第1页共8页编号：时间：2021年x月x日书山有路勤为径，学海无涯苦作舟页码：第1页共8页UsesofMisoprostolinObstetricsandGynecologyRebeccaAllen,MD,MPHandBarbaraMO’Brien,MDDepartmentofObstetricsandGynecology,WomenandInfants’HospitalandWarrenAlpertMedicalSchoolofBrownUniversity,Providence,RIAbstractMisoprostolisasyntheticprostaglandinE1analoguethatisusedoff-labelforavarietyofindicationsinthepracticeofobstetricsandgynecology,includingmedicationabortion,medicalmanagementofmiscarriage,inductionoflabor,cervicalripeningbeforesurgicalprocedures,andthetreatmentofpostpartumhemorrhage.Duetoitswide-rangingapplicationsinreproductivehealth,misoprostolisontheWorldHealthOrganizationModelListofEssentialMedicines.Thisarticlebrieflyreviewsthevariedusesofmisoprostolinobstetricsandgynecology.Keywords:Misoprostol,Inducedabortion,Inductionoflabor,Postpartumhemorrhage,Cervicalripening,HysteroscopyMisoprostolisasyntheticprostaglandinE1analoguemarketedasanoralpreparationusedtopreventandtreatgastroduodenaldamageinducedbynonsteroidalanti-inflammatorydrugs(NSAIDs).However,misoprostolisusedoff-labelforavarietyofindicationsinthepracticeofobstetricsandgynecology,includingmedicationabortion,medicalmanagementofmiscarriage,inductionoflabor,cervicalripeningbeforesurgicalprocedures,andthetreatmentofpostpartumhemorrhage.Misoprostol’seffectsaredosedependentandincludecervicalsofteninganddilation,uterinecontractions,nausea,vomiting,diarrhea,fever,andchills.AlthoughmisoprostolisnotapprovedbytheUSFoodandDrugAdministration(FDA)fortheseindications,in2002,pregnancywasremovedfromthelabelasanabsolutecontraindicationtomisoprostoluse.Misoprostol’sadvantagesoverothersyntheticprostaglandinanaloguesareitslowcost,longshelflife,lackofneedforrefrigeration,andworldwideavailability(Figure1).PharmacokineticsRoutesofmisoprostoladministrationincludeoral,vaginal,sublingual,buccal,orrectal.Pharmacokineticsstudies(Figure2)comparingoralandvaginaladministrationhaveshownthatvaginalmisoprostolisassociatedwithslowerabsorption,lowerpeakplasmalevels,andslowerclearance,similartoanextended-releasepreparation.Vaginalmisoprostolisalsoassociatedwithagreateroverallexposuretothedrug(areaunderthecurve[AUC])andgreatereffectsonthecervixanduterus.Thereis,however,awidevariationintheabsorptionofmisoprostolthroughthevaginalepitheliumamongdifferentwomen.Thereisnoclinicallysignificantdifferencebetweenvaginalmisoprostolthatisadministereddryandvaginalmisoprostolmoistenedwithwater,saline,oraceticacid.Therectalrouteofadministrationshowsasimilarpatterntovaginaladministration,buthasalowerAUC,includingasignificantlylowermaximumpeakconcentration.ThesublingualrouteofadministrationhasanAUCsimilartovaginaladministration,butmorerapidabsorptionandhigherpeaklevelsthaneithervaginalororaladministration(Figure2).Thistranslatesintohigherratesofgastrointestinalsideeffects.Nevertheless,thesublingualroutealsocausesuterinecontractionsata第2页共8页第1页共8页编号：时间：2021年x月x日书山有路勤为径，学海无涯苦作舟页码：第2页共8页rateequivalenttovaginaladministrationandhaslessvariationinabsorption.ThebuccalrouteofadministrationshowsalowerAUC,alowerpeakconcentration,andfewersideeffectsthansublingualadministration.Thebuccalroutehasapatternofabsorptionsimilartothevaginalroute,butproduceslowerserumlevelsoverall.Nonetheless,thebuccalandvaginalroutesofadministrationhavesimilareffectsonuterine...
