View source for Misoprostol

{{Short description|Medication to induce abortion and treat ulcers}}
{{Use dmy dates|date=June 2023}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox drug
| Watchedfields = changed
| verifiedrevid = 456483721
| image = Misoprostol.svg
| image_class = skin-invert-image
| width = 200
| alt = 
| caption = <!-- Clinical data -->
| pronounce = 
| tradename = Cytotec, Misodel, others
| Drugs.com = {{drugs.com|monograph|misoprostol}}
| MedlinePlus = a689009
| DailyMedID = Misoprostol
| pregnancy_AU = X
| pregnancy_AU_comment = <ref>{{cite web | url=https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2023-PI-01073-1 | title=TGA eBS - Product and Consumer Medicine Information Licence | access-date=14 April 2023 | archive-date=14 April 2023 | archive-url=https://web.archive.org/web/20230414033450/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2023-PI-01073-1 | url-status=live }}</ref><ref>{{cite web | url=https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-05416-3 | title=TGA eBS - Product and Consumer Medicine Information Licence | access-date=14 April 2023 | archive-date=14 April 2023 | archive-url=https://web.archive.org/web/20230414031955/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-05416-3 | url-status=live }}</ref>
| pregnancy_category = [[Abortifacient|Used for terminating pregnancy]]
| routes_of_administration = [[Oral administration|By mouth]], [[rectal administration|rectal]], [[intravaginal administration|intravaginal]], [[sublingual administration|sublingual]]
| class = 
| ATCvet = 
| ATC_prefix = A02
| ATC_suffix = BB01
| ATC_supplemental = {{ATC|G02|AD06}}

<!-- Legal status -->| legal_AU = S4
| legal_AU_comment = <ref>{{cite web | title=Angusta (Norgine Pty Ltd) | website=Therapeutic Goods Administration (TGA) | date=13 January 2023 | url=https://www.tga.gov.au/resources/prescription-medicines-registrations/angusta-norgine-pty-ltd | access-date=9 April 2023 | archive-date=18 March 2023 | archive-url=https://web.archive.org/web/20230318025815/https://www.tga.gov.au/resources/prescription-medicines-registrations/angusta-norgine-pty-ltd | url-status=live }}</ref>
| legal_BR = C1
| legal_BR_comment = Hospital use only<ref>{{Cite web |author=Anvisa |author-link=Brazilian Health Regulatory Agency |date=2023-03-31 |title=RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial |trans-title=Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control|url=https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 |url-status=live |archive-url=https://web.archive.org/web/20230803143925/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 |archive-date=2023-08-03 |access-date=2023-08-15 |publisher=[[Diário Oficial da União]] |language=pt-BR |publication-date=2023-04-04}}</ref>
| legal_CA = Rx-only
| legal_CA_comment = 
| legal_DE = <!-- Anlage I, II, III or Unscheduled -->
| legal_DE_comment = 
| legal_NZ = <!-- Class A, B, C -->
| legal_NZ_comment = 
| legal_UK = POM
| legal_UK_comment = <ref>{{cite web | title=Angusta 25 microgram tablets - Summary of Product Characteristics (SmPC) | website=(emc) | date=8 April 2022 | url=https://www.medicines.org.uk/emc/product/12147/smpc | access-date=9 April 2023 | archive-date=10 April 2023 | archive-url=https://web.archive.org/web/20230410051926/https://www.medicines.org.uk/emc/product/12147/smpc | url-status=live }}</ref>
| legal_US = Rx-only
| legal_US_comment = <ref>{{cite web | title=Cytotec- misoprostol tablet | website=DailyMed | date=9 July 2021 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4ab12da7-5731-4e06-bf1c-bc3f2e711f12 | access-date=13 April 2023 | archive-date=18 April 2023 | archive-url=https://web.archive.org/web/20230418121539/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4ab12da7-5731-4e06-bf1c-bc3f2e711f12 | url-status=live }}</ref>
| legal_EU = Rx-only
| legal_EU_comment = <ref>{{cite web | url=https://www.ema.europa.eu/documents/psusa/misoprostol-gynaecological-indication-labour-induction-list-nationally-authorised-medicinal-products/00010353/202005_en.pdf | title=List of nationally authorised medicinal products. Misoprostol (gastrointestinal indication). Procedure no.: PSUSA/00010353/202005 | publisher=European Medicines Agency | date=14 January 2021 | access-date=8 August 2021 | archive-date=29 June 2022 | archive-url=https://web.archive.org/web/20220629032409/https://www.ema.europa.eu/en/documents/psusa/misoprostol-gynaecological-indication-labour-induction-list-nationally-authorised-medicinal-products/00010353/202005_en.pdf | url-status=live }}</ref><ref>{{cite web | url=https://www.ema.europa.eu/documents/psusa/misoprostol-gastrointestinal-indication-list-nationally-authorised-medicinal-products-psusa/00010291/202006_en.pdf | title=List of nationally authorised medicinal products. Misoprostol (gastrointestinal indication). Procedure no.: PSUSA/00010291/202006 | publisher=European Medicines Agency | date=14 January 2021 | access-date=8 August 2021 | archive-date=29 June 2022 | archive-url=https://web.archive.org/web/20220629032409/https://www.ema.europa.eu/en/documents/psusa/misoprostol-gastrointestinal-indication-list-nationally-authorised-medicinal-products-psusa/00010291/202006_en.pdf | url-status=live }}</ref>
| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV -->
| legal_UN_comment = 
| legal_status = <!-- For countries not listed above -->

<!-- Pharmacokinetic data -->| bioavailability = extensively absorbed
| protein_bound = 80–90% (active metabolite, misoprostol acid)
| metabolism = Liver (extensive to misoprostic acid)
| metabolites = 
| onset = 
| elimination_half-life = 20–40 minutes
| duration_of_action = 
| excretion = Urine (80%)

<!-- Identifiers -->| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 59122-46-2
| CAS_supplemental = 
| PubChem = 5282381
| IUPHAR_ligand = 1936
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00929
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 4445541
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = 0E43V0BB57
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00419
| ChEBI = 
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 606
| NIAID_ChemDB = 
| PDB_ligand = 
| synonyms = <!-- Chemical and physical data -->
| IUPAC_name = Methyl 7-((1''R'',2''R'',3''R'')-3-hydroxy-2-((''S,E'')-4-hydroxy-4-methyloct-1-enyl)-5-oxocyclopentyl)heptanoate
| C = 22
| H = 38
| O = 5
| SMILES = CCCC[C@](C)(O)C/C=C/[C@H]1[C@H](O)CC(=O)[C@@H]1CCCCCCC(=O)OC
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C22H38O5/c1-4-5-14-22(2,26)15-10-12-18-17(19(23)16-20(18)24)11-8-6-7-9-13-21(25)27-3/h10,12,17-18,20,24,26H,4-9,11,13-16H2,1-3H3/b12-10+/t17-,18-,20-,22?/m1/s1
| StdInChI_comment = 
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = OJLOPKGSLYJEMD-URPKTTJQSA-N
| density = 
| density_notes = 
| melting_point = 
| melting_high = 
| melting_notes = 
| boiling_point = 
| boiling_notes = 
| solubility = 
| sol_units = 
| specific_rotation = 
}}

