Cytotec (Misoprostol) in Ajman
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The use of misoprostol (Cytotec) in termination of pregnancy in Ajman
Misoprostol in Ajman has been approved to be an effective agent for termination of pregnancy in various gestation, cervical ripening, labor induction in term pregnancy, and possible management of postpartum hemorrhage.
For the termination of second-trimester pregnancy using the combination of mifepristone and misoprostol seems to have the highest efficacy and the shortest time interval of abortion. When mifepristone is not available, misoprostol alone is a good alternative.
Misoprostol, 400 μg given vaginally every 3–6 hours, is probably the optimal regimen for second-trimester abortion. More than 800 μg of misoprostol is likely to have more side effects, especially diarrhea.
Although misoprostol in Ajman can be used in women with scarred uterus for termination of second-trimester pregnancy, it is recommended that women with a scarred uterus should receive lower doses and do not double the dose if there is no initial response. It is also important for us to recognize the associated teratogenic effects of misoprostol and thorough consultation before prescribing this medication to patients regarding these risks, especially when failure of abortion occurs, is needed.
Misoprostol in Ajman became one of the most useful drugs in termination of pregnancy and also for induction of labor.
The pharmacologic properties of misoprostol in Ajman
Misoprostol in Ajman is a synthetic 15-deoxy-16-hydroxy-16-methyl analog of PGE1 and is water soluble. The most common commercial preparation available in UAE is Cytotec (Pfizer) tablets (200 μg) that contains the inactive ingredients hydrogenated castor oil, hydroxypropyl methylcellulose, microcrystalline cellulose, and sodium starch glycolate.
The bioactivity of misoprostol is characterized by rapid absorption, extensive metabolism, and rapid excretion. After oral administration, the Tmax of misoprostol acid is 12 ± 3 minutes with a terminal half-life of 20–40 minutes.
There is high variability of plasma levels of misoprostol acid after single doses showing a linear relationship with dose over the range of 200–400 μg. No accumulation of misoprostol acid was noted in multiple dose studies and a plasma steady state was achieved within 2 days.
Misoprostol in Ajman is mainly metabolized in the liver, and less than 1% excreted in the urine. There is no known drug interaction of misoprostol.
In the beginning, misoprostol was only used as an oral tablet, but many studies showed many different routes of administration, such as vaginal route, sublingual route, and buccal route. Some pharmacokinetic studies show the systemic bioavailability with vaginal route is three times higher than that of oral route. Another study from Lumbiganon et al concluded that sublingual misoprostol reached peak concentration in the shortest time and had the highest bioavailability comparison with vaginal and oral routes.
Termination of pregnancy with misoprostol in Ajman
Of the various PG analogs, misoprostol is the drug of choice as it is cheap, stable at room temperature, and available in most countries. It has been used orally, vaginally, or sublingually for medical abortion.
Several PGs have been shown to have abortifacient, which is effective for inducing abortion. More analogs of PG were reported to be effective for abortion, such as parenteral sulprostone and intravaginal gemeprost. However, the adverse side effects of these medications and the higher cost made them unsuitable as single agents for abortion.
The first report of the potential effect of misoprostol in Ajman for the termination of the first-trimester pregnancy was published. Reported the effect of misoprostol in Ajman on uterine contractility and showed that misoprostol, with or without mifepristone, resulted in augmentation of the amplitude and frequency of uterine contractions. This publication was a landmark study of misoprostol and let it be a promising uterotonic agent. After this report, many researchers became interested in the effect of misoprostol as a cervical priming agent before surgical abortion or medical abortion.
Termination of second-trimester pregnancy in Ajman
The ability of early prenatal diagnosis of fetal anomalies has expanded the indications for termination of pregnancy in the second trimester. A variety of methods such as dilation and evacuation (D&E), systemic medications, intra-amniotic or extra-amniotic abortifacients, and hysterotomy have been used.
The traditional use of D&E in the second trimester basically is safe and effective. However, its safety depends on the surgeon’s skill and experience, and it may cause psychologically trauma. Thus, less traumatic and noninvasive methods for termination of pregnancy seem to be the better choices.
Furthermore, if the fetus can be delivered intact, it can give us more detailed information for further pathological and cytogenetic diagnosis. This information is very important for prenatal counseling in the future. Therefore, an alternative method is required to replace the use of D&E.
Many alternative methods for medical termination of second-trimester pregnancy are recommended, including intra-amniotic hypertonic saline or urea, intra-amniotic PGF2α infusion, oxytocin infusion, and vaginal gemeprost administration.
