Misoprostol is a part of the drug Cytotec. It is a synthetic analog of prostaglandin E1. One tablet contains a dosage of 200 mcg. It has a gastroprotective, pro-ulcer effect, suppressing the basal, nocturnal, and stimulated secretion of parietal cells of the stomach, reducing its volume and proteolytic activity. The drug is prophylactic in relation to the appearance of erosive lesions when taking non-steroidal anti-inflammatory drugs. Heals ulcers and protects the gastric mucosa. The composition of this drug also includes castor oil, which is an auxiliary substance and has a protective property against the gastric mucosa. Misoprostol promotes mucus production, increases the secretion of sodium bicarbonate, and improves blood circulation, thereby enhancing cell regeneration. Misoprostol is actively used in obstetrics due to its effect on the cells of the uterine myometrium. It promotes the contraction of smooth muscles and the expansion of the cervix, making it indispensable in stimulating labor.
Used internally, fast adsorption from the gastrointestinal tract, food intake reduces the adsorption of the drug. It binds to plasma proteins. Metabolism occurs in the liver to the active metabolite called misoprostol acid. The maximum concentration reaches after 12 minutes. Half-life is 30 minutes. The drug does not accumulate with repeated use. The kidneys excrete it up to 85% and by bile up to 15%.
Cytotec is actively used in combination with non-steroidal anti-inflammatory drugs due to the protection of the mucous membrane and ulceration. With ulcerative lesions of the stomach, duodenum, with or without bleeding.
It is used for early termination of pregnancy (up to 42 days of amenorrhea) in combination with mifepristone.
Weak labor and slow dilatation of the cervix.
The medication is absorbed faster when taken on an empty stomach.
In case of ulcerative lesions – take internally, during meals, or at night, 200 mcg up to 4 times a day, or take 400 mcg (2 tablets) 2 times a day.
The duration of treatment is up to 2 months.If there is renal failure, the dosage is reduced to 100 mcg per dose.
To prevent the irritating effect of non-steroidal drugs (ulcerogenic action) 200 mcg 2-4 times a day during the entire treatment of non-steroidal anti-inflammatory drugs (NSAIDs).
When using the drug in doses higher than recommended, the following symptoms may develop decreased heart rate, tremors, convulsions, drowsiness, decreased blood pressure, an attack of palpitations, pain in the epigastric and small pelvis, fever, stool disorders - diarrhea.
When it occurs, it is necessary to begin symptomatic treatment, and there are no antidotes.
Cytotec is contraindicated in renal and hepatic insufficiency in the terminal stages, acute phase, and hypersensitivity to medication components.
With caution in arterial hypotension, epilepsy, stroke, coronary artery disease, cardiosclerosis, enterocolitis of any etiology, glaucoma, diseases of the endocrine system, bronchial asthma. Cytotec is contraindicated for children.
Cytotec is contraindicated for use in pregnancy and pregnancy planning and allowed only in case of the desire to terminate the pregnancy.
You should interrupt lactation for the period of taking the medication. In case of termination of pregnancy and while breastfeeding, you should interrupt the feeding for 5 days if combined with mifepristone for 7 days.
It mainly affects the digestive tract organs, including abdominal pain, nausea, vomiting, and loose stools. There can be heavy menstruation, contraction of the uterus, irregularities, constipation, skin rashes, Quincke's edema. Seizures were infrequent, mainly in women close to menopause or already in the postmenopausal period.
When taken simultaneously with antacids, the bioavailability of Cytotec decreases. If antacids contain magnesium or aluminum, diarrhea worsens.
If Acenocoumarol is used together with Cytotec, the effect of the anticoagulant is reduced.
Diclofenac enhances the side effects of misoprostol, while coadministration with indomethacin increases the side effects of both Cytotec and indomethacin.
Anticonvulsants, bicarbonates, antidepressants, isoniazid, indomethacin, rifampicin, cimetidine, and especially their long-term use, helps to reduce the concentration of Cytotec in the blood serum.
Misoprostol reduces the nephrotoxicity of cyclosporine and minimizes the side effects of Lornoxicam.
The medication is used to terminate pregnancy only in conjunction with mifepristone and only in hospitals where there is an ability to provide emergency gynecological, surgical care, and a blood transfusion department. The patient must be informed about how the medication works and its side effects. 4 hours before the procedure, the patient should be under the supervision of medical staff. After taking medicine, the patient usually has prolonged bleeding.
