Misoprostol Ibuprofen

Two prospective, crossover, placebo controlled, double-bhnd evaluations of the nephroprotective role of misoprostol in patients with mild stable chronic renal failure, taking either ibuprofen or indomethacin have been reported [183]. The mean baseline GFR of the patients at the time of entry into the study was 53 ml/min (misoprostol)/55 ml/min (placebo), and 57 ml/min (misoprostol)/57 ml/min (placebo) in Study I (ibuprofen) and Study II (indomethacin) respectively. At this level of renal functional impairment, the use of the non-selective NSAIDs did not produce additional significant impairment of renal function, hence a renal protective role for misoprostol could not be... 

Small RE, Wilmot-Pater MG, McGee BA, Willis HE, Effects of misoprostol or ranitidine on ibuprofen pharmacokinetics. Clin Pharm (1991) 10, 870-2. 

Misoprostol increases the incidence of abdominal pain and diarrhoea when used with diclofenac or indometacin. Isolated cases of neurological adverse effects have been seen with naproxen or phenylbutazone given with misoprostol. However, no important pharmacokinetic interactions seem to occur between aspirin, diclofenac, ibuprofen or indometacin and misoprostol. NSAIDs are reported not to affect the abortive effects of intravaginal misoprostol. 

No clinically important pharmacokinetic interactions have been found to occur between aspirin 975 mg and misoprostol 200 micrograms, or between ibuprofen and misoprostol. One study found that misoprostol 800 micrograms daily decreased the AUC of a single 100-mg dose of diclofenac by a modest 20%. However, other studies have found that misoprostol had no effect on steady-state diclofenac pharmacokinetics. One study found that misoprostol 200 micrograms raised the steady-state levels of indometacin 50 mg three times daily by about 30%, whereas another found that misoprostol 400 micrograms twice daily reduced the AUC of indometacin 50 mg twice daily by 13% after one dose and reduced the maximum steady-state plasma concentration by 24%. These modest changes in serum indometacin levels are unlikely to be clinically important. 

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