Prescribing information:
Benign gastric and duodenal ulceration and NSAID-associated ulceration
- By mouth, 800 micrograms daily (in 2-4 divided doses) with breakfast (or main meals) and at bedtime; treatment should be continued for at least 4 weeks and can be continued for up to 8 weeks if required.
Prophylaxis of NSAID-induced gastric and duodenal ulceration
- By mouth, 200 micrograms 2-4 times daily (depending on the perceived risk of bleeding in that patient), taken with the NSAID.
Synthetic prostaglandin analogue
- Reduces the volume and proteolytic actionof gastric juice.
- Also increases bicarbonate and mucus secretion.
- See prostaglandins section (p. 450) for more information.
Risk factors for NSAID-induced gastric ulceration
- Linear increase in risk with increasing age (especially over 65 years).
- History of peptic ulceration.
- Debilitated patients.
- Long-term treatment with maximal doses of NSAIDs.
- Concomitant treatment with drugs that can cause bleeding.
Treatment and prevention of benign gastric and duodenal ulcers.
- Its most common use is as prophylaxis against gastric ulceration in those at risk who need to continue taking NSAIDs.
- Unlicensed use to induce a medical abortion and to induce labour.
- Misoprostol increases uterine tone and can induce abortion. It is contraindicated in women who are pregnant or planning pregnancy.
- The manufacturers advise against use in all women of childbearing age, unless they are fully aware of the risks.
- Misoprostol has the potential to cause hypotension, although this is not commonly seen in practice. Consider alternatives for those in whom hypotension can precipitate severe complications (e.g. cerebrovascular and cardiovascular disease).
- No dosage reduction is usually required in renal or hepatic insufficiency.
Combination formulations: Advantages and disadvantages
A combination formulation contains two or, rarely, three drugs of different types. Many combination products are available, but they are only acceptable or even preferable when the following minimum criteria are met:
- When the frequency of administration of the two drugs is the same
- When the fixed doses in the combination product are therapeutically and optimally effective in most cases (i.e. when it is not necessary to alter the dose of one drug independently of the other)
- It is the second criterion that is the most difficult to achieve in clinical practice. For example, patients may require different dosages of an NSAID over time, but the dose of misoprostol does not need to change. A new prescription of the combination product will be required each time the dose of NSAID is changed; this is expensive and may be confusing for the patient.
Nevertheless, combination products do have a number of potential advantages:
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