There are significant differences in the pharmacokinetics of misoprostol administered by vaginal and oral routes that may explain the difference observed in clinical efficacy. Assuming that the pharmacologic effect of misoprostol is related to its concentration in the plasma, our observation of the prolonged serum concentrations in the vaginal group suggests that vaginal administration could be dosed at longer intervals than oral.

No abstract

T IS ESTIMATED THAT HALF OF THE 3.5 million unintended pregnancies that occur each year in the United States could be averted if emergency contraception (EC) were easily accessible and used. 1 This figure has been extrapolated from efficacy trials that demonstrate that the risk of pregnancy after a single act of unprotected intercourse is reduced by 75% with use of combined EC (the "Yuzpe" regimen). 2 In efforts to increase access to EC, to date 6 states (Alaska, California, Hawaii, Maine, New Mexico, and Washington) have implemented pharmacy access legislation whereby women can obtain EC directly from pharmacists without having to see a clinician or obtain a prescription first. Although women in Washington State have had increased access to EC through direct pharmacy access since 1997, an outcome evaluation is not available, and it is not clear if reductions in pregnancy and abortion rates in Washington State over the same time period can be attributed to this increased access. 3For editorial comment see p 98.