<!-- Definition and uses -->
'''Misoprostol''' is a synthetic [[prostaglandin]] medication used to prevent and treat [[peptic ulcer|stomach and duodenal ulcer]]s, [[labor induction|induce labor]], cause an [[abortion]], and treat [[postpartum bleeding]] due to poor contraction of the [[uterus]].<ref name=Ros2002>{{cite journal | vauthors = Rostom A, Dube C, Wells G, Tugwell P, Welch V, Jolicoeur E, McGowan J | title = Prevention of NSAID-induced gastroduodenal ulcers | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 4 | article-number = CD002296 | year = 2002 | pmid = 12519573 | pmc = 8439413 | doi = 10.1002/14651858.CD002296 | s2cid = 1052260 }}</ref><ref name=AHFS2015>{{cite web|title=Misoprostol|url=https://www.drugs.com/monograph/misoprostol.html|publisher=The American Society of Health-System Pharmacists|access-date=20 February 2015|url-status=live|archive-url=https://web.archive.org/web/20150221072240/http://www.drugs.com/monograph/misoprostol.html|archive-date=21 February 2015}}</ref> It is taken [[by mouth]] when used to prevent gastric ulcers in people taking [[nonsteroidal anti-inflammatory drug]]s (NSAID).<ref name=AHFS2015/> For abortions it is typically used in conjunction with [[mifepristone]] or [[methotrexate]], but can be used alone.<ref name="Zhang_2022">{{cite journal | vauthors = Zhang J, Zhou K, Shan D, Luo X | title = Medical methods for first trimester abortion | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 5 | article-number = CD002855 | date = May 2022 | pmid = 35608608 | pmc = 9128719 | doi = 10.1002/14651858.CD002855.pub5 }}</ref> By itself, effectiveness for abortion is between 82% and 100%.<ref name="Moseson_2024">{{cite journal | vauthors = Moseson H, Jayaweera R, Baum SE, Gerdts C | title = How Effective Is Misoprostol Alone for Medication Abortion? | journal = NEJM Evidence | volume = 3 | issue = 6 | article-number = EVIDccon2300129 | date = June 2024 | pmid = 38804786 | doi = 10.1056/EVIDccon2300129 }}</ref> Its efficacy with mifepristone is higher, but varies based on gestational age.<ref>{{cite journal | vauthors = Fjerstad M, Sivin I, Lichtenberg ES, Trussell J, Cleland K, Cullins V | title = Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days | journal = Contraception | volume = 80 | issue = 3 | pages = 282–286 | date = September 2009 | pmid = 19698822 | pmc = 3766037 | doi = 10.1016/j.contraception.2009.03.010 }}</ref> The misoprostol-only abortion regimen is typically recommended only when mifepristone is not available.<ref name="Krugh_2025">{{cite book | vauthors = Krugh M, Patel P, Maani CV | chapter = Misoprostol |date=2025 | title = StatPearls | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK539873/ |access-date=2025-03-12 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30969695 }}</ref> For labor induction or abortion, it is taken by mouth, dissolved in the mouth, or [[Intravaginal administration|placed in the vagina]].<ref name="Zhang_2022" /><ref>{{cite journal | vauthors = Marret H, Simon E, Beucher G, Dreyfus M, Gaudineau A, Vayssière C, Lesavre M, Pluchon M, Winer N, Fernandez H, Aubert J, Bejan-Angoulvant T, Jonville-Bera AP, Clouqueur E, Houfflin-Debarge V, Garrigue A, Pierre F | title = Overview and expert assessment of off-label use of misoprostol in obstetrics and gynaecology: review and report by the Collège national des gynécologues obstétriciens français | journal = European Journal of Obstetrics, Gynecology, and Reproductive Biology | volume = 187 | pages = 80–84 | date = April 2015 | pmid = 25701235 | doi = 10.1016/j.ejogrb.2015.01.018 }}</ref><ref>{{cite journal |vauthors=Prager S |title=Early Pregnancy Loss |url=https://static1.squarespace.com/static/5d3a2e1399c0960001b14452/t/5dc2031df1ffb26c011ff481/1572995870418/ACOG+EPL+Bulletin_update.pdf |journal=ACOG Practice Bulletin |issue=200 |publisher=ACOG |access-date=2 June 2021 |archive-date=2 June 2021 |archive-url=https://web.archive.org/web/20210602215845/https://static1.squarespace.com/static/5d3a2e1399c0960001b14452/t/5dc2031df1ffb26c011ff481/1572995870418/ACOG+EPL+Bulletin_update.pdf |url-status=live }}</ref><ref name="ACOG Practice Bulletin No. 200: Ear" /><ref name="Early Pregnancy Loss">{{cite web | title=Early Pregnancy Loss | website=ACOG | date=20 January 2015 | url=https://www.acog.org/en/clinical/clinical-guidance/practice-bulletin/articles/2018/11/early-pregnancy-loss | access-date=25 June 2023 | archive-date=19 January 2023 | archive-url=https://web.archive.org/web/20230119024855/https://www.acog.org/en/clinical/clinical-guidance/practice-bulletin/articles/2018/11/early-pregnancy-loss | url-status=live }}</ref> For postpartum bleeding it may also be [[Rectal administration|used rectally]].<ref>{{cite journal | vauthors = Blum J, Alfirevic Z, Walraven G, Weeks A, Winikoff B | title = Treatment of postpartum hemorrhage with misoprostol | journal = International Journal of Gynaecology and Obstetrics | volume = 99 | issue = Suppl 2 | pages = S202–S205 | date = December 2007 | pmid = 17961565 | doi = 10.1016/j.ijgo.2007.09.013 | s2cid = 10997666 }}</ref>

<!-- Side effects and mechanism-->
Common side effects include [[diarrhea]] and abdominal pain.<ref name=AHFS2015/> It is in [[pregnancy category]] X, meaning that it is known to result in negative outcomes for the fetus if taken during [[pregnancy]].<ref name=AHFS2015/> In rare cases, [[uterine rupture]] may occur.<ref name=AHFS2015/> It is a [[prostaglandin analogue]]—specifically, a synthetic [[prostaglandin E1|prostaglandin E<sub>1</sub>]] (PGE<sub>1</sub>).<ref name=AHFS2015/>

<!-- Society and economics -->
Misoprostol was developed in 1973 and first created for the treatment of gastric ulcers.<ref>{{cite book|vauthors=Paul M|title=Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care|date=2011|publisher=John Wiley & Sons|isbn=978-1-4443-5847-6|chapter-url=https://books.google.com/books?id=iK7xrRr2p9sC&pg=RA1-PT161|chapter=Misoprostol|access-date=18 August 2020|archive-date=29 June 2022|archive-url=https://web.archive.org/web/20220629032410/https://books.google.com/books?id=iK7xrRr2p9sC&pg=RA1-PT161|url-status=live}}</ref><ref name="Moseson_2024" /> Its first uses for abortion emerged in Latin America in the 1980s, as women noticed miscarriage was a side effect of the medication.<ref name="Moseson_2024" /> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO22nd">{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 22nd list (2021) | year = 2021 | hdl = 10665/345533 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2021.02 | hdl-access=free }}</ref> It is available as a [[generic medication]].<ref name=AHFS2015/>

