Misoprostol is a prescription-only medicine with two very different roles: preventing stomach ulcers in people taking anti-inflammatories, and a range of uses in pregnancy and childbirth, including inducing labour, managing miscarriage, controlling bleeding after birth, and medical termination of pregnancy. It must be used under medical supervision.
What is Misoprostol?
Misoprostol is Schedule 4 in South Africa — prescription-only. It appears as:
| Product | Contains |
|---|---|
| Misoprostol (Cytotec) | Misoprostol 200 mcg tablet |
| Arthrotec 50 | Diclofenac 50 mg + misoprostol 200 mcg |
| Arthrotec | Diclofenac 75 mg + misoprostol 200 mcg |
| Medabon Co | Mifepristone 200 mg + misoprostol (combination pack) |
Misoprostol is a synthetic prostaglandin E1 analogue — a manufactured version of a natural signalling molecule. It has two distinct effects, and they explain its two unrelated uses:
- In the stomach, prostaglandins maintain the protective lining: they stimulate mucus and bicarbonate production and support blood flow to the mucosa. Anti-inflammatories work by blocking prostaglandin production, which is precisely why they cause ulcers. Misoprostol replaces what the NSAID removed.
- In the uterus, prostaglandins cause the muscle to contract and soften (ripen) the cervix.
The second effect is the reason for the most important warning about this medicine. Misoprostol causes uterine contractions, so when it is used for ulcer prevention it must not be taken by anyone who is pregnant or who could become pregnant without effective contraception — it can cause miscarriage, premature labour, and birth defects. Anyone prescribed Arthrotec or misoprostol for their stomach should understand this clearly.
What is Misoprostol commonly used for?
Stomach protection:
- Preventing ulcers caused by anti-inflammatories in people at high risk — those who have had an ulcer, older people, or those on long-term NSAIDs. Combination products such as Arthrotec pair the anti-inflammatory with the protection.
- Treating NSAID-associated ulcers, though proton pump inhibitors such as lansoprazole are now generally preferred, as they are better tolerated.
Obstetric and gynaecological uses, all under medical supervision:
- Inducing labour, and ripening the cervix before induction.
- Preventing and treating postpartum haemorrhage — heavy bleeding after birth. This is a major use worldwide, because misoprostol is inexpensive, stable without refrigeration and effective, which makes it valuable where other options are unavailable.
- Managing miscarriage, helping the uterus empty without surgery.
- Medical termination of pregnancy, in combination with mifepristone.
- Cervical preparation before gynaecological procedures.
In South Africa, termination of pregnancy is legal under the Choice on Termination of Pregnancy Act, and services are available free of charge at designated public health facilities. Medicines for this purpose are prescription-only and require assessment, because gestational age must be confirmed, certain conditions must be excluded, and follow-up is needed.
Misoprostol bought informally — online, through social media, or from unregistered sellers — is genuinely dangerous. Such products are frequently counterfeit, wrongly dosed, or something else entirely, and are supplied without the assessment or follow-up that makes the process safe. Serious complications include heavy bleeding, incomplete termination, and infection, and the risk of uterine rupture is significantly higher in anyone who has had a caesarean section or other uterine surgery. If you are considering this, a clinic or your nearest public health facility can help safely and legally.
How Misoprostol fits into this medicine category
| Group | Examples | Role |
|---|---|---|
| Prostaglandin analogues | Misoprostol | Stomach protection; uterine contraction |
| Proton pump inhibitors | Lansoprazole, omeprazole | Now preferred for ulcer prevention and healing |
| H2 blockers | Cimetidine, famotidine | Moderate acid reduction |
| NSAIDs | Diclofenac, ibuprofen | Cause the ulcer risk misoprostol offsets |
| NSAID + protectant | Arthrotec, Vimovo | Anti-inflammatory with built-in protection |
| Uterotonics | Oxytocin, ergometrine | Uterine contraction after birth |
Misoprostol is unusual in bridging two entirely separate therapeutic areas. See the general medicines hub and the HP553 guide for other pages in this category.
