Misoprostol Therapeutics Revisited

Davies, Neal M.; Longstreth, James; Jamali, Fakhreddin

doi:10.1592/phco.21.1.60.34442

Cited by 65 publications

(39 citation statements)

References 148 publications

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“…20 Apart from its uterotonic effects, misoprostol has known pharmacologic effects on several organ systems. It inhibits platelet-activating factor 21 and affects metabolic and physiological processes, including thermoregulation. Life-threatening hyperpyrexia has been reported following the use of misoprostol, 800 µg orally, after childbirth.…”

Section: Introductionmentioning

confidence: 99%

Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects

Hofmeyr¹,

Gülmezoglu²,

Novikova³

et al. 2009

Bull World Health Org

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Objective To review maternal deaths and the dose-related effects of misoprostol on blood loss and pyrexia in randomized trials of misoprostol use for the prevention or treatment of postpartum haemorrhage. Methods We searched the Cochrane Controlled Trials Register and Pubmed, without language restrictions, for "(misoprostol AND postpartum) OR (misoprostol AND haemorrhage) OR (misoprostol AND hemorrhage)", and we evaluated reports identified through the Cochrane Pregnancy and Childbirth Group search strategy. Randomized trials comparing misoprostol with either placebo or another uterotonic to prevent or treat postpartum haemorrhage were checked for eligibility. Data were extracted, tabulated and analysed with Reviewer Manager (RevMan) 4.3 software. Findings We included 46 trials with more than 40 000 participants in the final analysis. Of 11 deaths reported in 5 trials, 8 occurred in women receiving ³ 600 µg of misoprostol (Peto odds ratio, OR: 2.49; 95% confidence interval, CI: 0.76-8.13). Severe morbidity, defined as the need for major surgery, admission to intensive care, organ failure or body temperature ³ 40 °C, was relatively infrequent. In prevention trials, severe morbidity was experienced by 16 of 10 281 women on misoprostol and by 16 of 10 292 women on conventional uterotonics; in treatment trials, it was experienced by 1 of 32 women on misoprostol and by 1 of 32 women on conventional uterotonics. Misoprostol recipients experienced more adverse events than placebo recipients: 8 of 2070 versus 5 of 2032, respectively, in prevention trials, and 5 of 196 versus 2 of 202, respectively, in treatment trials. Meta-analysis of direct and adjusted indirect comparisons of the results of randomized trials showed no evidence that 600 µg are more effective than 400 µg for preventing blood loss ³ 1000 ml (relative risk, RR: 1.02; 95% CI: 0.71-1.48). Pyrexia was more than twice as common among women who received ³ 600 µg rather than 400 µg of misoprostol (RR: 2.53; 95% CI: 1.78-3.60). Conclusion Further research is needed to more accurately assess the potential beneficial and harmful effects of misoprostol and to determine the smallest dose that is effective and safe. In this review, 400 µg of misoprostol were found to be safer than ³ 600 µg and just as effective.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

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Section: Introductionmentioning

confidence: 99%

Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects

Hofmeyr¹,

Gülmezoglu²,

Novikova³

et al. 2009

Bull World Health Org

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“…Contraindications to the use of mifepristone are adrenal failure and hereditary porphyria. Misoprostol is a synthetic prostaglandin E1 analog which regulates various immunologic cascades (Davies et al, 2001). It is a potent uterotonic drug, but its use in obstetrics and gynaecology is in all countries apart from France an offlabel use as it is only marketed for the prevention and treatment of peptic ulcer disease.…”

Section: Mifepristone and Misoprostolmentioning

confidence: 99%