Pharmacokinetics of different routes of administration of misoprostol

Tang, Oi Shan; Schweer, Horst; Seyberth, Hannsjörg W.; Lee, Sharon W.H.; Ho, Pak Chung

doi:10.1093/humrep/17.2.332

Cited by 441 publications

(349 citation statements)

References 18 publications

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“…Similarly, our study also showed less proportion of women had meconiumstained liquor in the PGE1 group as against PGE2 group (Grade III-4.2 %). Recently published study revealed that when compared to oral and vaginal route, sublingual misoprostol achieved its peak serum concentration in an interval similar to that achieved by the oral route [12]. Our findings contradict the existing evidences which compared vaginal PGE1 and PGE2 and showed increased incidence of hyperstimulation and foetal distress [7,13].…”

Section: Discussioncontrasting

confidence: 79%

Sublingual Misoprostol (PGE1) Versus Intracervical Dinoprostone (PGE2) Gel for Induction of Labour: A Randomized Control Trail

Veena¹,

Samal

Inbaraj

et al. 2015

J Obstet Gynecol India

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Background Prostaglandins are popular agents for induction of labour, owing to their dual action of cervical ripening and inducing uterine contractions. Sublingual misoprostol offers high efficacy as it bypasses first-pass metabolism. Researchers have proved that intracervical PGE1 is as effective as PGE2 except for increased caesarean rate and hyperstimulation. Limited knowledge is available on the efficacy of sublingual PGE1 and intracervical PGE2. This study was designed to compare the effectiveness of sublingual PGE1 with intracervical PGE2. Methods A randomized control trial was conducted in Bangalore Baptist Hospital, Bangalore. One hundred and ninety women with singleton, term pregnancy were equally divided into PGE1 and PGE2 groups, and primary outcome was measured. Results Post-induction mean Bishop's score in PGE1 group was statistically significant (t = 6.57, p \ 0.05).This study was conducted at Bangalore Baptist Hospital, Bellary Road, Hebbal, Bangalore, 560024 (Phone: 080-22024700). Sr. Dr. Veena Braganza is a missionary nun belonging to the Sisters of Charity which runs health centres in Goa and rural Karnataka. She did her DGO in Goa Medical College and served in various mission hospitals before she obtained DNB from Bangalore Baptist Hospital, Bangalore. She is passionate in reaching out to the poor with low-cost affordable yet safe and effective care. This PG thesis on PGE1 as promising agent was her special interest due to its low cost, and she herself used in limited resource settings. Hence, she conceptualized this trail to prove its efficacy scientifically. Her keen interest is VBAC to bring down cost of surgeries and obstetric care. She is currently involved in making health care accessible to migrant population in Goa and Karnataka. Braganza Veena is Medical Director and Consultant in Obstertics andThe Journal of Obstetrics and Gynecology of India (September-October 2016) 66(S1):S122-S128 DOI 10.1007/s13224-015-0820-8123 Conclusion Sublingual PGE1 is a better cervical ripening agent, faster and more effective, with a shorter inductionto-delivery interval as compared to intracervical PGE2. We also noted lower incidence of caesarean section and foetal distress with sublingual PGE1 compared to oral or vaginally administered PGE1.

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Section: Discussioncontrasting

confidence: 79%

Sublingual Misoprostol (PGE1) Versus Intracervical Dinoprostone (PGE2) Gel for Induction of Labour: A Randomized Control Trail

Veena¹,

Samal

Inbaraj

et al. 2015

J Obstet Gynecol India

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“…7,8 The drug is absorbed through mucous membranes and can be administered sublingually, orally, vaginally, and rectally. 9,10 Misoprostol used alone for nonviable first-trimester pregnancy resulted in uterine expulsion in 13% to 96% of women. 11,12 Explanations for this wide range include different indications for treatment, dosing regimen, routes of administration, and measures of success.…”

mentioning

confidence: 99%

“…13 Drug absorption after vaginal administration varies widely. 9,14 In an observational study, Zalanyi 15 moistened the tablets with saline solution and reported expulsion in 88% of women with anembryonic or embryonic/fetal death pregnancies. Perhaps the addition of saline solution to the tablets enhanced the drug's effectiveness.…”

mentioning

confidence: 99%

A randomized trial of saline solution–moistened misoprostol versus dry misoprostol for first-trimester pregnancy failure

