Misoprostol Aspirin

Bismudi subsalicylate is used in combination witii otiier dru > to treat gastric and duodenal ulcers caused by H. pylori bacteria Mesalamine is used in the treatment of chronic inflammatoiy bowel disease Misoprostol is used to prevent gastric ulcers in those taking aspirin or nonsteroidal anti-inflammatory dragp in high doses for a prolonged time Olsalazine is used in the treatment of ulcerative colitis in those allergic to sulfasalazine. Sulfasalazine is used in the treatment of Crohn s disease and ulcerative colitis. Sucralfate is used in the treatment of duodenal ulcer. 

Hypersensitivity to diclofenac or to misoprostol or other prostaglandins. Do not give to patients who have experienced asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. 

Johnston et al. (1995) studied the effect of misoprostol on aspirin-induced gastrointestinal lesions in dogs. Lesions were induced by 35 mg/kg aspirin p.o. tid. En-... 

There is an increased risk of diarrhea in patients taking misoprostol with the m nesium-containing antacids. Sulfasalazine may increase the risk of toxicity of oral hypoglycemic dru, zidovudine, methotrexate, and phenytoin. There is an increased risk of crys-talluria when sulfasalazine is administered with medienamine. A decrease in the absorption of iron and folic acid may occur when these ents are administered with sulfasalazine. When bismuth subsalicylate is administered witli aspirin-containing dru, there is an increased risk of salicylate toxicity. There is an increased risk of toxicity of valproic acid and methotrexate and decreased effectiven s of the corticosteroids when these agents are administered with bismuth subsalicylate. 

Misoprostol (Cytotec) Prostaglandin E analog which increases HCO3 and mucin release. Also reduces acid secretion. Prevention of ulcers caused by aspirin and other NSAIDS. Abortion (uterine contraction), diarrhea, abdominal pain, nausea, flatulance. 

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. 

Karim A, RozekLF,Leese PT. Absorption of misoprostol (C5ftotec), an antiulcer prostaglandin, or aspirin is not affected when given concomitantly to healthy human subjects. Gastroenterology (1987) 92, 1742. 

The PGEs, along with several other PGs, suppress gastric ulceration and appear to heal gastric ulcers. The PGEi analog, misoprostol, is currently used primarily to prevent ulceration associated with aspirin-like NSAIDs ... 

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