Ellen Campbell-Grizzle
The brand name for the drug misoprostol is Cytotec. Often referred to on the streets as 'the star pill', it is registered in Jamaica for the treatment and prevention of stomach ulcers.
For such conditions, misoprostol is prescribed as one tablet four times to be taken by mouth for an extended period. It is usually co-prescribed with non-steroidal anti-inflammatory drugs (NSAIDS) widely used to treat arthritis. However, misoprostol has a side effect that has proved controversial. It induces labour with the potential to cause chemical abortions.
From stomach ulcers to unborn babies
We know that anti-inflammatory drugs reduce inflammation in the joints. In this process, NSAIDS will deplete the prostaglandins that protect the stomach lining. Misoprostol, a man-made prostaglandin, replenishes the depletion of prostaglandins by stimulating their secretion in the lining of the gastrointestinal tract and increases mucosal blood flow.
The drug inhibits acid secretion and enhances mucosal defence. However, like all prostaglandins, misoprostol softens the woman's cervix and stimulates uterine contraction. Obstetricians and Gynaecologists have found this side effect useful and use the drug to help women who need to get into labour for medical reasons. The American College of Obstetricians and Gynaecologists (ACOG) urges that the drug be used in hospitals and not for home births. There are other drugs that can be used for this purpose. However, misoprostol, commonly used vaginally to dilate the cervix, has proved to be more effective and less expensive.
Odd Twist
The use of misoprostol to induce labour is considered an off-label use. The United States Food and Drug Administration has approved misoprostol for use in conjunction with RU486 for chemical abortions. However, Searle, the maker of misoprostol, has not registered the drug for any other use except for anti-ulcer treatment. In the United States, medical practitioners and pharmacists are covered for off-label use of medication. In Jamaica, pharmacists have no such cover and by law cannot 'conspire to procure abortions' as was reported. The Pharmacy Council of Jamaica has for many years advised pharmacists to dispense misoprostol only for the purposes for which it is registered. There is great disparity between the anti-ulcer dosage and the abortifacient regimen.
Adverse effects
The routine use of misoprostol is still controversial. Women need to know that the product in high doses can cause foetal death, uterine rupture and severe foetal brain damage. Adverse effects can occur hours after the drug is taken. It can cause:
- nausea, vomiting, diarrhoea
- excessive bleeding
- abdominal pain
- chills and fever that can last up to three weeks.
It is absolutely contraindicated in women of childbearing age who are not using contraception. Searle warns that "miscarriages caused by Cytotec may be incomplete, which could lead to dangerous bleeding, hospitalisation, surgery, infertility, maternal or foetal death."
The Cytotec black market
All over the world, a sizeable black market has grown around Cytotec. Generic versions are available. The drug has put a number of women into hospital emergency rooms for haemorrhaging or suffering from the effects of incomplete abortions. It is dangerous to take this drug without medical supervision and then rush to the hospital when bleeding starts. All experts agree that the drug's off-label use must be limited to the supervision of qualified physicians.
In Jamaica, pharmacists are prevented from dispensing the drug for the purpose of inducing labour, under the law. Consumers need to be aware of the appropriate use for misoprostol , the risks associated with off-label use and the importance of discussing such use with a physician.
Ellen Campbell-Grizzle, president, Caribbean Association of Pharmacists; director, Information & Research, National Council on Drug Abuse; email: yourhealth@gleanerjm.com.
