Misoprostol: a prostaglandin E1 analog with antisecretory and cytoprotective properties

Misoprostol, a methylester analog of prostaglandin E1, with antisecretory and cytoprotective properties, has undergone extensive investigation and has received Food and Drug Administration approval for the prevention of nonsteroidal-induced ulceration. The drug represents the first synthetic, orally active prostaglandin evaluated for the treatment of peptic ulcer disease. Clinical studies reveal a trend toward slightly lower healing rates with misoprostol when compared with histamine (H2)-receptor antagonists in the treatment of gastric and duodenal ulcers. In addition, misoprostol was less effective than H2-blockers in reducing ulcer pain, and caused a higher incidence of adverse reactions, particularly diarrhea occurring in up to 13 percent of the patients treated. Several studies have shown misoprostol to be superior to cimetidine and sucralfate in the prevention of alcohol- and drug-induced gastritis. This report summarizes the biopharmaceutics, pharmacokinetics, and clinical efficacy of misoprostol in the treatment of gastric and duodenal ulcers and in the prevention of mucosal injury.