Misoprostol

Legal status and availability in the UK

Misoprostol is a prescription-only medicine (POM) in the UK.

In our online pharmacy, misoprostol is available without a prescription, with discreet delivery to the United Kingdom in 9–21 days.

Basic misoprostol information

• INN (international nonproprietary name): Misoprostol
• Brand names available in the United Kingdom: Cytotec; Gymiso; Oxaprost (combination with diclofenac).
• ATC code: G02AD06
• Forms and dosages: Tablets 200 mcg (standard). Combination tablets with diclofenac (for example Oxaprost: 200 mcg misoprostol / 50 mg diclofenac).
• Registration status in the United Kingdom: prescription-only medicine (POM).
• OTC / Rx classification: Prescription-only medicine (POM)

Product basics: what misoprostol is and how it works

Misoprostol is the International Nonproprietary Name (INN) and is classified under ATC code G02AD06 as a prostaglandin.

It is a synthetic prostaglandin E1 analogue with both uterotonic and gastric mucosal protective actions.

Mechanism: misoprostol induces uterine smooth muscle contractions and reduces gastric acid while increasing mucus and bicarbonate secretion, protecting the gastric mucosa.

The primary formulation is the oral tablet, most commonly 200 mcg, and fixed-dose diclofenac combinations are also available.

Mechanism of action

How does it work for different indications?

Uterotonic effect: stimulates uterine contractions to expel uterine contents or reduce postpartum bleeding.

Gastroprotection: increases gastric mucus and bicarbonate and decreases acid secretion to reduce NSAID-induced ulceration.

Formulations and strengths

Tablets are typically 200 mcg, and combination tablets with diclofenac (for example Oxaprost) are also used.

• INN: Misoprostol.
• ATC code: G02AD06.
• Primary action: uterotonic and gastric mucosal protector.
• Primary formulation: oral tablets, 200 mcg (standard).

Indications and standard doses

Dosing varies substantially by indication and by route, so adherence to prescriber instructions is essential.

Missed-dose guidance: for ulcer prophylaxis take the missed dose as soon as possible unless it is near the next dose, then skip it; for abortion or labour protocols consult a clinician and do not double doses.

Dosing and route differ by indication, so the prescriber’s directions should be followed exactly.

Gastric ulcer prevention

What should patients expect on long‑term use?

Typical therapy is 200 mcg two to four times daily while on NSAIDs or as prescribed, often continued for the duration of NSAID therapy or 4–8 weeks initially.

Diarrhoea can occur; taking doses with food reduces gastrointestinal upset.

Abortion and miscarriage regimens

How is misoprostol used with mifepristone?

Medical abortion commonly uses mifepristone 200 mg followed by misoprostol 800 mcg via the buccal, vaginal or sublingual route; timing between doses varies and is set by the prescriber.

For miscarriage management misoprostol 800 mcg vaginally is a standard single‑use protocol with a possible repeat after 3–12 hours if needed.

Labour induction and postpartum haemorrhage

What are typical regimens in maternity care?

Labour induction regimens often use low-dose vaginal misoprostol (25 mcg every 4–6 hours) and are off‑label, so maternity teams document consent and surgical history carefully.

For prevention or treatment of postpartum haemorrhage, a single oral dose of 600–800 mcg is common.

Contraindications and clinical cautions

Who should not take misoprostol?

Absolute contraindications include known hypersensitivity to misoprostol or prostaglandins and pregnancy when using misoprostol for gastric ulcer prevention; suspected ectopic pregnancy is also an absolute contraindication to proceeding with abortion regimens until confirmed or excluded.

Relative contraindications that require close monitoring are inflammatory bowel disease, chronic diarrhoea, severe cardiovascular disease, asthma, uncontrolled hypertension and a history of multiple caesarean sections or prior uterine surgery.

Absolute contraindications

What must stop supply immediately?

Known hypersensitivity to misoprostol or other prostaglandins.

Pregnancy when the indication is gastric ulcer prophylaxis (but clinical protocols exist where pregnancy is the reason for use, such as abortion or postpartum haemorrhage management under clinician direction).

Suspected ectopic pregnancy for abortion/miscarriage protocols until appropriately assessed.

Relative contraindications

When is extra caution required?

Inflammatory bowel disease and ongoing chronic diarrhoea may be worsened by misoprostol and require alternative plans.

Cardiovascular instability, severe hypertension, asthma and prior uterine surgery increase the risk profile for uterotonic uses.

Pregnancy‑specific warnings

How does pregnancy change risk assessment?

Misoprostol is teratogenic when used inadvertently in pregnancy for non‑obstetric indications and must not be used for ulcer prophylaxis in pregnant patients.

Conversely, misoprostol is an established component of medical abortion and postpartum haemorrhage management under clinical supervision.

Side effects, adverse reactions and overdose response

What side effects should patients expect and when should they seek help?

Common side effects include diarrhoea, abdominal pain, nausea, flatulence, headache and menstrual irregularities and are usually self‑limiting.

Moderate effects can include vomiting, dyspepsia, uterine cramps and heavier vaginal bleeding when used in abortion or miscarriage care.

Rare but serious events include severe hypersensitivity and uterine rupture, mostly in labour induction settings and especially in women with prior uterine surgery.

Common side effects

What is most frequently reported?

