Cytotec is used to prevent stomach ulcers during treatment with aspirin or an NSAID. Cytotec may also be used for purposes not listed in this medication guide.

General Information

Cytotec reduces stomach acid and helps protect the stomach from damage that can be caused by taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

Indications and Usage

This medicine comes with a patient information leaflet. Read it carefully. If you have any questions about this drug, ask your doctor, nurse, or pharmacist. Dosage is based on your medical condition and response to therapy. If you are taking this drug to prevent stomach ulcers, take it by mouth usually four times a day, after meals and at bedtime to minimize diarrhea, or as directed by your doctor. If you are taking this medication for abortion, take it by mouth exactly as directed by your doctor. If you are using this medication to start labor, your healthcare professional will insert it into your vagina. Avoid taking antacids that contain magnesium while using misoprostol because they may make the diarrhea it causes worse. If you need an antacid, consult your doctor or pharmacist to help you choose a product. For ulcer prevention, continue to take this drug for as long as you take NSAIDs. Use this medication regularly in order to get the most benefit from it. Remember to use it at the same times each day. Inform your doctor if your condition persists or worsens.

Side Effects

Nausea or stomach cramps may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Diarrhea is common with misoprostol and usually occurs about two weeks after you start taking it, and lasts for about a week. Be sure to keep up your intake of fluids and minerals/electrolytes to prevent dehydration. Diarrhea that doesn't go away may sometimes lead to a large loss of your body's water and minerals. Tell your doctor right away if you develop any of these serious signs of dehydration and mineral imbalance: severe dizziness, decreased urination, mental/mood changes, muscle weakness, slow/irregular heartbeat. Tell your doctor right away if any of these unlikely but serious side effects occur: menstrual problems or irregularities, unusual/heavy vaginal bleeding. A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Precautions

Before taking misoprostol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your medical history, especially of: stomach/intestinal disease (such as inflammatory bowel disease). Daily use of alcohol and tobacco may increase your risk for stomach bleeding. Limit alcohol beverages and stop smoking. Consult your doctor or pharmacist for more information. If you are taking this medication in combination with mifepristone to end a pregnancy, an incomplete abortion may rarely occur. It is very important for you to be closely monitored by your doctor and to keep your scheduled appointments to follow your progress. Be sure to have clear instructions from your doctor about who to call and what to do in case of an emergency. Expect vaginal bleeding after you take the combined medicine, however tell your doctor right away if you develop any unlikely symptoms such as severe/prolonged vaginal bleeding, signs of infection (including fever, chills), or fainting. This drug must not be used during pregnancy to prevent stomach ulcers because of possible harm to an unborn baby. If you are of childbearing age, use effective birth control methods while taking misoprostol and for at least one month or one completed menstrual cycle after you stop taking it. If you become pregnant or think you may be pregnant, inform your doctor right away.

What should I know!

2. What is the difference between mifepristone and misoprostol?

Mifepristone blocks the activity of progesterone (a hormone needed to maintain a pregnancy) in the uterus and softens the cervix so the pregnancy comes out more easily. Misoprostol makes the uterus contract and push out the pregnancy. This is similar to what happens when a person has a miscarriage.

When both medications are available, mifepristone is taken first, and then misoprostol is taken 1–2 days later. Mifepristone is always swallowed. Misoprostol is put in the mouth to dissolve, either in between the cheek and gum or under the tongue. Note: You don't need to take misoprostol vaginally, and no one ever needs to insert it for you.

Misoprostol is more widely available around the world, less expensive than mifepristone, and easier to buy from pharmacies and medicine sellers. In addition to being used to induce an abortion, misoprostol is also used to treat ulcers and to prevent or treat heavy bleeding after childbirth, therefore it is generally easier to purchase without a prescription.

Misoprostol is the medication's clinical name, but it is sold internationally under many different trade names, such as Cytotec, Misoclear, Misotac, Kontrac, and Isovent.

What do abortion pills look like?

Both mifepristone and misoprostol are sold in tablet or pill form. Misoprostol pills usually, but not always, have a unique six-sided shape. Mifepristone is usually a round, white pill. If someone is selling these medications in capsule form, they are not legitimate. (A capsule is a shell or container, usually made of gelatin, that contains a medication.)

What does mifepristone combined with misoprostol look like?

Where mifepristone is available, it is usually sold packaged together with misoprostol as a “combi-pack.” Combi-packs are rarely counterfeit and should look something like this.

What is a “blister pack” and why is it important?

A “blister pack” is a way of packaging medicines where individual pills are sealed in a “bubble” between two layers of material. The most common materials used for blister packs are cardboard, plastic and aluminum.

Misoprostol becomes less effective when the pills are exposed to heat and moisture. For that reason, misoprostol must be sealed in double-aluminum blister packs (aluminum on top and bottom), rather than cardboard or plastic. You are unlikely to find legitimate or effective misoprostol that is being kept in cardboard, plastic or as loose pills in a bottle.

A double-aluminum blister pack should look something like this. Be sure the aluminum is not opened on any side until you are ready to use the pills.

How much do the pills cost?

The cost of misoprostol varies around the world. But misoprostol is widely available, so it's generally not very expensive. Manufacturers sell the pills to pharmacies for very little cost - less than $0.05 USD (5 cents) per pill. The highest sales price found in a recent study was $2 USD per pill.

Misoprostol is usually an affordable option for someone seeking an abortion. Of course, some pharmacists or medicine sellers may take advantage of people seeking misoprostol and try to charge too much for the pills. You can ask people you trust if they know how much the pills should cost where you live, or you can search the internet for local cost information. But remember: Misoprostol should not be expensive.

Pre-packaged combi-packs of mifepristone and misoprostol are only available in a limited number of countries (less than 30), and they are less likely to be sold without a prescription. If you live in a low- or middle-income country where combi-packs are available, the prices are likely controlled, and a combi-pack should cost less than $20 USD.

How many pills do I need to buy?

If you have access to both mifepristone and misoprostol, you will need 1 mifepristone pill of 200mg and at least 4 misoprostol pills of 200mcg each. If you are 10–12 weeks pregnant, you may need to take 1 or 2 extra doses (4 or 8 extra pills) of misoprostol to finish the abortion process. If you have access to misoprostol only, you will need at least 12 misoprostol pills of 200mcg each if you are less than 13 weeks pregnant.

How can I know if the pills are real and not counterfeit?

Even if you ask for abortion pills by name, such as misoprostol or mifepristone, some medicine sellers may try to sell you counterfeit pills that won't work and may delay you from having an abortion. Safe, effective abortion pills should be:

Can I buy abortion pills without a prescription?

Mifepristone and misoprostol can be obtained from a health provider, from pharmacies and medicine sellers, and from the internet. Depending on what country you live in, a prescription may be required to buy mifepristone and misoprostol from a local pharmacy or medicine seller. But the two medications are often sold without a prescription. Misoprostol is typically much easier to buy because it is also used to treat ulcers and to prevent or stop heavy bleeding after childbirth. Mifepristone and misoprostol “combi-packs” and misoprostol alone can be bought from online pharmacies and organizations that support people to self-manage their abortions.