==Medical uses==

===Ulcer prevention===
Misoprostol is used for the prevention of [[NSAID]]-induced gastric ulcers. It acts upon gastric [[parietal cell]]s, inhibiting the secretion of [[gastric acid]] by [[G-protein coupled receptor]]-mediated inhibition of [[adenylate cyclase]], which leads to decreased intracellular [[cyclic AMP]] levels and decreased [[proton pump]] activity at the [[apical membrane|apical]] surface of the parietal cell. Misoprostol is sometimes coprescribed with NSAIDs to prevent their common adverse effect of [[gastric ulcer]]ation (e.g., with [[diclofenac]] in ''[[Arthrotec]]'').<ref name="Krugh_2025" />

However, even in the treatment of NSAID-induced ulcers, [[omeprazole]] proved to be at least as effective as misoprostol,<ref>{{cite journal | vauthors = Hawkey CJ, Karrasch JA, Szczepañski L, Walker DG, Barkun A, Swannell AJ, Yeomans ND | title = Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. Omeprazole versus Misoprostol for NSAID-induced Ulcer Management (OMNIUM) Study Group | journal = The New England Journal of Medicine | volume = 338 | issue = 11 | pages = 727–34 | date = March 1998 | pmid = 9494149 | doi = 10.1056/NEJM199803123381105 | hdl = 2445/178575 | hdl-access = free }}</ref> but was significantly better tolerated, so misoprostol is not considered a first-line treatment. Misoprostol-induced diarrhea and the need for multiple daily doses impairing treatment for gastric ulcers.<ref>{{cite journal | vauthors = Rostom A, Dube C, Wells G, Tugwell P, Welch V, Jolicoeur E, McGowan J | title = Prevention of NSAID-induced gastroduodenal ulcers | journal = The Cochrane Database of Systematic Reviews | issue = 4 | article-number = CD002296 | date = 2002 | volume = 2021 | pmid = 12519573 | doi = 10.1002/14651858.CD002296 | pmc = 8439413 }}</ref>

===Labor induction===
Misoprostol is commonly used for [[labor induction]]. It causes [[uterine]] contractions and the ripening ([[Cervical effacement|effacement]] or thinning) of the [[cervix]].<ref>{{cite journal | vauthors = Goldberg AB, Greenberg MB, Darney PD | title = Misoprostol and pregnancy | journal = The New England Journal of Medicine | volume = 344 | issue = 1 | pages = 38–47 | date = January 2001 | pmid = 11136959 | doi = 10.1056/NEJM200101043440107 }}</ref> It can be less expensive than the other commonly used ripening agent, [[Prostaglandin E2|dinoprostone]].<ref name="summers"/>

[[Oxytocin]] has long been used as the standard agent for labor induction, but does not work well when the cervix is not yet ripe. Misoprostol also may be used in conjunction with oxytocin.<ref name="summers">{{cite journal | vauthors = Summers L | title = Methods of cervical ripening and labor induction | journal = Journal of Nurse-Midwifery | volume = 42 | issue = 2 | pages = 71–85 | year = 1997 | pmid = 9107114 | doi = 10.1016/S0091-2182(96)00138-3 }}</ref>

Between 2002 and 2012, a misoprostol vaginal insert was studied, and was approved in the EU.<ref>{{cite press release | title=Misodel, Ferring's Removable Misoprostol Vaginal Delivery System, Approved for Labour Induction in European Decentralised Procedure | publisher=Ferring Pharmaceuticals | via=Business Wire | date=17 October 2013 | url=https://www.businesswire.com/news/home/20131017005499/en/MISODEL%E2%84%A2-Ferring%E2%80%99s-Removable-Misoprostol-Vaginal-Delivery-System-Approved-for-Labour-Induction-in-European-Decentralised-Procedure | access-date=25 June 2023}}</ref><ref>{{cite journal | vauthors = Wing DA, Brown R, Plante LA, Miller H, Rugarn O, Powers BL | title = Misoprostol vaginal insert and time to vaginal delivery: a randomized controlled trial | journal = Obstetrics and Gynecology | volume = 122 | issue = 2 Pt 1 | pages = 201–9 | date = August 2013 | pmid = 23857539 | doi = 10.1097/AOG.0b013e31829a2dd6 | s2cid = 31090241 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Varlas VN, Bostan G, Nasui BA, Bacalbasa N, Pop AL | title = Is Misoprostol Vaginal Insert Safe for the Induction of Labor in High-Risk Pregnancy Obese Women? | journal = Healthcare | volume = 9 | issue = 4 | page = 464 | date = April 2021 | pmid = 33919898 | pmc = 8070889 | doi = 10.3390/healthcare9040464 | doi-access = free }}</ref> It was not approved for use in the United States, and the US FDA still considers cervical ripening and labor induction to be outside of the approved uses for misoprostol.<ref>{{cite web|title=Safety Information, Cytotec (misoprostol) Tablets|url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm330991.htm|publisher=U.S. [[Food and Drug Administration]] (FDA)|access-date=16 March 2017|date=11 December 2012|archive-url=https://web.archive.org/web/20170120123024/http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm330991.htm|archive-date=20 January 2017}}</ref><ref>{{cite web|title=Misoprostol (marketed as Cytotec) Information|url=https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/misoprostol-marketed-cytotec-information|publisher=U.S. [[Food and Drug Administration]] (FDA)|access-date=17 August 2020|date=10 July 2015|archive-url=https://web.archive.org/web/20200527035726/https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/misoprostol-marketed-cytotec-information|archive-date=27 May 2020}}</ref> The vaginal and oral routes of misoprostol for labor induction are comparably effective, and are considered on a case-by-case basis by healthcare professionals.<ref>{{cite journal | vauthors = Rahimi M, Haghighi L, Baradaran HR, Azami M, Larijani SS, Kazemzadeh P, Moradi Y | title = Comparison of the effect of oral and vaginal misoprostol on labor induction: updating a systematic review and meta-analysis of interventional studies | journal = European Journal of Medical Research | volume = 28 | issue = 1 | article-number = 51 | date = January 2023 | pmid = 36707858 | pmc = 9881312 | doi = 10.1186/s40001-023-01007-8 | doi-access = free }}</ref>

===Myomectomy===
When administered prior to [[myomectomy]] in women with [[Uterine fibroid|uterine fibroids]], misoprostol reduces operative blood loss, requirement of blood transfusion, and operating time.<ref>{{cite journal | vauthors = Wali S, Balfoussia D, Touqmatchi D, Quinn S | title = Misoprostol for open myomectomy: a systematic review and meta-analysis of randomised control trials | journal = BJOG | volume = 128 | issue = 3 | pages = 476–483 | date = February 2021 | pmid = 32613769 | doi = 10.1111/1471-0528.16389 | s2cid = 220307235 }}</ref> 