If pregnancy is early, abortion may already occur while using mifepristone, but misoprostol tablets should still be used to improve the treatment's effect. Abortion occurs within the first day in 70-80% of women, the rest within 7 days. 2 weeks after the abortion, a medical examination is required at the clinic where the abortion was performed. If the abortion was incomplete, aspiration and histological examination must be performed.
If the medication is used as a gastroprotective agent and moderate to severe diarrhea develops, spotting, skin itching, decreased blood pressure, decreased liver enzymes, the treatment should be interrupted. After treatment with misoprostol, NSAIDs should not be used for a week.
A Peptic Ulcer is a wounded surface of the gastric mucosa and/or duodenum formed due to exposure to pepsin and other digestive juices. The disease is chronic, and periods of remission alternate with exacerbations. More often, it is seasonal, with exacerbations in spring and autumn, when the health reserves of the body decrease. Ulcers come in different sizes and are divided into small ones - less than 0.5 cm, medium - 0.5-1.0 cm, large - 1.1-3 cm, giant more than 3 cm in diameter. Ulcers develop at all ages, even in infancy, but most often in adults. Gastritis is a diagnosis that every third person has and is one of the provoking factors for developing peptic ulcer disease.
The most common ulcers of the duodenum, more often at several cm from the cardia of the stomach, then there are already stomach ulcers, which are in the lower part of the stomach. If part of the patient's stomach is missing, it was removed for surgical reasons, and then ulcers can form at the junction of the stomach and duodenum and are called marginal.
Peptic ulcer disease develops when the natural protection of the stomach is bicarbonates, the renewal of the mucous membrane is no longer able to cope with constant mechanical injuries.
Two main reasons are leading to peptic ulcer disease: helicobacter-associated, caused by Helicobacter infection, and NSAID-associated, caused by uncontrolled intake of analgesics.
In 50% of people with peptic ulcers, ulcers are NSAID-associated, but taking these medications does not cause ulcers in most people.
In smokers, the likelihood of developing ulcers increases, treatment is difficult, and frequent relapses of the disease occur.
Excess alcohol consumption and stress are also risk factors. A sharp jump in the growth of the disease was revealed after the terrorist attacks in New York and earthquakes in Japan. Rare causes include Zollinger-Ellison syndrome, a type of malignant oncology associated with the regrowth of the hormone gastrin, which promotes excess production of stomach acid that eats away at the walls of the stomach.
In terms of symptoms, malignant ulcers correspond to non-malignant ones. But treatment with basic drugs does not help, and the effect is insignificant.
Half of the people suffering from peptic ulcer disease have relatives with a history of peptic ulcers. Helicobacter pylori infection is transmitted between family members.
It is worth noting that a peptic ulcer may not appear at all. And have a different clinic depending on the location and age of the patient.
The most common symptom is pain in the left hypochondrium or left the epigastric region, depending on localization. The pain can be burning, dull, aching, cutting, stabbing, pulling, varying intensity with and without irradiation, after eating, or, on the contrary, on an empty stomach. Everything relates to the localization of the peptic ulcer. If, for example, with a stomach ulcer in its cardiac and subcardial sections, the pain will be early, then in the intermission sections and duodenum late, hungry and night pains. Early pains are the ones that appear 30-60 minutes after eating; late pains are pains that occur 2-3 hours after eating. Hunger pains that appear not earlier than 2 hours after the last meal and pass after eating. And night pains - pains that occur at night, forcing the patient to wake up.
Syndromes that accompany peptic ulcer disease:
1) Syndrome of gastric dyspepsia - heartburn, nausea, vomiting, sour eructation, decreased appetite, or an increase in appetite, in the case of a duodenal ulcer to relieve pain, a feeling of heaviness and fullness. Vomiting is often sour content and bringing relief, so patients usually try to cause it deliberately.
2) Syndrome of intestinal dyspepsia - diarrhea, characteristic of stomach ulcers, constipation, characterize duodenal ulcers,
3) Asthenic-vegetative syndrome - weakness, fatigue, mood swings.
For the disease diagnosis, fibro gastroscopy, a type of endoscopic examination, can be attributed to the gold standard. This method will determine the localization, size, depth, shape of the ulcer, its edges, and the state of the mucous membrane around, to assess the motor and evacuation function of the stomach. As well as taking material for biopsy and conducting a test for Helicobacter pylori infection, monitoring the quality of the prescribed therapy is essential.
