostol.

Some doctors may give misoprostol buccally (dissolved between the gums and cheek). One study found that taking misoprostol buccally works as well as when it is given vaginally. ⁵

Choosing a medical or surgical procedure for an abortion will depend on your medical history, 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 to prevent a fetus from developing abnormally.

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.

Unlike other prostaglandins, misoprostol does not increase the risk of a heart attack or bronchospasm.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. U.S. Food and Drug Administration (2006). FDA Public Health Advisory: Sepsis and Medical Abortion Update. Available online: http://www.fda.gov/cder/drug/advisory/mifeprex200603.htm.

2. Goldberg AB, et al. (2001). Misoprostol and pregnancy. New England Journal of Medicine, 344(1): 3845.

3. American College of Obstetricians and Gynecologists (2005, reaffirmed 2007). Medical management of abortion. ACOG Practice Bulletin No. 67. Obstetrics and Gynecology, 106(4): 871–882.

4. Guttmacher Institute (2008). In Brief: Facts on Induced Abortion in the United States. Available online: http://www.guttmacher.org/pubs/fb_induced_abortion.html.

5. 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.