Gilles

Creinin

Barnhart

et al. 2004

American Journal of Obstetrics and Gynecology

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Objective-The purpose of this study was to estimate whether the efficacy of treatment with intravaginal misoprostol for first-trimester pregnancy failure is enhanced by the addition of saline solution.Study design-Eighty women with embryonic/fetal death or anembryonic pregnancy were assigned randomly to receive either 800 μg of misoprostol with saline solution (group I, 41 women) or without (group II, 39 women). Treatment was repeated on day 3 if the gestational sac remained. Curettage was performed if the gestational sac remained on day 8 or as necessary during at least 30 days of follow-up. Data were analyzed with the Student t test and the χ 2 or Fisher exact test.Results-By the first follow-up visit, 73% (group I) and 64% (group II) of women passed the gestational sac (P = .38). By the second follow-up visit, expulsion rates were 83% and 87%, respectively (P = .59). Five subjects in each group underwent curettage. Conclusion-Misoprostol is effective for the treatment of failed first-trimester pregnancy. The expulsion rate is not improved by adding saline solution. KeywordsMissed abortion; Misoprostol; Anembryonic pregnancy; Fetal death; Spontaneous abortion Approximately 15% of clinically evident pregnancies result in first-trimester loss. 1 Curettage, commonly performed for this condition, is comparatively costly when performed in the operating room. 2 Although curettage is relatively safe, it can be associated with intrauterine infection, adhesion, perforation, and cervical stenosis. 3 An alternative may be expectant or medical treatment. Expectant treatment usually results in the complete expulsion of the products of conception 4 ; however, the interval after diagnosis and expulsion varies. Luise et al 5 reported that most women passed products within 2 weeks of diagnosis. Jurkovic et al 6 found only a 25% success rate in women whose cases were followed for >6 weeks. MedicalReprints not available from the authors. NIH Public Access Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2010 May 10.Published in final edited form as: Am J Obstet Gynecol. 2004 February ; 190(2): 389-394. doi:10.1016/j.ajog.2003 NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript treatment may provide prompt expulsion and avoid costs and complications that are associated with surgery and the uncertainties of expectant treatment.A uterotonic drug that is proposed for medical treatment is misoprostol, an inexpensive widely available prostaglandin E 1 analog that is stable at room temperature. 7,8 The drug is absorbed through mucous membranes and can be administered sublingually, orally, vaginally, and rectally. 9,10 Misoprostol used alone for nonviable first-trimester pregnancy resulted in uterine expulsion in 13% to 96% of women. 11,12 Explanations for this wide range include different indications for treatment, dosing regimen, routes of administration, and measures of success. Vaginal administration appears to be more effective than oral administration for the inducement of ut...

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“…The oral route may result in improved clinical outcomes over the vaginal route [10,11], and women's convenience and comfort also seem to be increased [15][16][17][18]. The regimens most frequently used were either 20-25 mg every 2 h for a maximum of 12 doses (24 h), or 50 mg every 4 h for a maximum of 6 doses (24 h).…”

Section: Introductionmentioning

confidence: 99%

What is the optimal duration of oral misoprostol treatment for cervical ripening?

Drakopoulos

Duyck

Gayet-Ageron

et al. 2016

The Journal of Maternal-Fetal & Neonatal Medicine

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Objectives: To evaluate the number of misoprostol tablets needed to obtain a Bishop score (BS) 6 or a significant cervical change ( 2 points in BS) during cervical ripening. Methods: Retrospective study of women with term singleton pregnancies and a BS56 taking oral misoprostol (20 mg first 2 doses followed by 40 mg every 2 h) for cervical ripening. Results: We included 400 women, 72% nulliparous, mean age of 31.3 ± 5.9 years and 70% with a baseline BS 2. During cervical ripening, 61 (15.3%) achieved a BS 6 and 205 (51.3%) a significant change in BS. The incremental risk to achieve a BS 6 after 4 tablets was low (+3.25%) with an incremental probability of +12.75% for painful uterine contractions and +0.5% for abnormal fetal tracing (AFT). The incremental probability to achieve a significant change in BS after 7 tablets was low (+2.0%). 24.3% women delivered by cesarean section which likelihood significantly increased with maternal age 535 years, BMI 30, nulliparity, AFT, and baseline BS 2. Conclusions: The marginal benefit of giving more than 7 misoprostol tablets (14 h) during cervical ripening is very low.

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Pharmacokinetics of different routes of administration of misoprostol

Abstract: The new sublingual route of administration of misoprostol demonstrated a great potential to be developed into a method of medical abortion.

Cited by 441 publications

References 18 publications

Sublingual Misoprostol (PGE1) Versus Intracervical Dinoprostone (PGE2) Gel for Induction of Labour: A Randomized Control Trail

Sublingual Misoprostol (PGE1) Versus Intracervical Dinoprostone (PGE2) Gel for Induction of Labour: A Randomized Control Trail

A randomized trial of saline solution–moistened misoprostol versus dry misoprostol for first-trimester pregnancy failure

What is the optimal duration of oral misoprostol treatment for cervical ripening?

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