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Once-a-month treatment with a combination of mifepristone and the prostaglandin analogue misoprostol. (1/308)In this two centre study, the efficacy of 200 mg mifepristone orally followed 48 h later by 0.4 mg misoprostol orally for menstrual regulation was investigated. The dose of mifepristone was taken the day before the expected day of menstruation. Each volunteer was planned to participate for up to 6 months. A plasma beta human chorionic gonadotrophin (HCG) was measured on the day of mifepristone intake. The study was disrupted prematurely due to low efficacy. In 125 treatment cycles the overall pregnancy rate was 17.6% (22 pregnancies) and the rate of continuing pregnancies (failure) was 4.0%. Eight women discontinued the study due to bleeding irregularities which were seen in 15 cycles (12%). These effects on bleeding pattern made the timing of treatment day difficult. Late luteal phase treatment with a combination of mifepristone and misoprostol is not adequately effective for menstrual regulation. (+info)
Prevention of nonsteroidal anti-inflammatory drug-induced gastropathy: clinical and economic implications of a single-tablet formulation of diclofenac/misoprostol. (2/308)Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage arthritis. While controlling symptoms and improving quality of life, NSAID use is associated with gastroduodenal injury and a 2%-4% annual risk for symptomatic gastroduodenal ulceration, hemorrhage, and perforation. This requires clinicians to balance the efficacy of NSAIDs against the potential risk of serious gastrointestinal events. Identification and stratification of risk can help guide the optimal approach for arthritis management of individual patients or large populations such as managed care organizations. NSAID-induced gastroenteropathy carries considerable economic consequences; 46% of arthritis costs are related to managing serious adverse events. It is reasonable to assume that these costs may not be incurred if high-risk patients are recognized and optimally managed. Newer therapies with proven safety margins present an attractive option, especially for patients at higher risk. The single-tablet formulations of diclofenac and misoprostol (Arthrotec) offer an alternative in managing NSAID patients because of their inherent safety profile. Studies with diclofenac/misoprostol indicate its effectiveness in treating signs and symptoms of arthritis and in reducing the incidence of NSAID-induced gastroenteropathy. As such, this agent may provide improved medical and economic outcomes. This review discusses the clinical aspects of NSAID-induced gastroenteropathy, including available preventive therapies. Approaches to assessing patients' risk for developing complications, and the relationship of medical risk and economic outcomes, are also examined. Although not all patients require preventive therapy, patients with heightened risk may benefit clinically and economically from gastroprotective NSAIDs. Additional research or modeling may provide further insight into the economic implications of managing and preventing NSAID-induced gastroenteropathy. (+info)
A randomized double-blind placebo-controlled study to assess the effect of oral contraceptive pills on the outcome of medical abortion with mifepristone and misoprostol. (3/308)This was a randomized double-blind placebo-controlled trial to determine the effect of oral contraceptive (OC) pills taken immediately after medical abortion on the duration of bleeding and complete abortion rate. Two hundred women in the first 49 days of pregnancy were given 200 mg mifepristone orally followed by 400 microg misoprostol vaginally 48 h later. One day later, they were randomized to receive either OC pills (30 microg of ethinyl oestradiol and 0.15 mg of levonorgestrel per tablet) or placebo for 21 days. The complete abortion rates were 98% in the OC group and 99% in the placebo group. The median duration of bleeding was similar: 17 (range: 5-57) days in the OC group and 16 (range: 6-55) days in the placebo group. In the OC group there was a small but significant fall in the haemoglobin concentration by 14 days (5.3 g/dl) after administration of mifepristone. The incidence of side-effects was similar in the two groups. We conclude that the use of OC pills does not decrease the duration of bleeding after medical abortion nor does it affect the abortion rate. (+info)
