Rectal Misoprostol controversy

Misoprostol tablets are formulated for oral administration, not rectal administration. The studies in the TABLE show that rectal administration of misoprostol results in lower circulating concentration of the medication compared to oral, buccal, or vaginal administration.⁶⁻⁸ After rectal administration it takes about 60 minutes to reach the peak circulating concentration of misoprostol.^6,7 By contrast, parenteral oxytocin, methylergonovine, and carboprost tromethamine reach peak serum concentration much more quickly after administration.




 If you have access to oxytocin, there is no advantage to using misoprostol to treat a PPH due to uterine atony.⁵. Next time when you are using rectal MISOPROSTOL think of other route or administer 1000  µg

• 5. Weeks A. The prevention and treatment of postpartum hemorrhage: what do we know and where do we go to next? BJOG. 2015;122(2):202−210.
• 6. Khan RU, El-Refaey H. Pharmacokinetics and adverse-effect profile of rectally administered misoprostol in the third stage of labor. Obstet Gynecol. 2003;101(5 pt 1):968−974.
• 7. Khan RU, El-Refaey H, Sharma S, Sooranna D, Stafford M. Oral, rectal and vaginal pharmacokinetics of misoprostol. Obstet Gynecol. 2004;103(5 pt 1):866−870.
• 8. Meckstroth KR, Whitaker AK, Bertisch S, Goldberg AB, Darney PD. Misoprostol administered by epithelial routes: drug absorption and uterine response. Obstet Gynecol. 2006;108(3 pt 1):582−590.