Do not take this medication if you think that you may be pregnant. It may cause abortion, premature birth, or birth defects. In rare cases, serious complications (e.g., uterine rupture) have occurred when misoprostol was used to start labor or when used in combination with another drug to cause abortion after the eighth week of pregnancy. These complications have resulted in harm to the unborn baby and mother. Avoid pregnancy while taking misoprostol and for at least one month or one completed menstrual cycle after you have stopped treatment. If you become pregnant while taking misoprostol, contact your doctor right away. If you are pregnant, do not take this medication to reduce the risk of stomach ulcers due to aspirin or other related drugs (non-steroidal anti-inflammatory drugs-NSAIDs such as ibuprofen). Pharmacists can play an important role in counseling women who experience early pregnancy loss. It is important for patients to know that routine activities, such as exercise, sexual intercourse, and working, do not cause early pregnancy loss. About 50% of all cases of early pregnancy loss are attributable to fetal chromosomal abnormalities. The American College of Obstetricians and Gynecologists (ACOG) defines early pregnancy loss as a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without a heartbeat within the first 12 weeks of gestation. Here are 5 things pharmacists should know about misoprostol for early pregnancy loss management: 1. Misoprostol has been studied for early pregnancy loss. Misoprostol, a prostaglandin E1 analogue, reduces the need of suction dilation and curettage (D&C) by up to 60% and shortens the time to completion compared with placebo. 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Prophylaxis: 600 mcg PO within 1 minute of delivery Treatment: 800 mcg PO once; use caution if prophylactic dose already given and adverse effects present or observed Use only in settings where oxytocin not available Bacterial infections reported after use Patients must seek medical attention if excessive bleeding occurs Administration to pregnant women can cause abortion, premature birth, or birth defects Uterine rupture has been reported when drug is administered to pregnant women to induce labor; risk of uterine rupture increases with advancing gestational ages and prior uterine surgery, including cesarean delivery Contraindicated in pregnant women to reduce peptic ulcer risk from nonsteroidal anti-inflammatory drugs (NSAIDs) Warn patients of risk for abortion, and warn them not to give drug to others May cause diarrhea; should not be coadministered with other drugs that cause diarrhea (eg, magnesium-containing antacids) Adequate contraception is required in women of childbearing age May cause anaphylactic reaction May cause chills Unknown whether drug is safe for use in women with severe anemia Misoprostol may cause birth defects, abortion (sometimes incomplete), premature labor or rupture of the uterus if given to pregnant women Safety and efficacy in patients with cardiovascular disease, diabetes, renal impairment, or respiratory disease are not established Use with caution in women Pregnancy category: X Lactation: Drug is rapidly metabolized in mother to misoprostol acid, which is biologically active and is excreted in breast milk; although no published reports of adverse effects of misoprostol in breast-feeding infants exist, caution should be exercised when misoprostol is administered to breastfeeding women Synthetic prostaglandin E analogue parent drug that is rapidly deesterified to misoprostol acid (active metabolite) and replaces protective prostaglandins consumed with therapies that inhibit prostaglandin synthesis; inhibits gastric acid secretion and protects gastric mucosa Significantly reduces degree of fat malabsorption in patients with Extensive and rapid 1st-pass metabolism by liver to form misoprostol acid (active metabolite) Metabolites: Misoprostol acid (principal and active metabolite), dinor and tetranor metabolites of misoprostol acid The above information is provided for general informational and educational purposes only. 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Cytotec misoprostol can be used in the management of a missed or incomplete miscarriage as an alternative to the dilation and curettage procedure.