P & T committee review of misoprostol: prevention of NSAID side effects is key--roundtable discussion

Misoprostol, a prostaglandin of the E series, was recently introduced for the prevention of NSAID-induced gastric ulcers. Misoprostol was classified as "1A" (denoting a new chemical entity that is a significant therapeutic advance) for purposes of review priority by the Food and Drug Administration in 1988. A dosage of 200 micrograms qid is recommended for prophylaxis, for the duration of NSAID therapy. Misoprostol is generally well-tolerated, with some patients reporting diarrhea. Misoprostol should not be given to pregnant women because of its uterotonic effects. (Please see full prescribing information for a discussion of the safety profile of misoprostol.) Because of the magnitude of the problem of NSAID-induced gastric ulceration and the expense of treatments and hospitalizations, the use of misoprostol in preventing these ulcers should be clinically beneficial, and may contribute to significant cost savings in the hospital and other managed-care settings.