Protection against aspirin-induced human gastric mucosal injury by bosentan, a new endothelin-1 receptor antagonist. (4/308)BACKGROUND: Gastric ulceration induced by aspirin and by non-steroidal anti-inflammatory drugs (NSAIDs) is a major clinical problem. The mechanism of injury is unclear. There is evidence that NSAID-induced injury may cause endothelin activation. Endothelin-induced vasoconstriction has been shown to be capable of causing gastric ulceration. AIM: To investigate whether acute gastroduodenal injury induced in humans by aspirin can be prevented by the endothelin-1 antagonist, bosentan. METHODS: Eighteen healthy volunteers each received 5 x 900 mg aspirin every 12 h on three separate occasions (with either placebo, bosentan 700 mg or misoprostol 400 mg). Treatment order was randomized by Latin square design. Subjects were endoscoped and erosions counted before and 90 min after the first and last dose of aspirin. Plasma concentrations of bosentan were measured up to 5 h post-dose. RESULTS: There was a significant reduction in the mean number of erosions in the aspirin plus bosentan and aspirin plus misoprostol groups after the first dose of aspirin, compared with controls (aspirin plus placebo) (P<0.05). This was not sustained after the fifth dose of aspirin in the aspirin plus placebo and aspirin plus bosentan groups, but was still present in the aspirin plus misoprostol group. The mean plasma concentration of bosentan measured 3.5 h post-dose fell from 4510 (95% CI: 2791-6230) ng/mL after the 1st dose to 2508 (95% CI: 1733-3283) ng/mL after the 5th dose (P = 0.02). CONCLUSION: Endothelin receptor antagonism by bosentan can protect the gastric mucosa against aspirin damage. After five doses, bosentan levels fell, possibly because of enzyme induction, and protection was no longer evident. Further investigation is needed to assess whether higher doses would be effective. (+info)
Effect of glutamine on the intestinal permeability changes induced by indomethacin in humans. (5/308)BACKGROUND: Long-term non-steroidal anti-inflammatory drug (NSAID) intake may induce increased intestinal permeability, eventually resulting in enteropathy. Because increased permeability might be related to cell damage resulting from energy depletion, it was hypothesized that glutamine--the major energy source of the intestinal mucosal cell--might prevent permeability changes. METHODS: The 6-h urinary excretion of 51Cr-EDTA after an oral load of 51Cr-EDTA was used in this study as a measure for intestinal permeability. Healthy volunteers underwent a series of permeability tests: (i) basal test; (ii) test following NSAID (indomethacin); (iii) test following NSAID in combination with glutamine and/or misoprostol. RESULTS: The NSAID induced increased permeability in all volunteers. Pre-treatment with glutamine (3x7 g daily, 1 week before NSAID-dosing) did not prevent the NSAID-induced increase in permeability. Multiple doses of glutamine close in time to NSAID-dosing resulted in significantly lower permeability compared to the NSAID without glutamine. Co-administration of misoprostol with the multiple-dose scheme of glutamine resulted in a further reduction in the NSAID-induced increase in permeability. CONCLUSIONS: Glutamine decreases the permeability changes caused by NSAID-dosing when it is administered close in time, and misoprostol has a synergistic effect. (+info)
Does an acidic medium enhance the efficacy of vaginal misoprostol for pre-abortion cervical priming? (6/308)Absorption pharmacokinetics reveal a relationship between plasma concentrations of misoprostol and its therapeutic effect. To achieve a constant plasma profile and optimal efficacy, it is important to develop a medium that ensures complete dissolution of vaginal misoprostol tablets. Vaginal misoprostol is said to liquefy better in an acidic medium; thus, the aim of this study was to determine whether a 200 microg misoprostol tablet dissolved in acetic acid would be more efficacious than 200 microg misoprostol dissolved in water for pre-abortion cervical priming. A total of 120 healthy nulliparous women requesting legal termination of pregnancy between 6-12 weeks gestation were allocated randomly to either of the study groups. Vacuum aspiration was performed 3-4 h after insertion of the misoprostol tablet. Using Hegar's dilator, the degree of cervical dilatation before operation was measured. Of 60 women, 14 (23%) achieved a cervical dilatation of >/=8 mm when the misoprostol dose was dissolved in acetic acid; 12 (20%) achieved a similar cervical dilatation when the dose was dissolved in water. The mean cervical dilatation for the acid and water media used was 6.3 mm and 6.2 mm respectively; these differences were not statistically significant, neither were pre-operative and intra-operative blood losses statistically different between the two groups. Twenty-four (40%) and four (7%) respectively of women in whom a water medium was used experienced vaginal bleeding and abdominal pain; 20 (33%) and 0 women respectively among those in whom an acetic acid medium was used experienced vaginal bleeding and abdominal pain. These differences in side effects were not statistically significant. Our study shows that the use of acetic acid to dissolve vaginal misoprostol does not improve the efficacy in achieving successful cervical dilatation for pre-abortion cervical priming. (+info)
