Because other classes of drugs, especially H2-receptor antagonists and proton pump inhibitors, are more effective for the treatment of acute peptic ulcers, misoprostol is only indicated for use by people who are both taking NSAIDs and are at high risk for NSAID-induced ulcers, including the elderly and people with ulcer complications. Misoprostol is sometimes coprescribed with NSAIDs to prevent their common adverse effect of gastric ulceration (e.g. with diclofenac in Arthrotec).However, even in the treatment of NSAID-induced ulcers, omeprazole proved to be at least as effective as misoprostol, but was significantly better tolerated, so misoprostol should not be considered a first-line treatment. Misoprostol-induced diarrhea and the need for multiple daily doses (typically four) are the main issues impairing compliance with therapy. Labor induction
Misoprostol is commonly used for labor induction. It causes uterine contractions and the ripening (effacement or thinning) of the cervix. It can be less expensive than the other commonly used ripening agent, dinoprostone.Oxytocin has long been used as the standard agent for labor induction, but does not work well when the cervix is not yet ripe. Misoprostol also may be used in conjunction with oxytocin.Between 2002 and 2012, a misoprostol vaginal insert was studied, and was approved in the EU. It was not approved for use in the United States, and the US FDA still considers cervical ripening and labor induction to be outside of the approved uses for misoprostol, because no company has sent the FDA scientific proof that misoprostol is safe and effective for these uses.
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.