Misoprostol

Pregnancy & gynaecology-specific. Every dose row is source-referenced; verify against institutional protocols.

MisoprostolEMERGENCY KITProstaglandin E1 analogue

Regimens checked: 2026-10-17. Each indication has its own preparation, limits and safety checks.

Misoprostol: indication-specific regimens
Indication	Dose	Route	Frequency	Duration / preparation	Maximum	Monitoring / cautions
Atonic PPH when IV oxytocin is unavailable or bleeding does not respond; additional uterotonic selection depends on drugs already given MSFchecked	800 micrograms	Sublingual; rectal if sublingual administration is not feasible	Single rescue dose	One acute dose; arrange further haemorrhage control if bleeding continues · Four 200-microgram tablets = 800 micrograms; place under the tongue. Do not confuse this with the 25-microgram labour-induction dose	800 micrograms in this rescue regimen; do not automatically repeat	Monitor Quantified blood loss, uterine tone, BP/pulse, perfusion and urine output; record every dose and time Persistent shock or bleeding needs source control and blood products in parallel; do not wait for all drug doses Temperature, shivering, gastrointestinal effects; distinguish drug fever from ongoing sepsis Contraindications / cautions Do not use PPH dosing before birth of the baby
After appropriate eligibility, pregnancy-location assessment and consent; comply with India MTP law and approved service arrangements WHOsummary checked	800 micrograms 24–48 h after mifepristone 200 mg	Sublingual, buccal or vaginal	Initial dose once; additional doses require a defined abortion-care regimen and reassessment	Initial combined course over 1–2 days; confirm completion using the service follow-up plan · Four 200-microgram tablets = 800 micrograms. Use the prescribed route; do not substitute the labour-induction dose	WHO permits repeat doses when required without a universal fixed maximum; do not import the ≥12-week 400-microgram schedule into this <12-week row	Monitor Expected bleeding/pain, heavy bleeding, infection signs and pregnancy resolution; persistent pain or symptoms requires ectopic assessment Contraindications / cautions Suspected ectopic pregnancy, haemodynamic instability, uncontrolled major bleeding; urgent assessment rather than outpatient dosing
NICE NG126 medical management of confirmed missed miscarriage NICE · NG126checked	800 micrograms 48 h after mifepristone 200 mg orally, unless the sac has already passed	Vaginal, oral or sublingual	One initial dose	Single initial combined course; review if bleeding has not started within 48 h of misoprostol · Four 200-microgram tablets = 800 micrograms; provide analgesia and contact arrangements	800 micrograms initially; further treatment follows reassessment rather than automatic repeat dosing	Monitor Bleeding, pain, fever and haemodynamic symptoms; home urine pregnancy test at 3 weeks with assessment if positive or symptomatic Contraindications / cautions Uncertain viability/location, suspected ectopic or uncontrolled bleeding
NICE NG126 medical management of confirmed incomplete miscarriage NICE · NG126checked	600 micrograms (800 micrograms may be used to align local protocols)	Vaginal, oral or sublingual	Once	Single initial treatment; follow-up and further intervention depend on symptoms/completion · 600 micrograms = three 200-microgram tablets; 800 micrograms = four. Do NOT add mifepristone for incomplete miscarriage	One initial 600/800-microgram dose; reassess persistent bleeding or retained tissue	Monitor Bleeding/pain, fever and urine pregnancy test at 3 weeks; positive test or concerning symptoms requires reassessment Contraindications / cautions Instability, major haemorrhage, infection requiring source control or uncertain diagnosis
Unscarred uterus, live fetus and an approved hospital induction indication; cited 25-microgram product is for ≥37 weeks Norgine / emcchecked	25 micrograms orally every 2 h (alternative product regimen: 50 micrograms every 4 h)	Oral	Every 2 h for the 25-microgram regimen; stop further doses when labour begins or monitoring is abnormal	At most 24 h before review; stop for labour, tachysystole or fetal concern · Use a manufactured 25-microgram tablet. The cited tablet score is NOT for splitting. Do not estimate 25 micrograms by casually cutting a 200-microgram tablet Vaginal and sublingual regimens have different intervals; do not copy this two-hour oral schedule to another route.	200 micrograms in 24 h; wait ≥4 h after the last dose before oxytocin	Monitor Fetal heart rate and uterine contractions; hospital staff and emergency birth facilities available Contraindications / cautions Prior caesarean/uterine scar, concurrent oxytocin, unexplained bleeding or fetal concern requiring delivery

Pregnancy safety

Teratogenic reports with failed first-trimester exposure - counselling; therapeutic uses standardised by WHO/MTP guidance

Lactation

Compatible

Adverse effects

Pyrexia/shivering (antipyretics help), GI upset

MSFcheckedIN REVIEW