The use of misoprostol for pre-operative cervical dilatation prior to vacuum aspiration: a randomized trial. (7/308)Misoprostol is effective for cervical priming prior to vacuum aspiration for first trimester termination of pregnancy. Previous studies showed that the oral route was more acceptable to patients but there were higher incidences of side-effects when compared with the vaginal route. This study is to determine the optimal dosage and route of administration of misoprostol for pre-operative cervical dilatation. A double-blind, randomized trial was undertaken for 225 nulliparous women with 8-12 weeks amenorrhoea. They were randomly assigned to groups given 0 (placebo), 200 or 400 microg oral or vaginal misoprostol 3 h prior to vacuum aspiration. In misoprostol-treated groups the baseline cervical dilatation was significantly increased when compared with the placebo group; the effect was dose-related in the oral but not in the vaginal group. The cumulative force and blood loss was significantly decreased in the misoprostol-treated groups. The incidences of side-effects were more frequent in misoprostol groups but were not related to the route and dosage of medication. The duration of procedure, incidences of post-operative complications, the duration of post-operative bleeding and the interval to the first period were similar in the five treatment groups. We conclude that a 3 h pre-treatment interval is effective for both oral and vaginal routes. When given orally, 400 microg is more effective than 200 microg. The efficacy was otherwise similar when compared with the vaginal route. We recommend 400 microg oral misoprostol 3 h prior to vacuum aspiration for cervical dilatation. (+info)
Cyclooxygenase inhibitors increase Na-K-2Cl cotransporter abundance in thick ascending limb of Henle's loop. (8/308)Cyclooxygenase inhibitors, such as indomethacin and diclofenac, have well-described effects to enhance renal water reabsorption and urinary concentrating ability. Concentrating ability is regulated in part at the level of the thick ascending limb of Henle's loop, where active NaCl absorption drives the countercurrent multiplication mechanism. We used semiquantitative immunoblotting to test the effects of indomethacin and diclofenac, given over a 48-h period, on the expression levels of the ion transporters responsible for active NaCl transport in the thick ascending limb. Both agents strongly increased the expression level of the apical Na-K-2Cl cotransporter in both outer medulla and cortex. Neither agent significantly altered outer medullary expression levels of other thick ascending limb proteins, namely, the type 3 Na/H exchanger (NHE-3), Tamm-Horsfall protein, or alpha1- or beta1-subunits of the Na-K-ATPase. Administration of the EP3-selective PGE(2) analog, misoprostol, to indomethacin-treated rats reversed the stimulatory effect of indomethacin on Na-K-2Cl cotransporter expression. We conclude that cyclooxygenase inhibitors enhance urinary concentrating ability in part through effects to increase Na-K-2Cl cotransporter expression in the thick ascending limb of Henle's loop. This action is most likely due to elimination of an EP3-receptor-mediated tonic inhibitory effect of PGE(2) on cAMP production. (+info)
Postpartum hemorrhage can be caused by various factors, including:
1. Uterine atony: This occurs when the uterus fails to contract properly after delivery, leading to excessive bleeding.
2. Lacerations or tears in the genital tract: Tears in the vaginal tissues, cervix, or uterus can cause bleeding.
3. Placenta accreta or placenta praevia: These conditions occur when the placenta attaches abnormally to the uterine wall, causing bleeding during delivery.
4. Cervical insufficiency: This occurs when the cervix is unable to support the weight of the baby, leading to bleeding.
5. Blood coagulopathy disorders: These are rare conditions that affect the body's ability to form blood clots, leading to excessive bleeding.