===Abortion===
Misoprostol is used either alone or in conjunction with another medication ([[mifepristone]] or [[methotrexate]]) for [[medical abortion]]s as an alternative to [[vacuum aspiration|surgical abortion]].<ref>{{Cite web|title = Medical methods for first trimester abortion|url = http://apps.who.int/rhl/fertility/abortion/dgguide/en/|website = [[World Health Organization]] (WHO) |access-date = 4 February 2016|archive-url = https://web.archive.org/web/20160214074838/http://apps.who.int/rhl/fertility/abortion/dgguide/en/|archive-date = 14 February 2016}}</ref> Misoprostol alone is typically only recommended when another medication is not available and is more effective when paired with mifepristone or methotrexate.<ref name="Krugh_2025" /><ref name="WHO_2012" /> Medical abortion has the advantage of being less invasive, and more autonomous, self-directed, and discreet. It is preferred by some women because it feels more natural, as the drugs induce a miscarriage.<ref>{{cite journal | vauthors = Harvey SM, Beckman LJ, Castle MA, Coeytaux F | s2cid = 30491792 | title = Knowledge and perceptions of medical abortion among potential users | journal = Family Planning Perspectives | volume = 27 | issue = 5 | pages = 203–7 | date = 1 October 1995 | pmid = 9104607 | doi = 10.2307/2136276 | jstor = 2136276 }}</ref> It is also more easily accessible in places where abortion is illegal.<ref name="Löwy_2020">{{cite journal | vauthors = Löwy I, Dias Villela Corrêa MC | title = The "Abortion Pill" Misoprostol in Brazil: Women's Empowerment in a Conservative and Repressive Political Environment | journal = American Journal of Public Health | volume = 110 | issue = 5 | pages = 677–684 | date = May 2020 | pmid = 32191521 | pmc = 7144453 | doi = 10.2105/AJPH.2019.305562 }}</ref> The [[World Health Organization]] (WHO) provides clear guidelines on the use, benefits and risks of misoprostol for abortions.<ref>{{cite web|title= Medical methods for first trimester abortion|publisher= The WHO Medical Reproductive Library|url= http://apps.who.int/rhl/fertility/abortion/dgguide/en/|access-date= 22 June 2014|archive-url= https://web.archive.org/web/20140802174632/http://apps.who.int/rhl/fertility/abortion/dgguide/en/|archive-date= 2 August 2014}}</ref>

Misoprostol is most effective when it is used in combination with methotrexate or mifepristone (RU-486).<ref name="WHO_2012">{{Cite book|title=Safe abortion: technical and policy guidance for health systems | publisher = World Health Organization |isbn=978-92-4-154843-4|edition=Second|location=Geneva|oclc=812323067|year = 2012}}</ref> Mifepristone blocks signaling by [[progesterone]], causing the uterine lining to degrade, the blood vessels of the [[cervix]] and [[uterus]] to dilate and causing uterine contraction, similar to a [[menstrual period]], which causes the embryo to detach from the uterine walls.<ref name=AHFS2023>{{cite web|title=Mifepristone|url=https://www.drugs.com/monograph/mifepristone.html|publisher=The American Society of Health System Pharmacists|access-date=25 February 2023|date=18 January 2023|url-status=live|archive-date=22 December 2015|archive-url=https://web.archive.org/web/20151222083002/http://www.drugs.com/monograph/mifepristone.html}}</ref> Misoprostol then dilates the cervix and induces muscle contractions which clear the uterus.<ref>{{cite journal | vauthors = Alfirevic Z, Aflaifel N, Weeks A | title = Oral misoprostol for induction of labour | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 6 | article-number = CD001338 | date = June 2014 | pmid = 24924489 | pmc = 6513439 | doi = 10.1002/14651858.CD001338.pub3 }}</ref><ref name="Allen_2007" /> Misoprostol alone is less effective (typically 88% up to eight-weeks gestation).<ref name="Moseson_2024" /> It is not inherently unsafe if medically supervised, but 1% of women will have heavy bleeding requiring medical attention, some women may have [[ectopic pregnancy]], and the 12% of pregnancies that continue after misoprostol failure are more likely to have birth defects and are usually followed up with surgical intervention.<ref>{{cite journal | vauthors = Haimov-Kochman R, Arbel R, Sciaky-Tamir Y, Brzezinski A, Laufer N, Yagel S | title = Risk factors for unsuccessful medical abortion with mifepristone and misoprostol | journal = Acta Obstetricia et Gynecologica Scandinavica | volume = 86 | issue = 4 | pages = 462–466 | date = 2007 | pmid = 17486469 | doi = 10.1080/00016340701203632 }}</ref>

Most large studies recommend a protocol for the use of misoprostol in combination with mifepristone.<ref>{{cite web|title=Annotated Bibliography on Misoprostol Alone for Early Abortion|publisher=Gynuity Health Projects|url=https://gynuity.org/assets/resources/biblioref_misoearlyab.pdf |access-date=22 August 2006|url-status=live |archive-url=https://web.archive.org/web/20070929071156/http://www.rhtp.org/news/publications/documents/Miso%20for%20Pregnancy%20Termination.Bibliography.pdf|archive-date=29 September 2007}}</ref><ref>{{cite web | title=Annotated Bibliography - Misoprostol for Early Abortion | website=Gynuity Health Projects | date=1 September 2004 | url=https://gynuity.org/resources/annotated-bibliography-misoprostol-for-early-abortion | access-date=25 June 2023 | archive-date=18 May 2022 | archive-url=https://web.archive.org/web/20220518184738/https://gynuity.org/resources/annotated-bibliography-misoprostol-for-early-abortion | url-status=live }}</ref> Together they are effective in around 95% for early pregnancies.<ref>{{cite book|title=Providing medical abortion in low-resource settings|date=2009|publisher=Gynuity Health Projects|page=4|edition= Second | url = https://gynuity.org/assets/resources/clinguide_maguide2nd_edition_en.pdf |url-status=live |archive-url=https://web.archive.org/web/20160222095552/http://gynuity.org/downloads/clinguide_maguide2nd_edition_en.pdf|archive-date=22 February 2016|access-date=31 August 2015}}</ref> Misoprostol alone may be more effective in earlier gestation.<ref>{{cite web|title=Instructions for Use: Abortion Induction with Misoprostol in Pregnancies up to 9 Weeks LMP|publisher=Gynuity Health Projects |year=2003|url=https://gynuity.org/assets/resources/clinguide_ifu_abortion_en.pdf |access-date=24 August 2006|url-status=live |archive-url=https://web.archive.org/web/20070929071204/http://www.rhtp.org/news/publications/documents/Miso%20for%20Pregnancy%20Termination.IFU.English.pdf#search=%22%20site%3Awww.rhtp.org%20misoprostol%20abortion%20success%20rate%22|archive-date=29 September 2007}}</ref>

Misoprostol can also be used to [[Cervical dilation|dilate the cervix]] in preparation for a first-trimester surgical abortion (either alone or in combination with [[osmotic dilators]]), but is not routinely recommended.<ref name="Allen_2007">{{cite journal | vauthors = Allen RH, Goldberg AB | title = Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation). SFP Guideline 20071 | journal = Contraception | volume = 76 | issue = 2 | pages = 139–156 | date = August 2007 | pmid = 17656184 | doi = 10.1016/j.contraception.2007.05.001 }}</ref>