Misoprostol with Mifepristone in Ajman
There were some reports talk about the use of combination of mifepristone and misoprostol, which could possibly fasten the mean abortion time and improve the efficacy.
Ashok and Templeton reviewed 500 consecutive cases of medical abortion in second trimester of pregnancy and concluded that the combination of mifepristone followed by misoprostol provided a noninvasive and effective regimen for this indication.
Another present study reported that combination of mifepristone followed by misoprostol could achieve a high successful rate (95.9%) of abortion within 24 hours and mean abortion time was 6 hours.
The mean abortion time after the use of misoprostol ranged from 5.4 hours to 10 hours. The conventional timing of misoprostol administration after mifepristone for second-trimester medical abortion is 36–48 hours.
With misoprostol alone in Ajman
When mifepristone is not available, misoprostol alone is also an efficient method. There were many different studies talking about this issue, including the variation in dosage, time interval, and the route of administration were well discussed.
About the dosage in Ajman, UAE
The required amount of misoprostol in Ajman not only decreases with increasing gestational age, but has also been found to be lower in women with a died fetus. In 2002, Dickinson and Evans introduced a randomized trial comparing three regimens of intravaginal misoprostol (200 μg hourly; 400 μg 6 hourly; 600 μg loading dose followed by 200 μg 6 hourly) suggested that the 400 μg regimen was preferred.
Their latter publication of randomized controlled trial on a comparison of oral and vaginal misoprostol (400 μg orally 3 hourly; 400 μg vaginally 6 hourly; vaginally 600 μg loading dose then 200 μg orally 3 hourly) showed similar results.
Table 2. Misoprostol alone in Ajman
Misoprostol could be administered at longer than 3-hour intervals to reduce its side effects, and the 3-hour regimen provides a significantly shorter abortion interval and higher percentage of successful abortion within 48 hours than the 6-hour interval group.
The incidence of side effects was similar in the two groups excluding fever. Another pilot study from Taiwan showed that oral administration of 200 μg misoprostol at hourly intervals is also a promising method for termination of mid-trimester pregnancies, the means of induction to delivery interval was 12.0 hours with 81.3% women undergoing vaginal delivery within 24 hours, and the side effects was not significantly increased, but the case number is too small to have a new conclusion.
The latest Cochrane Database reviewed four randomized controlled trials for termination of mid-trimester pregnancy (12–28 weeks’ gestation) preferably using misoprostol tablets at 3-hourly intervals.
We can see that most of these studies use misoprostol in Ajman with the time interval from 3 hours to 6 hours, and their result had a good abortion rate and short induction to abortion interval. It seems that 3–6 hours interval is a good choice for mid-trimester termination.
About the route of administration
Many studies investigated the different routes of administration of misoprostol, such as orally, vaginally, buccally, and sublingually, even with titrated oral misoprostol has been reported.
Oral misoprostol is as effective as vaginal misoprostol if the dose was doubled. In the following year, a randomized trial of oral versus vaginal misoprostol was conducted by Gilbert and Reid and suggested that the vaginal route of administration was significantly more effective.
When comparing sublingual and vaginal routes, sublingual and vaginal misoprostol are equally safe and effective for mid-trimester pregnancy termination. We sometimes recommend that the optimal route for administrating misoprostol is vaginally.
Adverse effects of misoprostol in Ajman
Many adverse effects of misoprostol have been reported, include diarrhea, abdominal pain, headache, menstrual cramps, nausea and flatulence, chills, shivering, and fever, all of them are dose-dependent. The most common side effects are chills/shivering (38%), fever (35%), and diarrhea (24%).
Cytotec in UAE | Cytotec in Ajman
Multiple trials have proved that misoprostol in Ajman is an effective agent for termination of second-trimester pregnancy. For termination of second-trimester pregnancy, using the combination of mifepristone and misoprostol seems to have the highest efficacy and shortest abortion time interval.
When mifepristone is not available, cytotec (misoprostol) alone is a good alternative. Misoprostol, 400 μg given vaginally every 3–6 hours, is probably the optimal regimen for second-trimester abortion. More than 800 μg of misoprostol is likely to have more side effects, especially diarrhea.
Although, misoprostol can be used in women with scarred uterus for termination of second-trimester pregnancy, it is recommended that women with a scarred uterus should receive lower doses and do not double the dose if there is no initial response.
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