Drugs List

Therapeutic Indications

Uses

Labour - induction of

Contraindications

Congenital abnormality of the uterus
Foetal distress
Foetal malpresentation
Placenta praevia
Renal impairment - eGFR below 15ml/minute/1.73m sq
Scarred uterus
Undiagnosed vaginal bleeding during current pregnancy

Precautions and Warnings

Children under 18 years
Breastfeeding
Gestational age below 37 weeks
Hepatic impairment
Hypertonic uterine contractions
Modified bishop score greater than 6
Multiple pregnancy
Renal impairment
Ruptured amniotic membranes
Severe pre-eclampsia

Allow at least a 4 hour interval before using oxytocin if necessary
Treatment to be administered by or under supervision of specialist
Monitor uterine contractions and foetal heart rate
Pregnancy: Monitor for disseminated intravascular coagulation postpartum
Withhold treatment if excessive or prolonged uterine contractions occur
Consider dose reduction in hepatic impairment
Consider dose reduction in renal impairment

Chorioamnionitis may result in fast delivery. It is up to the physician with regards to use of antibiotic treatment, induction of labour or caesarean section.

Pregnancy and Lactation

Pregnancy

Misoprostol 25 micrograms tablet is indicated for induction of labour at full-time pregnancy.

The manufacturer states that there is no risk of foetal malformations if used following the recommended dosing schedules. Misoprostol 25 micrograms tablet should only be used prior to 37 weeks of gestation if clinically indicated. Pregnancies exposed to misoprostol in the first trimester have been reported to have a threefold increase in the risk of foetal malformation including Moebius syndrome, amniotic band syndrome and central nervous system anomalies.

Lactation

Use Misoprostol with caution during breastfeeding.

The manufacturer states that misoprostol has been detected in human milk following oral administration. Breastfeeding can start 4 hours after the last dose of misoprostol 25 micrograms tablet is administered. LactMed suggests that due to low levels of misoprostol in breast milk, no adverse effects are expected in breastfed infants.

Side Effects

Altered foetal heart rate patterns
Chills
Diarrhoea
Dizziness
Foetal acidosis
Low Apgar score in newborn
Meconium in amniotic fluid
Nausea
Neonatal asphyxia
Neonatal convulsion
Neonatal cyanosis
Postpartum haemorrhage
Premature separation of placenta
Pruritic rash
Pyrexia
Uterine hyperstimulation
Uterine rupture
Vomiting

Presentation

Oral formulation of misoprostol 25 micrograms.

Drugs List

Therapeutic Indications

Uses

Labour - induction of

Dosage

Adults

Contraindications

Congenital abnormality of the uterus
Foetal distress
Foetal malpresentation
Placenta praevia
Renal impairment - eGFR below 15ml/minute/1.73m sq
Scarred uterus
Undiagnosed vaginal bleeding during current pregnancy

Precautions and Warnings

Children under 18 years
Breastfeeding
Gestational age below 37 weeks
Hepatic impairment
Hypertonic uterine contractions
Modified bishop score greater than 6
Multiple pregnancy
Renal impairment
Ruptured amniotic membranes
Severe pre-eclampsia

Allow at least a 4 hour interval before using oxytocin if necessary
Treatment to be administered by or under supervision of specialist
Monitor uterine contractions and foetal heart rate
Pregnancy: Monitor for disseminated intravascular coagulation postpartum
Withhold treatment if excessive or prolonged uterine contractions occur
Consider dose reduction in hepatic impairment
Consider dose reduction in renal impairment

Chorioamnionitis may result in fast delivery. It is up to the physician with regards to use of antibiotic treatment, induction of labour or caesarean section.

Pregnancy and Lactation

Pregnancy

Misoprostol 25 micrograms tablet is indicated for induction of labour at full-time pregnancy.

The manufacturer states that there is no risk of foetal malformations if used following the recommended dosing schedules. Misoprostol 25 micrograms tablet should only be used prior to 37 weeks of gestation if clinically indicated. Pregnancies exposed to misoprostol in the first trimester have been reported to have a threefold increase in the risk of foetal malformation including Moebius syndrome, amniotic band syndrome and central nervous system anomalies.

Lactation

Use Misoprostol with caution during breastfeeding.

The manufacturer states that misoprostol has been detected in human milk following oral administration. Breastfeeding can start 4 hours after the last dose of misoprostol 25 micrograms tablet is administered. LactMed suggests that due to low levels of misoprostol in breast milk, no adverse effects are expected in breastfed infants.

Side Effects

Altered foetal heart rate patterns
Chills
Diarrhoea
Dizziness
Foetal acidosis
Low Apgar score in newborn
Meconium in amniotic fluid
Nausea
Neonatal asphyxia
Neonatal convulsion
Neonatal cyanosis
Postpartum haemorrhage
Premature separation of placenta
Pruritic rash
Pyrexia
Uterine hyperstimulation
Uterine rupture
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: April 2021

Reference Sources

Summary of Product Characteristics: Angusta 25 microgram tablets. Norgine Limited. Revised September 2020.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Misoprostol. Last revised: 17 March 2021
Last accessed: 12 April 2021