misoprostol and Drug-Overdose

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Drug Overdose; Female; Follow-Up Studies; Humans; Misoprostol; Portugal; Pregnancy; Pregnancy Trimester, First

Misoprostol is a synthetic prostaglandin E1 used during the first trimester of pregnancy as an adjacent to RU486 for medical termination of pregnancy. We present a case of a healthy 23-year-old woman who was admitted due to misoprostol overdose, used to induce an illegal abortion. Manifestations of toxicity included abdominal pain, vomiting, diarrhea and confusion. Treatment was supportive and included gastric lavage and administration of activated charcoal. Recovery was completed within a few hours, and the patient was scheduled for a dilatation and curettage the following day.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Criminal; Adult; Diarrhea; Drug Overdose; Female; Gastric Lavage; Gestational Age; Humans; Misoprostol; Poisoning; Pregnancy; Vomiting

We report the clinical course of a woman 31 weeks pregnant who ingested misoprostol (a prostaglandin E1 analog, Cytotek, used to prevent gastric ulcer) and trifluoperazine (Stelazine). Manifestations of toxicity included hypertonic uterine contraction with fetal death, hyperthermia, rhabdomyolysis, hypoxemia, respiratory alkalosis, and metabolic acidosis. We are concerned that misoprostol may be used as an llicit abortifacient.

Topics: Abortion, Criminal; Adult; Drug Overdose; Female; Humans; Misoprostol; Pregnancy; Suicide, Attempted; Trifluoperazine

The hepatoprotective effects of misoprostol on acetaminophen (APAP)-induced toxicity were studied in the rat. Liver injury was evaluated at 36 hr after APAP administration by measuring serum ornithine carbamoyltransferase (OCT) and alanine aminotransferase (ALT) levels, by using tetranitroblue tetrazolium (TNBT) staining and by histological analysis. After APAP administration, peak serum levels of the drug were detected at 15 min. Liver GSH was depleted from control levels of 448 +/- 48 micrograms/g to 82 +/- 2 micrograms/g (P < 0.01) within 3 hr. Serum ALT levels increased significantly after 16 hr and H&E staining revealed significant hepatic necrosis after 12 hr. Rats treated with misoprostol before and after APAP administration showed reduced OCT and ALT levels at 36 hr of overdose (454 +/- 446 IU/liter and 2571 +/- 2944 IU/liter, respectively) compared to those without misoprostol treatment (1348 +/- 480 IU/liter and 6077 +/- 3025 IU/liter, respectively, P < 0.01). TNBT staining showed a reduced area of damage from 28.6 +/- 22.3% to 7.3 +/- 8.9% (P < 0.01), and H&E staining also showed less extensive hepatic necrosis in rats treated with misoprostol before and after the overdose. In a time sequence study, misoprostol treatment starting within 10 hr of overdose showed the same protective effect as when it was given before and after APAP ingestion. No protection was detected when the treatment was started during the development of hepatic injury. However, misoprostol given when injury was established seemed to be protective. Our results show that misoprostol protects the liver against APAP-induced injury if given within 10 hr of overdose.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acetaminophen; Alanine Transaminase; Animals; Disease Models, Animal; Drug Overdose; Liver; Male; Misoprostol; Necrosis; Ornithine Carbamoyltransferase; Rats

Misoprostol (Cytotec) is a recently released prostaglandin E1 analog approved for use in prevention of nonsteroidal anti-inflammatory drug-induced gastropathy. We report one of the first known examples of toxicity in an acute ingestion since the drug was first released in international markets in 1984. After an accidental ingestion of 3 mg misoprostol (approximately 15 times the maximum recommended therapeutic dose), a 71-year-old woman exhibited fever, tremor, tachycardia, hypertension, nausea, and abdominal cramping. Recovery ensued with standard supportive care. The physiology of this unique drug and implications for management of acute toxicity are summarized.

Topics: Aged; Alprostadil; Anti-Ulcer Agents; Charcoal; Drug Overdose; Female; Humans; Misoprostol