Symptoms of PPH may include:
1. Heavy bleeding within the first 24 hours post-delivery
2. Soaking more than two pads per hour
3. Pale or clammy skin
4. Weak or rapid pulse
5. Shallow breathing
6. Confusion or disorientation
Treatment for PPH may include:
1. Observation and monitoring of vital signs
2. Administration of oxytocin to stimulate uterine contractions
3. Use of a blood transfusion to replace lost blood volume
4. Surgical intervention, such as suturing or repairing any lacerations or tears
5. Management of underlying causes, such as blood coagulopathy disorders
Prevention of PPH includes:
1. Proper prenatal care and monitoring of the mother's health during pregnancy
2. Use of cesarean delivery if necessary
3. Avoidance of excessive forceps or vacuum extraction during delivery
4. Use of oxytocin and other medications to stimulate uterine contractions
5. Close monitoring of the mother's vital signs after delivery
It is important for healthcare providers to be aware of the risk factors and symptoms of PPH, as well as the appropriate treatment and prevention strategies, in order to provide optimal care for mothers at risk of developing this condition.
There are several types of incomplete abortion, including:
1. Missed abortion: In this type, the pregnancy continues despite the attempt to end it. The fetus or embryo may have died, but some tissue remains in the uterus.
2. Incomplete evacuation: This occurs when not all of the contents of the uterus are removed during an abortion procedure.
3. Uterine rupture: This is a rare complication that can occur during pregnancy or labor, where the uterus tears and allows the fetus or embryo to move into the abdominal cavity.
Incomplete abortion can cause several symptoms, including:
* Vaginal bleeding that lasts for more than a few days
* Heavy cramping
* Pain in the lower abdomen
If you suspect that you have experienced an incomplete abortion, it is essential to seek medical attention as soon as possible. A healthcare provider can diagnose the condition by performing an ultrasound or a pelvic exam. Treatment options may include:
1. Surgical evacuation: This involves removing any remaining tissue from the uterus.
2. Medications: Antibiotics and pain medications may be prescribed to manage symptoms.
3. Dilation and curettage (D&C): This is a procedure where the healthcare provider opens the cervix and removes any remaining tissue from the uterus using a special instrument called a curette.
Preventing incomplete abortion is crucial, and it is essential to seek medical attention if you experience any symptoms of pregnancy complications after an attempted abortion. Proper follow-up care can help prevent or diagnose incomplete abortion early, reducing the risk of complications and improving outcomes.
Symptoms of a uterine hemorrhage may include:
* Vaginal bleeding that may be heavy or light in flow
* Pain in the lower abdomen
* Pain during sexual activity
* Spotting or bleeding between menstrual periods
* Unusual discharge from the vagina
If you experience any of these symptoms, it is important to seek medical attention as soon as possible. Uterine hemorrhages can be diagnosed through a physical examination and imaging tests such as ultrasound or MRI. Treatment depends on the underlying cause of the bleeding, but may include medications to control bleeding, surgery to remove fibroids or polyps, or hysterectomy in severe cases.
It is important to note that while uterine hemorrhages can be managed with appropriate medical care, they can also be life-threatening if left untreated. Seeking prompt medical attention and following the advice of your healthcare provider are crucial to preventing complications and ensuring a successful outcome.
Endometritis is a medical condition that affects the endometrium, which is the lining of the uterus. It can cause painful symptoms such as vaginal discharge, fever and abdominal pain. Treatment usually involves antibiotics to clear any infections, hormonal medications to reduce inflammation and promote healing. In severe cases surgery may be necessary to remove infected tissue or repair damaged structures.
Endometritis is an inflammatory condition that affects the endometrium, which lines the uterus. Symptoms include vaginal discharge, fever, painful urination, and abdominal pain. Treatment typically involves antibiotics to clear up any underlying infections, as well as hormonal medications to reduce inflammation and promote healing. In severe cases, surgery may be necessary to remove infected tissue or repair damaged structures.
Endometritis is an inflammatory condition that affects the endometrium, which is the lining of the uterus. It can cause a range of symptoms including vaginal discharge, fever, painful urination and abdominal pain. Treatment typically involves antibiotics to clear up any underlying infections and hormonal medications to reduce inflammation and promote healing. In severe cases surgery may be necessary to remove infected tissue or repair damaged structures.
