Misoprostol alone may be more effective in earlier gestation. WHO guidelines recommend for pregnancies up to 12 weeks to use 12 tablets of 200 mcg (micrograms). The woman should put 4 tablets of misoprostol under the tongue or far up the vagina and let them dissolve for 30 minutes. The woman should wait 3 hours and repeat with 4 pills under the tongue or in the vagina for 30 minutes. She should wait 3 hours and repeat once more. It works in 90% after first attempt and, in case of failure, the attempt may be repeated after a minimum of 3 days.Misoprostol can also be used to dilate the cervix in preparation for a surgical abortion, particularly in the second trimester (either alone or in combination with laminaria stents). Vaginal misoprostol can also be used to facilitate intrauterine device insertion after previous insertion failure.Misoprostol by mouth is the least effective treatment for producing complete abortion in a period of 24 hours due to the livers first-pass effect which reduces the bioavailability of the misoprostol. Vaginal and sublingual routes result in greater efficacy and extended duration of action because these routes of administration allow the drug to be directly absorbed into circulation by bypassing the liver first-pass effect.Hematocrit or Hb tests and Rh testing are recommended before use for abortion confirmation of pregnancy. Following use, it is recommended that people attend a follow-up visit 2 weeks after treatment.
This agent also causes cervical ripening with softening and dilation of the cervix. Misoprostol binds to and stimulates prostaglandin EP2 receptors, prostaglandin EP3 receptor and prostaglandin EP4 receptor but not Prostaglandin EP1 receptor and therefore is expected to have a more restricted range of physiological and potentially toxic actions than prostaglandin E2 or other analogs which activate all four prostaglandin receptors. Society and culture
A letter from Searle, inventor of the drug, generated some controversy over the use of misoprostol in labor inductions. The American College of Obstetricians and Gynecologists holds that substantial evidence supports the use of misoprostol for induction of labor, a position it reaffirmed in 2000 in response to the Searle letter. It is on the World Health Organizations List of Essential Medicines.The largest medical malpractice award of nearly $70 million was awarded due to the use of misoprostol to induce labor in a California hospital.A vaginal form of the medication is sold in the EU under the names Misodel and Mysodelle for use in labor induction. Black market
Misoprostol is used for self-induced abortions in Brazil, where black market prices exceed US$100 per dose. Illegal medically unsupervised misoprostol abortions in Brazil are associated with a lower complication rate than other forms of illegal self-induced abortion, but are still associated with a higher complication rate than legal, medically supervised surgical and medical abortions. Failed misoprostol abortions are associated with birth defects in some cases.