What to check before using Misoprostol
If you are taking it for stomach protection:
- Do not take it if you are pregnant, and use effective contraception throughout if you could become pregnant. Confirm you are not pregnant before starting.
- Stop and tell your doctor immediately if you become pregnant.
- Take it with food, which reduces diarrhoea.
- Do not take antacids containing magnesium alongside it, as they worsen diarrhoea.
- Never share it, particularly with anyone who might be pregnant.
If you are prescribed it in pregnancy or for a gynaecological indication:
- Follow the exact instructions given, including timing, route and what to expect.
- Know who to contact and where to go if bleeding is heavy or you feel unwell.
- Attend follow-up. This is not optional — it confirms the process is complete and catches complications early.
Tell your doctor or pharmacist if you:
- Are or might be pregnant, or are breastfeeding.
- Have had a caesarean section or other uterine surgery.
- Have inflammatory bowel disease or chronic diarrhoea.
- Have cardiovascular disease, or are dehydrated.
- Have kidney or liver disease.
- Have asthma or epilepsy.
- Have a bleeding disorder, or take a blood thinner.
- Have an IUD in place.
- Take any other medicines, including anti-inflammatories.
Possible cautions and when to ask a pharmacist or doctor
The most common effects are diarrhoea, abdominal cramping, nausea, wind and headache. Diarrhoea is the effect most people notice; taking it with food helps, and it often settles within a week.
For obstetric uses, cramping and bleeding are expected — they are the medicine working. What matters is knowing when they exceed the expected range.
Seek urgent medical attention if you experience:
- Very heavy bleeding — soaking two or more full-size pads per hour for two hours or more, or passing large clots.
- Fever, chills, or a foul-smelling discharge — possible infection.
- Severe or worsening abdominal pain not relieved as advised.
- Feeling faint, dizzy or very weak, or collapsing.
- A fast heartbeat with cold, clammy skin — possible significant blood loss.
- Severe or bloody diarrhoea, or diarrhoea with dehydration.
- Swelling of the face, lips or tongue, or difficulty breathing.
- Chest pain or breathlessness.
Do not wait to see whether heavy bleeding settles. Bleeding that is soaking through pads rapidly needs assessment now, not later. Public emergency departments will treat anyone who is bleeding, and doing so is their job — this is a medical situation, not one to be managed alone out of embarrassment.
Contact your doctor if symptoms do not follow the pattern you were told to expect, if pregnancy symptoms continue after treatment, or if you are unsure whether what you are experiencing is normal.
Related medicine guides
Frequently asked questions
What are misoprostol pills used for? Two distinct purposes: preventing stomach ulcers caused by anti-inflammatories, and uses in pregnancy and childbirth including labour induction, miscarriage management, controlling bleeding after birth, and medical termination of pregnancy.
What is misoprostol used for in labour? Ripening the cervix and inducing contractions, and preventing or treating heavy bleeding after birth. It is given by healthcare professionals in a supervised setting.
Is misoprostol used for abortion? Yes, usually combined with mifepristone. In South Africa termination of pregnancy is legal, and services are available free at designated public health facilities. It is prescription-only and requires medical assessment and follow-up.
Can I buy it without a prescription? No. It is Schedule 4. Products sold informally or online are frequently counterfeit or wrongly dosed, and are supplied without the assessment and follow-up that make treatment safe.
Why is it combined with diclofenac in Arthrotec? Anti-inflammatories cause ulcers by blocking protective prostaglandins. Misoprostol replaces them, so the combination delivers the anti-inflammatory with built-in stomach protection.
Can I take Arthrotec if I might be pregnant? No. Misoprostol causes uterine contractions and can cause miscarriage and birth defects. Effective contraception is required, and you should stop and contact your doctor if you become pregnant.
Why does it cause diarrhoea? Prostaglandins stimulate the gut as well as the stomach lining. Taking it with food helps, and it often settles within a week.
When is bleeding too heavy? Soaking two or more full-size pads an hour for two hours or more, or passing large clots, needs urgent medical attention. Do not wait to see if it settles.