Misoprostol ulcers

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. 

In patients at risk for NSAID-induced ulcers, proton pump inhibitors (PPIs) at standard doses reduce the risk of both gastric and duodenal ulcers as effectively as misoprostol and are generally better tolerated. 

Refer to Chapter 14 on gastroesophageal reflux disease for more information on the PPIs. The PPI omeprazole is superior to both ranitidine and misoprostol for preventing recurrence of NSAID-associated PUD. In one study, omeprazole 20 mg daily was compared to misoprostol 200 meg twice daily for NSAID-associated PUD prevention. At 6 months, the omeprazole-treated group had significantly fewer ulcers than those taking misoprostol. Furthermore, more patients discontinued ulcer prophylaxis in the misoprostol group due to adverse events.26... 

Misoprostol Abortifacient prevention of ulcers in combination with NSAlDs therapy... 

Misoprostol C22H38Os 382.5 immunosuppressive agent Anti-ulcer agent... 

Misoprostol (Cytotec) Anti-ulcer Tab 100, 200 mg 100-200 mg qid reduce dosage if diarrhea abortifacient, contraception mandatory. 

Arthrotec tablets contain the non-steroidal anti-inflammatory drug diclofenac and the prostaglandin misoprostol. The combination of the two active ingredients makes Arthrotec suitable in patients predisposed to gastrointestinal ulceration. Dulco-lax (bisacodyl) tablets act as a stimulant laxative. Voltarol Retard tablets contain the non-steroidal anti-inflammatory drug diclofenac. All... 

Rheumatoid arthritis Recommended dose is 50 mg diclofenac/200 meg misoprostol 3 or 4 times/day. For patients who experience intolerance, 50 mg/200 meg or 75 mg/200 meg twice/day can be used, but are less effective in preventing ulcers. Do not exceed 225 mg of diclofenac per day. 

Misoprostol should not be used for reducing the risk of NSAID-induced ulcers in women of childbearing potential unless the patient is at high risk of developing complications from gastric ulcers associated with NSAIDs or of developing gastric ulceration. In such patients, misoprostol may be prescribed if the patient ... 

Duodenal ulcers Misoprostol does not prevent duodenal uleers in patients on NSAIDs. 

However the dosages that are needed to inhibit gastric acid secretion are higher than those for achieving cytoprotective effects, i.e. enhanced secretion of mucus and HCO3 . Its indication is mainly protection against NSAID-associated gastric ulceration. Only misoprostol 800 pg/day has been directly shown to reduce the risk of ulcer complications. 

GI Age > 65 Previous ulcer Steroid treatment Treatment with more than one NSAID Scrutinize the indication, inform about the risks and choose another analgesic. Consider ulcer prophylaxis with proton pump inhihitors or misoprostol, or alternatively choose a COX-2 inhihitor... 

A. If the precipitant can be withdrawn then an-tisecretory treatment with a histamine H2 antagonist or proton pump inhibitor, or misoprostol (an antisecretory and mucosally protective prostaglandin) for a month may be enough to induce ulcer healing. 

Misoprostol (Cytotec) is a prostaglandin Ej analogue that is being evaluated as a cervical ripening agent. It also is used in the treatment and prevention of peptic ulcer disease (see Chapter 40). Clinical trials show that misoprostol is an effective agent for both cervical ripening and labor induction. It appears to be as effective as dinoprostone and is much less expensive. 

Geriatric Considerations - Summary Use of NSAIDs in older adults increases the risk of GI complications including gastric ulceration, bleeding, and perforation. These complications are not necessarily preceded by less severe GI symptoms. Concomitant use of a proton pump inhibitor or misoprostol reduces the risk for gastric ulceration and bleeding, but may not prevent long-term GI toxicity. No clinical data exist to support reduced GI toxicity with the use of diclofenac. 

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