Andrew Weeks


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    Misoprostol is an orally active prostaglandin
    E1 analogue, which was first licensed for the
    prevention and treatment of NSAID-induced ulcers.
    Because of its ease of use and strong uterotonic
    properties, it quickly found uses in reproductive
    health for the induction and treatment of abortion,
    induction of labour and in the management of
    postpartum haemorrhage. The manufacturer of the
    original brand (Cytotec) was reluctant to encourage
    its reproductive use for fear of a back-lash
    from the antiabortion lobby. It therefore remains

    off-label for reproductive health uses. This has
    done little to stem enthusiasm for the drug with
    protagonists pointing out that some of the most
    important drugs in obstetrics (e.g. corticosteroids
    to promote fetal lung maturity) remain off-label
    for pregnancy use. Furthermore, the World
    Health Organisation now considers misoprostol
    an essential drug for a variety of gynaecological
    indications. Clinicians are protected legally when
    using it by the principle that doctors should act
    according to ‘best practice’ as determined by
    their peers. They should not be deterred by the
    lack of licences, which were introduced to prevent
    misleading claims by the pharmaceutical industry
    rather than to guide clinicians’ prescribing. The
    current situation is made easier by the widespread
    production of generic misoprostol tablets, licensed
    for reproductive health indications.