Misoprostol by mouth is the least effective treatment for producing complete abortion in a period of 24 hours due to the liver's [[First pass effect|first-pass effect]] which reduces the [[bioavailability]] of the misoprostol. Vaginal and sublingual routes result in greater efficacy and extended duration of action because these routes of administration allow the drug to be directly absorbed into circulation by bypassing the liver first-pass effect.<ref name="Wu_2017" /><ref name="ACOG Practice Bulletin No. 200: Ear">{{cite journal | title = ACOG Practice Bulletin No. 200: Early Pregnancy Loss | journal = Obstetrics and Gynecology | volume = 132 | issue = 5 | pages = e197–e207 | date = November 2018 | pmid = 30157093 | doi = 10.1097/AOG.0000000000002899 | author1 = American College of Obstetricians Gynecologists' Committee on Practice Bulletins—Gynecology | s2cid = 13149908 }}</ref><ref name="Early Pregnancy Loss" />

[[Hematocrit]] or Hb tests and Rh testing are recommended before use for abortion confirmation of pregnancy.<ref name="ACOG_2014">{{cite journal | title = Practice bulletin no. 143: medical management of first-trimester abortion | journal = Obstetrics and Gynecology | volume = 123 | issue = 3 | pages = 676–92 | date = March 2014 | pmid = 24553166 | doi = 10.1097/01.AOG.0000444454.67279.7d | author1 = American College of Obstetricians Gynecologists | s2cid = 23951273 | doi-access =  }}</ref> Following use, it is recommended that people attend a follow-up visit 2 weeks after treatment. If used for treatment of complete abortion, a pregnancy test, physical examination of the uterus, and ultrasound should be performed to ensure success of treatment. Surgical management is possible in the case of failed treatment.<ref name="Wu_2017" />

===Early pregnancy loss===
Misoprostol may be used to complete a [[miscarriage]] or [[missed abortion]] when the body does not expel the embryo or fetus on its own. It can decrease the time to complete expulsion.<ref>{{cite journal | vauthors = Lemmers M, Verschoor MA, Kim BV, Hickey M, Vazquez JC, Mol BW, Neilson JP | title = Medical treatment for early fetal death (less than 24 weeks) | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | article-number = CD002253 | date = June 2019 | issue = 6 | pmid = 31206170 | pmc = 6574399 | doi = 10.1002/14651858.CD002253.pub4 }}</ref> Use of a single dose of misoprostol vaginally or buccally is preferred, with additional doses as needed. It also can be used in combination with mifepristone, with a similar regimen to medical abortion.<ref name="ACOG Practice Bulletin No. 200: Ear"/><ref name="Early Pregnancy Loss" />

===Postpartum bleeding===
Misoprostol is also used to prevent and treat [[post-partum bleeding]]. Orally administered misoprostol is marginally less effective than [[oxytocin]].<ref>{{cite journal | vauthors = Villar J, Gülmezoglu AM, Hofmeyr GJ, Forna F | s2cid = 24561459 | title = Systematic review of randomized controlled trials of misoprostol to prevent postpartum hemorrhage | journal = Obstetrics and Gynecology | volume = 100 | issue = 6 | pages = 1301–12 | date = December 2002 | pmid = 12468178 | doi = 10.1016/S0029-7844(02)02371-2 }}</ref> Rectally administered misoprostol has been shown to be associated with lower rates of side effects compared to other routes.<ref>{{cite journal | vauthors = O'Brien P, El-Refaey H, Gordon A, Geary M, Rodeck CH | title = Rectally administered misoprostol for the treatment of postpartum hemorrhage unresponsive to oxytocin and ergometrine: a descriptive study | journal = Obstetrics and Gynecology | volume = 92 | issue = 2 | pages = 212–4 | date = August 1998 | pmid = 9699753 | doi = 10.1016/S0029-7844(98)00161-6 }}</ref><ref>{{cite journal | vauthors = Lokugamage AU, Sullivan KR, Niculescu I, Tigere P, Onyangunga F, El Refaey H, Moodley J, Rodeck CH | title = A randomized study comparing rectally administered misoprostol versus Syntometrine combined with an oxytocin infusion for the cessation of primary post partum hemorrhage | journal = Acta Obstetricia et Gynecologica Scandinavica | volume = 80 | issue = 9 | pages = 835–9 | date = September 2001 | pmid = 11531635 | doi = 10.1034/j.1600-0412.2001.080009835.x | s2cid = 23335277 | doi-access = free }}</ref> It is inexpensive and thermostable (not requiring refrigeration like oxytocin), making it a cost-effective and valuable drug to use in the developing world.<ref>{{cite journal | vauthors = Bradley SE, Prata N, Young-Lin N, Bishai DM | title = Cost-effectiveness of misoprostol to control postpartum hemorrhage in low-resource settings | journal = International Journal of Gynaecology and Obstetrics | volume = 97 | issue = 1 | pages = 52–6 | date = April 2007 | pmid = 17316646 | doi = 10.1016/j.ijgo.2006.12.005 | s2cid = 23593148 }}</ref> A randomized control trial of misoprostol use found a 38% reduction in maternal deaths due to postpartum hemorrhage in resource-poor communities.<ref>{{cite journal | vauthors = Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, Patted SS, Patel A, Edlavitch SA, Hartwell T, Chakraborty H, Moss N | s2cid = 22275092 | title = Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial | journal = Lancet | volume = 368 | issue = 9543 | pages = 1248–53 | date = October 2006 | pmid = 17027730 | doi = 10.1016/S0140-6736(06)69522-6 }}</ref> Oxytocin must also be given by injection, while misprostol can be given orally or rectally for this use, making it much more useful in areas where nurses and physicians are less available.<ref>{{cite journal | vauthors = Prata N, Passano P, Bell S, Rowen T, Potts M | title = New hope: community-based misoprostol use to prevent postpartum haemorrhage | journal = Health Policy and Planning | volume = 28 | issue = 4 | pages = 339–46 | date = July 2013 | pmid = 22879523 | doi = 10.1093/heapol/czs068 | doi-access = free }}</ref>

===Insertion of intrauterine contraceptive device===
In women with prior caesarean section or prior failure of insertion of an intrauterine contraceptive device, pre-procedure administration of misoprostol reduces the rate of failure of insertion of intrauterine contraceptive device. However, due to a higher rate of adverse effects, routine use of misoprostol to dilate the cervix in preparation for intrauterine contraceptive device insertion in other cases is not recommended.<ref>{{cite journal |vauthors=Tassi A, Parisi N, Londero AP |title=Misoprostol administration prior to intrauterine contraceptive device insertion: a systematic review and meta-analysis of randomised controlled trials |journal=Eur J Contracept Reprod Health Care |volume=25 |issue=1 |pages=76–86 |date=February 2020 |pmid=31914331 |doi=10.1080/13625187.2019.1706079 |s2cid=210120219 |url=https://figshare.com/articles/dataset/Misoprostol_administration_prior_to_intrauterine_contraceptive_device_insertion_a_systematic_review_and_meta-analysis_of_randomised_controlled_trials/11555661 |access-date=21 June 2022 |archive-date=29 June 2022 |archive-url=https://web.archive.org/web/20220629032412/https://figshare.com/articles/dataset/Misoprostol_administration_prior_to_intrauterine_contraceptive_device_insertion_a_systematic_review_and_meta-analysis_of_randomised_controlled_trials/11555661 |url-status=live |url-access=subscription }}</ref><ref>{{Cite journal | vauthors = Curtis KM |date=2024 |title=U.S. Selected Practice Recommendations for Contraceptive Use, 2024 |url=https://www.cdc.gov/mmwr/volumes/73/rr/rr7303a1.htm#suggestedcitation |journal=MMWR. Recommendations and Reports |language=en-us |volume=73 |issue=3 |pages=1–77 |doi=10.15585/mmwr.rr7303a1 |pmid=39106301 |pmc=11340200 |issn=1057-5987}}</ref> 

