Latest NewsRussian guidelines added to the site The FIGO dosage chart has now been translated into Russian and is available here. New Guide to Diluting Misoprostol added A new pictorial guide to the dilution of Misoprostol has been added to the site. It outlines how to safely make up a 200ml batch of a 1 microgram per ml solution of misoprostol for oral administration, and can be found here. Misoprostol guidelines adopted by FIGOThe misoprostol dosage guidelines which appear on this site have recently been adopted by the International Federation of Gynecology and Obstetrics (FIGO). Although the guidelines had originally been commissioned by WHO, they made a strategic decision in 2008 not to produce specific dosage guidelines but instead to produce guidelines based on each specific indication. However, FIGO have now taken over the guidelines, and they disseminated them widely at the FIGO international conference in Cape Town in 2009. Misoprostol added to WHO Model list of Essential Medicines for the treatment of incomplete miscarriage and abortionThe World Health Organization announced the inclusion of misoprostol to its Model List of Essential Medicines based on its proven safety and efficacy for the treatment of incomplete abortion and miscarriage. The judgment was made by an expert committee that evaluated available evidence, which includes several guidelines and numerous randomized and comparative clinical trials for this indication. The proposal was submitted by Gynuity Health Projects based on the following evidence and considerations:
As described on the WHO website, the Model Essential Medicine List is a guide for the development of national and institutional essential medicine lists. For the past 30 years the Model List has led to a global acceptance of the concept of essential medicines as a powerful means to promote health equity. Essential medicines are selected with due regard to disease prevalence, evidence on efficacy and safety, and comparative cost-effectiveness. The Model List also forms the basis for medicines selection in emergency situations. Consequently, the EML guides the responses of humanitarian assistance agencies to country requests for assistance in acute emergency settings. Emergency preparedness is facilitated through standardization of medicine and medical supply needs in emergencies, as outlined in The Interagency Emergency Health Kit, and through guidance on appropriate medicines donations as agreed in the Interagency Guidelines on Drug Donations. The recommended doses for treatment of incomplete abortion and miscarriage are:
Contact empinfo@who.int or pubinfo@gynuity.org for more detailed information. Misoprostol approved in Uganda, Nigeria, Ethiopia, Somaliland and Mozambique for PPHThe Californian based non-profit making organisation Venture Strategies reports that misoprostol is being distributed throughout hospitals and clinics in Uganda, Nigeria and Ethiopia for the prevention and treatment of post-partum hemorrhage, the leading cause of maternal death. Venture Strategies worked with UC Berkeley's School of Public Health to help Nigerians obtain the world's first regulatory approval of misoprostol for controlling postpartum hemorrhage. They obtained the lowest prices in the world from high quality manufacturers in China and Egypt and are helping to facilitate the type of South-South trade established in Nigeria with other countries in Africa and the Middle East, at their request. The approved dosages are 600 microgrammes orally for prevention and 1000 microgrammes rectally for treatment. More details are available here from the Venture Strategies website. Misoprostol effective for preventing postpartum haemorrhage (PPH)A study by Richard Derman and colleagues conducted in rural India (Lancet 2006; 368:1248-1253) has revealed the efficacy of misoprostol tablets for prevention of PPH. Over 1600 low risk women were randomised to receive oral misoprostol (600 microgrammes) or placebo at the time of delivery. Blood was collected for the first hour post-partum. In the misoprostol group, the risk of PPH (>500mls) was halved, and the risk of severe PPH was reduced by 80%. The authors conclude that "oral misoprostol is safe, effective, and inexpensive ($1·00 per 600 μg dose) for women giving birth in low-resource settings". Click here for the free original article from the Lancet. In a Lancet letter on this research, Andrew Weeks demonstrates why misoprostol is effective for women with PPH, but has little effect on normal bleeding (in contrast to oxytocin). Oral misoprostol is absorbed more slowly than intramuscular oxytocin, and by the time it reaches its peak at 20 minutes the third stage is over for most women (see figure below). Thus, the more prolonged the bleeding (i.e. the PPH), the more effective misoprostol is.
Pfizer stops selling Cyotec in GermanyIn January 2006, Pfizer has stopped selling Cytotec in Germany without prior notice. The official reason given by the company is that misoprostol is an outdated treatment regimen and not “state of the art” anymore. Also the company stated that this decision is limited to Germany.
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