Endometritis is a medical condition that affects the endometrium, which lines the uterus. Symptoms can include vaginal discharge, fever, painful urination, and abdominal pain. Treatment options may involve antibiotics to clear up any underlying infections as well as hormonal medications to reduce inflammation and promote healing. In severe cases, surgery may be necessary to remove infected tissue or repair damaged structures.
Endometritis is an inflammatory condition that affects the endometrium which lines the uterus. Symptoms can include vaginal discharge fever painful urination and abdominal pain Treatment options may involve antibiotics to clear up any underlying infections as well as hormonal medications to reduce inflammation and promote healing In severe cases surgery may be necessary to remove infected tissue or repair damaged structures.
1. Incomplete abortion: The abortion may not have been complete, leaving some tissue from the pregnancy remaining in the uterus.
2. Incorrect dosage: The person performing the abortion may have used too low of a dose of medication or performed the surgical procedure for too short a time, resulting in an incomplete termination.
3. Timing issues: The abortion may not have been performed at the correct stage of pregnancy, making it more difficult to terminate the pregnancy completely.
4. Uterine anomalies: Abnormalities in the shape or size of the uterus can make it more difficult for the abortion to be complete.
5. Ectopic pregnancy: The fertilized egg may have implanted outside of the uterus, making it impossible for a normal abortion to occur.
Symptoms of a missed abortion can include vaginal bleeding, abdominal pain, and a fetal heartbeat that can be detected through ultrasound. If a missed abortion is suspected, medical attention should be sought immediately as the pregnancy will continue to develop and can be dangerous for the mother's health.
Treatment for a missed abortion usually involves a surgical procedure to remove any remaining tissue from the pregnancy. In some cases, medication may be used to help soften the cervix and dilate the cervix before the surgical procedure. If the pregnancy is far enough along, a delivery may be necessary.
Prevention of missed abortion includes proper training and experience of the person performing the abortion, correct dosage and timing of medication or surgical procedures, and appropriate follow-up care after the procedure to ensure that it was complete.
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- Misoprostol is used alone or in combination with mifepristone to end an early pregnancy. (medlineplus.gov)
- More than half of all abortions in the United States use a combination of two drugs, mifepristone and misoprostol, according to the Guttmacher Institute , a research group focusing on sexual and reproductive health. (go.com)
- We've got over 20 years of data showing the safety and efficacy of mifepristone and misoprostol for abortions,' Dr. Alisa Goldberg, an associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, told ABC News. (go.com)
- Numerous countries don't have access to mifepristone and, therefore, only use misoprostol for abortions. (go.com)
- Mifepristone (Mifeprex) and Misoprostol are seen at the Women's Reproductive Clinic in Santa Teresa, New Mexico, June 17, 2022. (go.com)
- However, research suggests that using misoprostol with mifepristone is more effective than misoprostol alone. (go.com)
- If mifepristone loses FDA approval, clinicians who provide abortions will be able to offer either surgical abortions or misoprostol-only abortions, but the new regimen will include extra training to properly communicate to patients their options. (go.com)
- In addition, a fatal case of C. sordellii toxic shock syndrome after medical abortion with mifepristone and misoprostol was reported in 2001, in Canada ( 2 ). (cdc.gov)
- Cases potentially associated with use of mifepristone or misoprostol should also be reported through the FDA MedWatch system available at http://www.fda.gov/medwatch/index.html or telephone 800-FDA-1088. (cdc.gov)
- The "abortion pill" is the generic name for two different drugs used to terminate a pregnancy: mifepristone and misoprostol. (thehealthforum.org)
- This site contains information about mifepristone and misoprostol - two drugs used to safely and effectively terminate pregnancies (the " abortion pill ") and allow women access to a DIY or at-home abortion . (abortionpillrx24.com)
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Dose of misoprostol2
- will begin misoprostol only on the second or third day of the next normal menstrual period. (nih.gov)
- Misoprostol oral tablets contain either 100 mcg or 200 mcg of misoprostol, a synthetic prostaglandin E 1 analog. (nih.gov)
