Cytotec (Misoprostol) - Oral

What Is Cytotec?

Cytotec (misoprostol) is a prescription medication used to prevent stomach ulcers in people taking non-steroidal anti-inflammatory drugs (NSAIDs). Although labeled as an ulcer medication, misoprostol is also commonly used in combination with Mifeprex (mifepristone) to end an early pregnancy (abortion).

Cytotec is a synthetic prostaglandin. Prostaglandin is a protective chemical naturally released in the body. NSAIDs can reduce the natural amount of prostaglandins in the stomach and intestines, leading to indigestion and ulcers if used long-term.

Misoprostol tablets replace the natural prostaglandins in the body to help reduce the risk of NSAID-induced ulcers and serious ulcer complications, such as bleeding. If you already have an ulcer, Cytotec will also help heal it.

Cytotec is a prescription medicine available as a tablet.

What Is Cytotec Used For?

The Food and Drug Administration (FDA) approved misoprostol to prevent or treat stomach ulcers due to NSAIDs (e.g., aspirin), especially in people at risk for developing ulcers and related complications. Prolonged use of NSAIDs, especially at higher doses, can lead to these kinds of ulcers. People may take NSAIDs long-term to treat chronic pain associated with arthritis or other inflammatory conditions.

Cytotec has not been shown to reduce the risk of duodenal ulcers (ulcers in the duodenum) in people taking NSAIDs.

Misoprostol is also widely used in combination with another drug called mifepristone to end an early pregnancy (abortion).

How to Take Cytotec

Ulcer Prevention

To reduce the risk of NSAID-induced gastric ulcers, take misoprostol for the duration of NSAID therapy. You will usually be prescribed to take misoprostol four times daily with meals. Take the last dose of the day before going to bed.

The dose of medicine is based on your medical condition and response to therapy. Tell your healthcare provider if you experience side effects, as they may lower your dose.

Abortion

The FDA approved misoprostol and mifepristone for use through 70 days gestation (10 weeks or less since the first day of the person's last menstrual period) for abortion. Generally, misoprostol is taken 24 to 48 hours after mifepristone. The pregnancy will pass within two to 24 hours after taking the misoprostol tablets.

In January 2023, the FDA permanently removed an in-person dispensing requirement for mifepristone, allowing certified pharmacies to offer the medication in stores or by mail with a prescription from a certified prescriber.

Misoprostol may be given to you in a healthcare provider's office or taken home.

The following are general instructions for taking misoprostol to end a pregnancy:

• Take four misoprostol tablets 24 to 48 hours after taking mifepristone
• When taking misoprostol, place two tablets in each cheek pouch (the area between the teeth and cheek) for 30 minutes. After 30 minutes, swallow what's leftover with water or another liquid.
• Make sure to take it at least 24 hours after mifepristone and no later than 48 hours after. Otherwise, it might not work as well.

Vaginal bleeding and cramping after taking mifepristone and misoprostol are expected, so don't worry if you notice this. This usually means the treatment is working. You may bleed or spot for about nine to 16 days, but it can last up to 30 days. Keep an eye on these side effects and report to your healthcare provider if you have heavy bleeding that is concerning or lasts longer than expected.

Visit your healthcare provider about one to two weeks after taking misoprostol for a follow-up appointment. They will check that the pregnancy has passed from the uterus.

Storage

Keep Cytotec tablets in their original container. Store it at or below room temperature (77 degrees F) in a dry area, away from direct light and moisture. Do not store medications in the bathroom. Keep all medicines locked away from the sight and reach of children.

Do not keep unwanted or expired medicines with you. Do not throw the unwanted drugs in the waste bin, pour them into a drain, or flush them down the toilet unless directed. The right way to discard the medications is to return them through a medicine take-back program.  Ask your pharmacist or local waste disposal company about how to discard the drugs safely.

Off-Label Uses

Healthcare providers may prescribe misoprostol for off-label uses, meaning for conditions not specifically indicated by the FDA.

Misoprostol is widely used off-label for several indications in the obstetrics and gynecology practice, including:

• Induction of labor (speeding up the process of childbirth)
• Medical management of miscarriage (loss of pregnancy)
• Cervical ripening before surgical procedures
• Treatment of postpartum hemorrhage
  

What Are the Side Effects of Cytotec?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Some common side effects of Cytotec are:

• Headache
• Stomach pain or distress (an upset stomach)
• Bloating
• Diarrhea
• Vomiting
• Constipation
• Indigestion

The following side effects are also common when taking misoprostol in combination with mifepristone for abortion:

• Vaginal bleeding: Bleeding may be similar to or heavier than your normal period.
• Cramping
• Nausea or vomiting
• Weakness
• Fever and chills
• Dizziness

Consult your healthcare provider if any of these symptoms do not go away or worsen.