===Other===
Misoprostol is used for [[Cervical dilation|cervical ripening]] in advance of endometrial biopsy to reduce the need for use of a tenaculum or cervical dilator, but may be associated with increased pain and side effects during and after the procedure.<ref>{{cite journal | vauthors = Perrone JF, Caldito G, Mailhes JB, Tucker AN, Ford WR, London SN | title = Oral misoprostol before office endometrial biopsy | journal = Obstetrics and Gynecology | volume = 99 | issue = 3 | pages = 439–444 | date = March 2002 | pmid = 11864671 | doi = 10.1016/s0029-7844(01)01742-2 }}</ref>

There is limited evidence supporting the use of misoprostol for the treatment of [[trigeminal neuralgia]] in patients with [[multiple sclerosis]].<ref>{{cite journal | vauthors = ((DMKG study group))| title = Misoprostol in the treatment of trigeminal neuralgia associated with multiple sclerosis | journal = Journal of Neurology | volume = 250 | issue = 5 | pages = 542–545 | date = May 2003 | pmid = 12736732 | doi = 10.1007/s00415-003-1032-1 | s2cid = 36493785 }}</ref><ref>{{cite journal | vauthors = Di Stefano G, Truini A, Cruccu G | title = Current and Innovative Pharmacological Options to Treat Typical and Atypical Trigeminal Neuralgia | journal = Drugs | volume = 78 | issue = 14 | pages = 1433–1442 | date = September 2018 | pmid = 30178160 | pmc = 6182468 | doi = 10.1007/s40265-018-0964-9 }}</ref>

==Adverse effects==
The most commonly reported [[adverse effect]] of taking misoprostol by mouth for the prevention of stomach ulcers is [[diarrhea]]. In clinical trials, an average 13% of people reported diarrhea, which was dose-related and usually developed early in the course of therapy (after 13 days) and was usually self-limiting (often resolving within 8 days), but sometimes (in 2% of people) required discontinuation of misoprostol.<ref name="Cytotec USPI">{{cite web | title=Cytotec- misoprostol tablet | website=DailyMed | date=9 July 2021 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4ab12da7-5731-4e06-bf1c-bc3f2e711f12 | access-date=25 June 2023 | archive-date=18 April 2023 | archive-url=https://web.archive.org/web/20230418121539/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4ab12da7-5731-4e06-bf1c-bc3f2e711f12 | url-status=live }}</ref>

The next most commonly reported adverse effects of taking misoprostol by mouth for the prevention of gastric ulcers are: [[abdominal pain]], [[nausea]], [[flatulence]], [[headache]], [[dyspepsia]], [[vomiting]], and [[constipation]], but none of these adverse effects occurred more often than when taking [[placebo]]s.<ref name="Cytotec USPI"/>

There are increased side effects with sublingual or oral misoprostol, compared to a low dose (400&nbsp;μg) vaginal misoprostol. However, low dose vaginal misoprostol was linked with low complete abortion rate.<ref name="Wu_2017">{{cite journal | vauthors = Wu HL, Marwah S, Wang P, Wang QM, Chen XW | title = Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis | journal = Scientific Reports | volume = 7 | issue = 1 | article-number = 1664 | date = May 2017 | pmid = 28490770 | pmc = 5431938 | doi = 10.1038/s41598-017-01892-0 | bibcode = 2017NatSR...7.1664W }} [[File:CC-BY icon.svg|50px]] Material was copied from this source, which is available under a [https://creativecommons.org/licenses/by/4.0/ Creative Commons Attribution 4.0 International License] {{Webarchive|url=https://web.archive.org/web/20171016050101/https://creativecommons.org/licenses/by/4.0/ |date=16 October 2017 }}.</ref> The study concluded that sublingually administered misoprostol dosed at 600&nbsp;μg or 400&nbsp;μg had greater instances of fever and diarrhea due to its quicker onset of action, higher peak concentration and bioavailability in comparison to vaginal or oral misoprostol.<ref name="Wu_2017" />

For the indication of medical abortion, bleeding and cramping is commonly experienced after administration of misoprostol. Bleeding and cramping is likely to be greater than that experienced with menses, however, emergency care is advised if bleeding is excessive.<ref name="ACOG_2014" />

Misoprostol should not be taken by pregnant women with wanted pregnancies to reduce the risk of NSAID-induced gastric ulcers because it increases uterine tone and contractions in pregnancy, which may cause partial or complete abortions, and because its use in pregnancy has been associated with birth defects.<ref name="Cytotec USPI"/><ref name="Cytotec UK SPC">{{cite web | title=Cytotec 200mcg Tablets - Summary of Product Characteristics (SmPC) | website=(emc) | date=26 April 2021 | url=https://www.medicines.org.uk/emc/product/1642/smpc | access-date=25 June 2023 | archive-date=1 July 2022 | archive-url=https://web.archive.org/web/20220701225414/https://www.medicines.org.uk/emc/product/1642/smpc | url-status=live }}</ref>

All cervical ripening and induction agents can cause [[uterine hyperstimulation]], which can negatively affect the blood supply to the fetus and increases the risk of complications such as uterine rupture.<ref name="briggs">{{cite journal | vauthors = Briggs GG, Wan SR | title = Drug therapy during labor and delivery, part 2 | journal = American Journal of Health-System Pharmacy | volume = 63 | issue = 12 | pages = 1131–9 | date = June 2006 | pmid = 16754739 | doi = 10.2146/ajhp050265.p2 }}</ref> Concern has been raised that uterine hyperstimulation that occurs during a misoprostol-induced labor is more difficult to treat than hyperstimulation during labors induced by other drugs.<ref>{{cite book | vauthors = Wagner M |title=Born in the USA: how a broken maternity system must be fixed to put mothers and infants first |publisher=University of California Press |location=Berkeley |year=2006 |isbn=0-520-24596-2}}, which cites:
: {{cite journal | vauthors = Wing DA, Paul RH | title = A comparison of differing dosing regimens of vaginally administered misoprostol for preinduction cervical ripening and labor induction | journal = American Journal of Obstetrics and Gynecology | volume = 175 | issue = 1 | pages = 158–64 | date = July 1996 | pmid = 8694043 | doi = 10.1016/s0002-9378(96)70267-3 }}
:{{cite journal | vauthors = Wing DA, Rahall A, Jones MM, Goodwin TM, Paul RH | title = Misoprostol: an effective agent for cervical ripening and labor induction | journal = American Journal of Obstetrics and Gynecology | volume = 172 | issue = 6 | pages = 1811–6 | date = June 1995 | pmid = 7778637 | doi = 10.1016/0002-9378(95)91416-1 }}</ref> Because the complications are rare, it is difficult to determine if misoprostol causes a higher risk than do other cervical ripening agents. One estimate is that it would require around 61,000 people enrolled in randomized controlled trials to detect a difference in serious fetal complications and about 155,000 people to detect a difference in serious maternal complications.<ref>{{harvnb|Goldberg|Wing|2003}}, which cites:
:{{cite journal | vauthors = Weeks A, Alfirevic Z | s2cid = 13063131 | title = Oral misoprostol administration for labor induction | journal = Clinical Obstetrics and Gynecology | volume = 49 | issue = 3 | pages = 658–71 | date = September 2006 | pmid = 16885670 | doi = 10.1097/00003081-200609000-00023 }}</ref>