- Misoprostol is a cytoprotective prostaglandin E 1 analog that displays agonist activity at EP receptors. (tocris.com)
- Misoprostol (Cytotec, Searle, England), a prostaglandin E1 analogue, is indicated for protection of peptic disease induced by cyclo-oxygenase inhibitors. (tubitak.gov.tr)
- If an abortion drug is banned, could misoprostol be used as a safe alternative? (go.com)
- OB-GYNs and abortion providers tell ABC News that data from around the world shows misoprostol is safe and effective -- and that they're ready to provide misoprostol-only abortions -- but that the two-dose regimen is more effective. (go.com)
- It just gets the body primed and ready for the rest of the abortion and then the next step is you take misoprostol,' Dr. Laura Laursen, an OB-GYN at Rush University Medical Center in Chicago, told ABC News. (go.com)
- One 2019 study found 'misoprostol alone is effective and safe and is a reasonable option for women seeking abortion in the first trimester. (go.com)
- The issue with misoprostol is that it generally takes longer to complete the abortion,' said Laursen. (go.com)
- There are no blood tests that can show that you have taken Misoprostol, so there will be no way to prove that you tried to do an abortion. (womenonwaves.org)
- Which type of pill containing Misoprostol is the most effective to cause an abortion? (womenonwaves.org)
- 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 complications from gastric ulcers associated with use of the NSAID, or is at high risk of developing gastric ulceration. (nih.gov)
- If you are a woman of childbearing age, you may take misoprostol to prevent ulcers only if you have had a negative pregnancy test in the past 2 weeks and if you use a reliable method of birth control while taking misoprostol. (medlineplus.gov)
- Another systematic review conducted in July 2020 found misoprostol, especially given in higher doses, was safe and effective in terminating a pregnancy. (go.com)
- Misoprostol still works after 12 weeks of pregnancy. (womenonwaves.org)
- Misoprostol is also used sometimes to treat ulcers and to induce labor. (medlineplus.gov)
- Since vaginal bleeding was reported during misoprostol use previously, we hypothesized that misoprostol might cause endometrial stimulation. (tubitak.gov.tr)
- Study group received 200-µg vaginal misoprostol , 3 h prior to vaginoscopic hysteroscopy . (bvsalud.org)
- Use of 200-µg vaginal misoprostol , administered vaginally 3 h before diagnostic vaginoscopic hysteroscopy , was found to be simple and effective method of cervical priming in facilitating cervical entry with minimal side effects. (bvsalud.org)
- You must begin taking misoprostol on the second or third day of your menstrual period. (medlineplus.gov)
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- Do not take misoprostol to prevent ulcers if you are pregnant or plan to become pregnant. (medlineplus.gov)
- Misoprostol is used to prevent ulcers in people who take certain arthritis or pain medicines, including aspirin, that can cause ulcers. (medlineplus.gov)
- Currently, the only FDA label use of misoprostol is for gastric ulcers. (go.com)
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- This study assessed the efficacy of the two outpatient processes of single-dose 50 µg oral misoprostol (OM) and membrane sweeping (MS) on the outcome of labour induction and the possibility of reducing the need for hospital admission for cervical ripening/ labour induction in uncomplicated post-term singleton pregnancies at a tertiary health institution in south-western Nigeria. (who.int)
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- Drug interaction studies between misoprostol and several nonsteroidal anti-inflammatory drugs showed no effect on the kinetics of ibuprofen or diclofenac, and a 20% decrease in aspirin AUC, not thought to be clinically significant. (nih.gov)
- Pharmacokinetic studies also showed a lack of drug interaction with antipyrine and propranolol when these drugs were given with misoprostol. (nih.gov)
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- has received both oral and written warnings of the hazards of misoprostol, the risk of possible contraception failure, and the danger to other women of childbearing potential should the drug be taken by mistake. (nih.gov)
- The second drug, misoprostol, taken 24 to 48 hours later, causes the uterus to contract and dilates the cervix, which will expel the embryo. (go.com)
- If you become pregnant while taking misoprostol, stop taking it and call your doctor immediately. (medlineplus.gov)
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- In normal volunteers, misoprostol is rapidly absorbed after oral administration with a T max of misoprostol acid of 12 ± 3 minutes and a terminal half-life of 20-40 minutes. (nih.gov)
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