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects can include the following:

• Severe ongoing stomach discomfort or diarrhea
• Dehydration symptoms such as feeling very thirsty or very hot, unable to urinate, or heavy sweating
• Vomiting blood
• Bloody, black, or tarry stools

A severe allergic reaction to Cytotec is unlikely. But seek immediate medical attention if you notice symptoms of a severe allergic reaction, such as:

• Rash or itching
• Swelling of the face, tongue, or throat
• Severe dizziness
• Difficulty breathing

If using misoprostol for abortion, contact your healthcare provider if you experience any of the following:

• Heavy bleeding (bleeding enough to soak two, thick full-size sanitary pads per hour or heavy bleeding for two hours or more)
• Stomach pain or discomfort for more than 24 hours
• Fever: A fever of 100.4 F that lasts more than four hours

Dosage: How Much Cytotec Should I Take?

Modifications

Evidence suggests no dose modifications (changes) are required in people 65 and older or in those with liver or kidney impairment.

However, your healthcare provider may prescribe a lower dose if you do not tolerate Cytotec well.

Missed Dose

Take the missed dose as soon as you remember. If it is nearly the time for the next dose, skip the missed dose. Take your following doses at the usual time. Never take a double dose to catch up.

Overdose: What Happens If I Take Too Much Cytotec?

Signs of an overdose may include:

• Sedation
• Tremor
• Convulsions
• Dyspnea (shortness of breath)
• Stomach pain
• Diarrhea
• Fever
• Palpitations (changes in the way the heart beats)
• Hypotension (low blood pressure)
• Bradycardia (slow heart rate)

Precautions

What Are Reasons I Shouldn’t Take Cytotec?

Misoprostol should not be used to treat or prevent ulcers in:

• People who can become pregnant who are not using effective contraception
• Pregnant people, those planning to become pregnant, or people who have not had a negative pregnancy test before taking the drug: Misoprostol increases uterine contractions in pregnancy, causing miscarriage, premature birth, or congenital disabilities (birth defects).
• Breastfeeding people: Misoprostol is rapidly metabolized into misoprostol acid, which is biologically active and excreted in breast milk. Therefore, it can cause diarrhea in nursing infants.
• Those with a known hypersensitivity to misoprostol, any other component of the medicine, or other prostaglandins

Intrauterine devices (IUDs) must be removed before taking misoprostol and mifepristone for abortion.

It is also only approved for use to end pregnancy up to 70 days (10 weeks) and no later.

What Other Medications Interact With Cytotec?

You can take Cytotec safely with most other drugs.

However, Cytotec may interact with the following:

• Magnesium-containing antacids: Avoid using magnesium-containing antacids during treatment with misoprostol, as it may worsen misoprostol-induced diarrhea.
• Oxytocic agents (drugs used to stimulate uterine activity and induce labor): Do not use Cytotec with these medications. An example of an oxytocic agent is Pitocin (oxytocin).

Always consult your healthcare provider about all prescription, non-prescription, and herbal or supplement products you take before starting Cytotec.

What Medications Are Similar?

Arthrotec (diclofenac and misoprostol) is a medication containing misoprostol that helps reduce pain, swelling, and joint stiffness in arthritis.

This combination drug treats the signs and symptoms of osteoarthritis or rheumatoid arthritis in people at high risk of getting gastric ulcers and complications from the ulcers.

How Can I Stay Healthy While Taking Cytotec?

Whether you have been prescribed misoprostol to prevent ulcers or end a pregnancy, it is important to take it exactly as your healthcare provider instructs.

To effectively prevent ulcers, continue taking Cytotec for as long as you are on NSAID therapy. Risk factors for NSAID-induced ulcers include:

• Older age
• Taking multiple NSAIDs
• Taking blood thinners, such as Jantoven (warfarin)
• Taking corticosteroids
• Smoking and alcohol use
• Previous history of stomach ulcers

Misoprostol as part of the abortion pill regimen (mifepristone plus misoprostol) has been widely, safely, and effectively used for some time. However, on June 24, 2022, the Supreme Court overturned Roe v. Wade—ending the constitutional right to abortion. Since that ruling, some states have enforced bans or severe restrictions on abortion, whereas others continue to protect the right to choose under state law.

Before undergoing an abortion, talk to your healthcare provider about what to expect. This can help put you more at ease when managing the side effects.

Consider the following tips to aid in your recovery after an abortion:

• Set aside time to rest for the first few days after your abortion.
• Do not engage in strenuous activity for the first week after the abortion.
• Avoid stimulating the nipples. Stimulating your nipples can cause breast discharge.
• Bleeding can occur for up to a week or more, so it can be helpful to have pads, tampons, and other menstrual supplies on hand.