==Contraindications==
It is recommended that medical treatment for [[missed abortion]] with misoprostol should only be considered in people without the following contraindications: suspected ectopic pregnancy, use of non-steroidal drugs, signs of pelvic infections or sepsis, unstable hemodynamics, known allergy to misoprostol, previous caesarean section, mitral stenosis, hypertension, glaucoma, bronchial asthma, and remote areas without a hospital nearby.<ref name="Wu_2017" />

==Pharmacology==

===Mechanism of action===
Misoprostol, a [[prostaglandin analogue]], binds to myometrial cells to cause strong myometrial contractions leading to expulsion of tissue. This agent also causes cervical ripening with softening and dilation of the cervix. Misoprostol binds to and stimulates [[prostaglandin EP2 receptor|prostaglandin EP<sub>2</sub> receptor]]s, [[prostaglandin EP3 receptor|prostaglandin EP<sub>3</sub> receptor]] and [[prostaglandin EP4 receptor|prostaglandin EP<sub>4</sub> receptor]] but not [[prostaglandin EP1 receptor|prostaglandin EP<sub>1</sub> receptor]] and therefore is expected to have a more restricted range of physiological and potentially toxic actions than prostaglandin E<sub>2</sub> or other analogs which activate all four prostaglandin receptors.<ref name="pmid27940058">{{cite journal | vauthors = Moreno JJ | s2cid = 1513449 | title = Eicosanoid receptors: Targets for the treatment of disrupted intestinal epithelial homeostasis | journal = European Journal of Pharmacology | volume = 796 | pages = 7–19 | date = February 2017 | pmid = 27940058 | doi = 10.1016/j.ejphar.2016.12.004 }}</ref>

==Society and culture==
In August 2000, a letter from [[G.D. Searle, LLC]], the inventor of the drug,<ref>{{Cite book | url=https://books.google.com/books?id=1A6kAgAAQBAJ&dq=%22inventor+of+misoprostol%22&pg=PA125 | title=Lipids in Health and Nutrition | isbn=978-1-84569-838-6 | vauthors=Tyman JH | date=January 1999 | publisher=Elsevier | access-date=10 May 2022 | archive-date=29 June 2022 | archive-url=https://web.archive.org/web/20220629032411/https://books.google.com/books?id=1A6kAgAAQBAJ&dq=%22inventor+of+misoprostol%22&pg=PA125 | url-status=live }}</ref> generated controversy by warning against its use by pregnant women because of its ability to induce abortion, citing reports of maternal and fetal deaths when it was used to induce labor.<ref name="goldberg">{{cite journal | vauthors = Goldberg AB, Wing DA | title = Induction of labor: the misoprostol controversy | journal = Journal of Midwifery & Women's Health | volume = 48 | issue = 4 | pages = 244–8 | year = 2003 | pmid = 12867908 | doi = 10.1016/S1526-9523(03)00087-4 }}</ref> The [[American College of Obstetricians and Gynecologists]] holds that substantial evidence supports the use of misoprostol for induction of labor, a position it reaffirmed in response to the Searle letter.<ref>{{harvnb|Goldberg|Wing|2003}}, which cites:
:{{cite journal |author=American College of Obstetricians and Gynecologists |author-link=American College of Obstetricians and Gynecologists |title=Induction of labor with misoprostol |journal=ACOG Committee Opinion No. 228 |location=Washington, DC |date=November 1999}}
:{{cite journal |author=American College of Obstetricians and Gynecologists |author-link=American College of Obstetricians and Gynecologists |title=Response to Searle's drug warning on misoprostol |journal=ACOG Committee Opinion No. 248 |location=Washington, DC |date=November 1999}}</ref> 

It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO22nd" /> In 2023, 63% of all abortions in the U.S. were non-surgical, using medications including misoprostol and mifepristone<ref>{{Cite web |date=2024-03-12 |title=Medication Abortion Accounted for 63% of All US Abortions in 2023—An Increase from 53% in 2020 {{!}} Guttmacher Institute |url=https://www.guttmacher.org/2024/03/medication-abortion-accounted-63-all-us-abortions-2023-increase-53-2020#:~:text=New%20Guttmacher%20Institute%20research%20from,the%20formal%20health%20care%20system. |access-date=2025-04-22 |website=www.guttmacher.org |language=en}}</ref>

A vaginal form of the medication is sold in the EU under the names Misodel<ref>{{Cite web |url=https://www.ema.europa.eu/en/documents/psusa/misoprostol-gynaecological-indication-labour-induction-list-nationally-authorised-medicinal-products/00010353/202005_en.pdf |title=List of nationally authorized medicinal products |access-date=29 June 2022 |archive-date=2 November 2021 |archive-url=https://web.archive.org/web/20211102122935/https://www.ema.europa.eu/en/documents/psusa/misoprostol-gynaecological-indication-labour-induction-list-nationally-authorised-medicinal-products/00010353/202005_en.pdf |url-status=live }}</ref> and Mysodelle<ref>{{Cite web |url=https://www.ema.europa.eu/en/documents/psusa/misoprostol-gynaecological-indication-labour-induction-list-nationally-authorised-medicinal-products/00010353/201905_en.pdf |title=List of nationally authorised medicinal products |access-date=26 June 2023 |archive-date=3 March 2022 |archive-url=https://web.archive.org/web/20220303093147/https://www.ema.europa.eu/en/documents/psusa/misoprostol-gynaecological-indication-labour-induction-list-nationally-authorised-medicinal-products/00010353/201905_en.pdf |url-status=live }}</ref> for use in labor induction.<ref>{{cite journal | vauthors = Nagdeve P, Shetty A | title = Review of use of Mysodelle as a method of induction of labour | language = EN | journal = Journal of Obstetrics and Gynaecology | volume = 38 | issue = 5 | page = 726 | date = July 2018 | pmid = 29944050 | doi = 10.1080/01443615.2018.1444404 }}</ref>

===Latin America===

Misoprostol's use for abortion was discovered and developed by women in Brazil.<ref name=":0" /> It spread throughout Latin America, where abortion was generally illegal at the time. 