Preventive measures include: • Compliance with oral hygiene, timely treatment of cavity; • Strict time-scheduled eating; • Proper nutrition. Eliminate or limit the consumption of smoked meats, spicy, fried food, carbonated drinks, and food that is too hot or cold; • Monitor vitamin balance and prevent vitamin deficiency; • Give up bad habits - smoking, alcohol; • Prevention of hormonal disruptions and disorders; • Regular and moderate physical activity; • Refusal from uncontrolled intake of medicines and self-medication; • Use of personal hygiene products and dishes; • Learn to respond to stress and minimize it in your life correctly, and applying mental health skills.
A peptic ulcer is a chronic disease that leads to constant exacerbations and remission. And how many remissions or exacerbations there will depend on the person and person's lifestyle. If you do not engage in treatment at all, or if it is not completely treated, then serious complications are possible. These include bleeding, pyloric stenosis, perforation, penetration, malignancy.
Let's talk in more detail about each one.
Bleeding is the most common and dangerous complication of peptic ulcer disease. Mortality accounts for 50% of all cases of mortality diagnosed with peptic ulcer disease. Symptoms: black stools - duodenal ulcer, vomiting of bloody thick - stomach ulcer. Additionally: weakness, chills, nausea, dizziness. Pale skin, tachycardia, cold sweat.
Pyloric stenosis is a narrowing of the sphincter due to scarring of an ulcer located in the duodenum or the pyloric canal. It leads to a violation of the evacuation of stomach contents into the intestines.
Perforation of the ulcer is the creation of a through the wound of the organ and the ingress of food and gastric contents into the abdominal cavity. The main symptom is sharp, stabbing pain. The pain can be so severe that the patient loses consciousness. 12 hours after perforation and not providing qualified assistance, peritonitis develops, which, in the case of a slow diagnosis, entails the patient's death.
Penetration is the germination of an ulcer into nearby organs - the greater omentum, pancreas, intestinal loops, liver. The ulcer symptoms intensify, and the organ's symptoms into which penetration occurred are added: girdle pain - pancreas, pain in the right hypochondrium - liver, Etc. The pain is constant, intense, loses connection with food intake, and does not decrease after taking medications.
Malignancy is the malignancy of the ulcer and the degeneration of normal cells into cancerous ones. Pain changes, connection with time and food intake is lost, the general condition worsens. There is constant weakness, low-grade fever, the patient loses weight. Most often, this complication appears with constant exacerbations of the ulcer.
In cases where the course of the disease is uncomplicated, conservative treatment is carried out with medications, and the patient must comply with the diet, regimen, and all recommendations of doctors. In addition to the regimen and diet, suture recommendations include timely and complete treatment with medications, following the courses, and supporting anti-relapse therapy. If the latter is not observed, complications and situations may develop with the need for surgical intervention.
Non-traditional approaches of treatment include decoctions, infusions, Etc. Some of the methods can alleviate the patient's condition, but they will never cure completely. Therefore, it is unlikely that it will be possible to do without the help of a qualified gastroenterologist.
As for the most unconventional treatment, the following recipes are passed from generation to generation: Freshly squeezed potato juice, which is squeezed out of raw tubers and taken half a glass 4 times a day before meals. A decoction of sea buckthorn berries. Sea buckthorn is poured with water, boiled over low heat, filtered, and taken in 100 ml 3 times a day for 2 months. Fresh cabbage juice is squeezed out and drunk in a glass 4 times a day on an empty stomach. It is even more effective if you drink it with a spoonful of honey. Bee honey is dissolved in warm water, 2 tablespoons per glass and consumed before each meal. It is recommended to use mineral medicinal waters.
All this only applies to additional strengthening therapy since none of the alternative methods can eliminate the Helicobacter pylori infection. Only eradication therapy based on antibiotics and antacids can cope with it.
A peptic ulcer is one of the most common diseases of internal organs. According to world statistics, the disease is registered in 15% of the world's population.
Peptic ulcer disease is of great importance both for medicine and humans and for the state because it affects the young working-age population. The prognosis of the disease is quite favorable, but only if strict rules are observed for patients, adequate and timely treatment. And rehabilitation, especially after complications, does not take a long time and leads to early disability.