Andrew Weeks
Speeches:
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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 remainsoff-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.