Diarrhoea and cramping are the most frequent complaints and may affect adherence to ulcer‑prevention regimens.

Headache and nausea are common but tend to resolve; oral rehydration helps with diarrhoea, and antiemetics can be prescribed if needed.

Serious adverse events

What warrants immediate medical attention?

Signs of severe allergic reaction such as facial swelling, severe rash or breathing difficulty require emergency care.

Suspected uterine rupture or heavy uncontrolled bleeding during labour or after abortion/miscarriage requires urgent hospital assessment.

Overdose management

What to do in case of suspected overdose?

Overdose signs include severe diarrhoea, hypotension, bradycardia, tremor, fever and excessive uterine contractions if pregnant.

An overdose can be harmful, so seek medical help promptly (NHS 111, or 999 in an emergency). Treatment is supportive and symptomatic: fluid resuscitation, monitoring of vital signs and hospital admission if significant symptoms occur.

Special populations and dose adjustments

How should dosing be adjusted for different populations?

Pregnancy context: the use of misoprostol depends entirely on the indication — contraindicated for ulcer prophylaxis but essential in abortion, miscarriage and postpartum haemorrhage protocols.

Elderly patients do not usually require standard dose changes but are more susceptible to GI side effects and dehydration from diarrhoea, so fluid status should be monitored.

Children are rarely treated with misoprostol outside specialist paediatric protocols and dosing must follow specialist guidance.

Renal impairment: no routine dose adjustment for mild to moderate impairment; use caution in severe impairment.

Hepatic impairment: exercise caution as metabolic clearance may be reduced and exposure could increase.

Pregnancy contexts

When is misoprostol appropriate during pregnancy?

As an obstetric medicine misoprostol is used under clinical protocols for medical abortion, miscarriage management and postpartum haemorrhage; these indications require clinician oversight and clear counselling.

Elderly and children

Elderly patients should be warned about diarrhoea and encouraged to maintain hydration and to report severe GI upset.

Children only receive misoprostol on specialist instruction.

Renal and hepatic impairment

No routine dose adjustments are recommended for mild to moderate renal impairment, but severe renal or significant hepatic impairment warrants a cautious approach and discussion with the prescriber.

Administration routes, timing and practical technique

Route and technique influence absorption and the side‑effect profile, so clear step‑by‑step instructions are essential for patient safety and efficacy.

Oral, buccal, vaginal and sublingual routes

Which route suits which indication?

Oral tablets swallowed are most common for gastric prophylaxis and for single‑dose postpartum haemorrhage regimens.

For abortion and miscarriage care the buccal, vaginal and sublingual routes are preferred because they provide effective uterotonic action with differing side‑effect profiles.

Step‑by‑step administration tips

Buccal: place tablets between cheek and gum and allow to dissolve for the time specified by the prescriber; avoid eating or drinking until fully dissolved.

Vaginal: wash hands and insert tablets high into the vagina (posterior fornix) as instructed by the prescriber.

Sublingual: allow tablets to dissolve under the tongue and avoid swallowing immediately to maximise mucosal absorption.

Oral: swallow tablets with water and take with food to reduce GI upset when used for ulcer prophylaxis.

Timing with mifepristone

How long after mifepristone should misoprostol be given?

Medical abortion regimens commonly administer misoprostol 24–48 hours after mifepristone 200 mg, though protocols vary and the prescriber’s timeframe must be followed precisely.

Drug interactions and common combinations

Which interactions matter most?

The principal clinical combination is mifepristone plus misoprostol for medical abortion, where timing rather than pharmacokinetic interaction is the key determinant of efficacy.

Fixed‑dose combinations such as misoprostol plus diclofenac (Oxaprost) are used to reduce NSAID‑related ulcer risk.

Combination with mifepristone

Confirm the correct sequence and timing: mifepristone 200 mg followed by misoprostol 800 mcg per the prescriber’s protocol, and make sure the route chosen is understood.

NSAID/diclofenac combination

Combination tablets such as Oxaprost (misoprostol + diclofenac) provide gastric protection for patients who require long‑term NSAID therapy.

Interactions to watch for

Concurrent uterotonics such as oxytocin or dinoprostone may have additive uterine effects and require hospital monitoring if used together.

Drugs that exacerbate diarrhoea or cause hypotension can interact with misoprostol’s side‑effect profile and should prompt caution and monitoring.

Regulatory and legal status in the UK

Misoprostol is a prescription-only medicine (POM) in the UK, and the MHRA regulates licensed products.

NHS prescriptions, private prescriptions and electronic prescriptions from UK prescribers are the usual lawful supply routes.

MHRA guidance covers licensed uses and gives advice on off‑label applications such as labour induction and the use of misoprostol for postpartum haemorrhage within maternity services.

Storage and shelf‑life

How should misoprostol be stored to preserve potency?

Store below 25°C in a dry place and protect from moisture and heat, keeping tablets in their original blister or bottle unless instructed otherwise.

Avoid refrigeration unless the manufacturer label expressly requires it.

At‑home guidance

Keep the product in its original packaging at room temperature below 25°C, away from children and direct heat or sunlight.

Check batch and expiry information, and discard tablets after the expiry date.

Contact the dispensing pharmacist if packaging appears tampered with or if batch/expiry information is missing.

Delivery across the United Kingdom