In the 21st century, abortion has become [[Reproductive rights in Latin America|legal in several countries in Latin America]] as part of the [[Green Wave (abortion rights)|Green Wave]], including Mexico, Argentina, and Uruguay.<ref>{{Cite web |last=Población |first=Consejo Nacional de |title=El reconocimiento de la Interrupción Legal del Embarazo (ILE) en México |url=http://www.gob.mx/conapo/documentos/el-reconocimiento-de-la-interrupcion-legal-del-embarazo-en-mexico |access-date=2025-07-17 |website=gob.mx |language=es}}</ref><ref>{{Cite web |date=2021-03-22 |title=Interrupción voluntaria del embarazo |url=https://www.argentina.gob.ar/justicia/derechofacil/leysimple/interrupcion-voluntaria-del-embarazo |access-date=2025-07-17 |website=Argentina.gob.ar |language=es}}</ref><ref>{{Cite web |title=Servicios IVE (Interrupción Voluntaria del Embarazo) |url=https://www.asse.com.uy/contenido/Servicios-IVE-Interrupcion-Voluntaria-del-Embarazo--14378 |access-date=2025-07-17 |website=ASSE |language=es}}</ref> In Cuba, abortion has been legal since 1965.<ref>{{Cite web |title=En Cuba, el aborto legal, seguro y gratu |url=https://www.programacuba.com/en-cuba-el-aborto-legal-seguro-y-gr |access-date=2025-07-17 |website=Programa Cuba |language=es}}</ref> 

===Black market===
Misoprostol is used for [[self-induced abortion]]s in Latin America, where [[black market]] prices exceed US$100 per dose.<ref name="Löwy_2020" /> Illegal medically unsupervised misoprostol abortions are associated with a lower complication rate than other forms of illegal self-induced abortion, but are still associated with a higher complication rate than legal, medically supervised surgical and medical abortion.<ref name="Löwy_2020" /> Failed misoprostol abortions are associated with birth defects in some cases.<ref>{{cite journal | vauthors = Costa SH, Vessey MP | s2cid = 30907894 | title = Misoprostol and illegal abortion in Rio de Janeiro, Brazil | journal = Lancet | volume = 341 | issue = 8855 | pages = 1258–61 | date = May 1993 | pmid = 8098402 | doi = 10.1016/0140-6736(93)91156-G }}</ref><ref>{{cite journal | vauthors = Coêlho HL, Teixeira AC, Cruz M, Gonzaga SL, Arrais PS, Luchini L, La Vecchia C, Tognoni G | title = Misoprostol: the experience of women in Fortaleza, Brazil | journal = Contraception | volume = 49 | issue = 2 | pages = 101–10 | date = February 1994 | pmid = 8143449 | doi = 10.1016/0010-7824(94)90084-1 }}</ref><ref>{{cite journal | vauthors = Barbosa RM, Arilha M | title = The Brazilian experience with Cytotec | journal = Studies in Family Planning | volume = 24 | issue = 4 | pages = 236–40 | year = 1993 | pmid = 8212093 | doi = 10.2307/2939191 | jstor = 2939191 }}</ref><ref>{{cite journal | vauthors = Rocha J | title = Brazil investigates drug's possible link with birth defects | journal = BMJ | volume = 309 | issue = 6957 | pages = 757–8 | date = September 1994 | pmid = 7950553 | pmc = 2540993 | doi = 10.1136/bmj.309.6957.757a }}</ref><ref>{{cite journal | vauthors = Gonzalez CH, Vargas FR, Perez AB, Kim CA, Brunoni D, Marques-Dias MJ, Leone CR, Correa Neto J, Llerena Júnior JC, de Almeida JC | title = Limb deficiency with or without Möbius sequence in seven Brazilian children associated with misoprostol use in the first trimester of pregnancy | journal = American Journal of Medical Genetics | volume = 47 | issue = 1 | pages = 59–64 | date = August 1993 | pmid = 8368254 | doi = 10.1002/ajmg.1320470113 }}</ref> Low-income and immigrant populations in [[New York City]] have also been observed to use self-administered misoprostol to induce abortions, as this method is much cheaper than a surgical abortion (about $2 per dose).<ref>{{cite news |author-link=John Leland (journalist) | vauthors = Leland J |url= https://www.nytimes.com/2005/10/02/weekinreview/02leland.html |title=Abortion Might Outgrow Its Need for Roe v. Wade |newspaper=[[The New York Times]] |date=2 October 2005 |access-date=6 March 2014 |url-status=live |archive-url=https://web.archive.org/web/20130518132249/http://www.nytimes.com/2005/10/02/weekinreview/02leland.html |archive-date=18 May 2013 }}</ref><ref name=":0">{{Citation |title=The Network: Saint-o-tec |date=2025-06-05 |url=https://open.spotify.com/episode/1awEJhNny67UUsejto9kHv |access-date=2025-07-17 |language=en}}</ref> The drug is readily available in Mexico.<ref name=NYT71313>{{cite news|title=In Mexican Pill, a Texas Option for an Abortion|url=https://www.nytimes.com/2013/07/14/us/in-mexican-pill-a-texas-option-for-an-abortion.html|access-date=14 July 2013|newspaper=The New York Times|date=13 July 2013| vauthors = Eckholm E |url-status=live|archive-url=https://web.archive.org/web/20130714154112/http://www.nytimes.com/2013/07/14/us/in-mexican-pill-a-texas-option-for-an-abortion.html|archive-date=14 July 2013}}</ref> Use of misoprostol has also increased in Texas in response to increased regulation of abortion providers.<ref>{{ cite news |url=https://www.theatlantic.com/health/archive/2014/06/the-rise-of-the-diy-abortion-in-texas/373240/ | vauthors = Hellenstein E |title=The Rise of the DIY Abortion in Texas |newspaper=The Atlantic |date=27 June 2014 |url-status=live |archive-url= https://web.archive.org/web/20170302015432/https://www.theatlantic.com/health/archive/2014/06/the-rise-of-the-diy-abortion-in-texas/373240/ |archive-date=2 March 2017 }}</ref> Following the United States Supreme Court decision of [[Dobbs v. Jackson Women's Health Organization|''Dobbs v. Jackson Women's Health Organization'']], many states restricted access to legal abortion services, including medication abortion using misoprostol. As a result of these restrictions, it was reported that there was an increase in self-managed abortions by women in the United States. Many women purchased the pills from overseas online pharmacies or obtained misoprostol from Mexico.<ref>{{Cite news |vauthors=Sanger-Katz M, Miller CC |date=30 October 2022 |title=Legal Abortions Fell Around 6 Percent in Two Months After End of Roe |language=en-US |work=The New York Times |url=https://www.nytimes.com/2022/10/30/upshot/legal-abortions-fall-roe.html |access-date=8 February 2023 |issn=0362-4331 |archive-date=8 February 2023 |archive-url=https://web.archive.org/web/20230208135146/https://www.nytimes.com/2022/10/30/upshot/legal-abortions-fall-roe.html |url-status=live }}</ref>

== References ==
{{Reflist}}

{{Abortion}}
{{Prostaglandins}}
{{Obstetric drugs}}
{{Drugs for peptic ulcer and GORD}}
{{Oxytocics}}
{{Prostanoidergics}}
{{Portal bar|Medicine}}

[[Category:Abortifacients]]
[[Category:Carboxylate esters]]
[[Category:Diols]]
[[Category:Gastroenterology]]
[[Category:Gynaecology]]
[[Category:Ketones]]
[[Category:Medication abortion]]
[[Category:Methyl esters]]
[[Category:Prostaglandins]]
[[Category:Drugs developed by Pfizer]]
[[Category:World Health Organization essential medicines]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Uterotonics]]