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 Other names for this medication:
Alsoben, Arthotec, Artotec, Artrenac, Artrotec, Asotec, Citrosol, Cyprostol, Cytil, Cytofine, Cytolog, Cytomis, Gastrul, Gymiso, Mesopil, Misodex, Misofenac, Misolast, Misolup, Misoprost, Misoprostolum, Misotrol, Noprostol, Normulen, Symbol

Pharmachologic effect
The synthetic analogue of prostaglandin E1. It has a cytoprotective effect associated with an increase in the formation of mucus in the stomach and increase the secretion of bicarbonate gastric mucosa. Providing a direct impact on the parietal cells of the stomach, misoprostol inhibits basal, nocturnal and stimulated (food, histamine, pentagastrin) secretion. It reduces basal (but not stimulated by histamine) production of pepsin.
Induces smooth muscle contraction of the myometrium and cervix expands. Increases the frequency and strength of contractions of the myometrium, giving a weak stimulating effect on the smooth muscles of the gastrointestinal tract.
The action begins in 30 minutes and lasts for at least 3-6 hours. At a dose of 50 micrograms effect of mild and short, 200 micrograms – pronounced.

Pharmacokinetics
When taken orally is rapidly and completely absorbed (food delays absorption). Plasma protein binding is 85%. In the walls of the gastrointestinal tract and liver metabolized to pharmacologically active misoprostol acid. Cmax is reached after 12 min. Css – after 2 days. Not accumulates after repeated administration. T1 / 2 – 20-40 minutes. Report the news (80%) and in the bile (15%). If the kidney function may increase Cmax almost 2-fold and increased T1 / 2.

Dosage
Is the inside. Single dose – 200-400 g, with high sensitivity and kidney failure – 100 micrograms. Multiplicity of reception and duration of use depends on the evidence and the effectiveness of treatment.

Drug Interactions
In an application with antacids decreases the concentration of misoprostol in the blood plasma.
While the use of magnesium-containing antacids may increase diarrhea.
In an application with acenocoumarol described a reduction of the anticoagulant action atsenokumarola.
While the use of diclofenac, indomethacin enhanced side effects of diclofenac and indomethacin.

Pregnancy and lactation
It contraindicated use during pregnancy and lactation (breastfeeding).
Please note that misoprostol increases the tone of the uterus and can cause miscarriage when using it as a gastroprotective agent.
If necessary, use in women of childbearing age should first conduct serum pregnancy test, which must be negative for 2 weeks before treatment with misoprostol. Treatment can be started only 2-3 days of normal menstruation. During the course of treatment should use reliable methods of contraception.

Side effects
From the digestive system: abdominal pain, flatulence, nausea, vomiting, diarrhea, constipation.
On the part of the reproductive system: abdominal pain associated with contractions of the myometrium, dysmenorrhea, polimenoreya, menorrhagia, metrorrhagia.
Allergic reactions: skin rash, itching, angioedema.
Other: changes in body weight, asthenia, fatigue; rarely – seizures (women in pre- or postmenopausal).

Indications
Prevention of gastric ulcers associated with the use of NSAIDs in patients with an increased risk of ulceration, treatment of acute duodenal ulcer, gastric ulcer.
In combination with mifepristone: termination of early pregnancy (up to 42 days of amenorrhea).

Contraindications
Expressions of the liver, inflammatory bowel disease, pregnancy, lactation, severe renal insufficiency, enteritis, childhood and adolescence to 18 years, increased sensitivity to misoprostol.

Special instructions
To use caution in patients with arterial hypertension, ischemic heart disease, cerebrovascular, koronarokardiosklerozom, epilepsy, enterocolitis, diarrhea, increased sensitivity to prostaglandins or their analogues.
Application for termination of pregnancy is carried out only in combination with mifepristone and only in specialized hospitals, with appropriately trained medical staff, and capability of emergency gynecological surgery and blood transfusion services.
Within 1 week after the administration of misoprostol should not be given aspirin and other NSAIDs.

If the kidney function
Is contraindicated in severe renal insufficiency.

If abnormal liver function
Is contraindicated in severe hepatic impairment.

Application in childhood
Is contraindicated in children and adolescents up to 18 years.
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