Cytotec (Misoprostol) 100 mcg and 200 mcg Tablets: Prescription Prostaglandin for Gastric Protection During NSAID Therapy

Information last reviewed: May 2026 — for educational purposes only.

Cytotec (misoprostol) is a prescription synthetic prostaglandin E1 (PGE1) analogue with two primary licensed indications: prevention of NSAID-induced gastric and duodenal ulcers in patients at high risk of gastrointestinal complications, and — when combined with mifepristone — for medical termination of early intrauterine pregnancy. Misoprostol is also used extensively off-label in obstetrics and gynaecology for cervical ripening and labour induction, miscarriage management, and postpartum haemorrhage prevention, making it one of the most versatile molecules in medicine despite its relatively niche original GI indication.

What Is Misoprostol?

Prostaglandin E1 normally plays an important role in the gastric mucosal defence system: it stimulates mucus and bicarbonate secretion, increases mucosal blood flow, and slightly inhibits acid secretion from parietal cells. NSAIDs (aspirin, ibuprofen, naproxen, diclofenac, etc.) suppress prostaglandin synthesis via COX inhibition, thereby removing this gastric protection — leading to gastric mucosal erosions, ulcers, and GI bleeding in susceptible patients. Misoprostol replaces this prostaglandin effect, restoring mucosal defence even while NSAID therapy continues.

Misoprostol also potently stimulates uterine smooth muscle contractions (via EP receptors on the myometrium), which underlies its off-label obstetric uses. This also explains its key contraindication: it must never be taken during pregnancy for GI indications because it can cause miscarriage, uterine rupture, or birth defects (Möbius syndrome has been reported with first-trimester exposure). It carries a mandatory black-box warning regarding this risk.

Prescription Status

Misoprostol is prescription-only in the United States. No OTC form is available. In the US, it is distributed with a Medication Guide and a mandatory patient agreement form acknowledging the teratogenicity risk. Women of childbearing potential must use effective contraception throughout treatment, have a documented negative pregnancy test before starting, and fully understand the risk.

Tablet Strengths and Dosing (GI Indications)

• 100 mcg tablets — lower dose option; may be used when 200 mcg causes intolerable GI side effects; less effective than 200 mcg for ulcer prevention
• 200 mcg tablets — standard dose for NSAID-induced ulcer prevention: 200 mcg four times daily with food; or 200 mcg twice daily if the full QID regimen is not tolerated

For NSAID co-prescription, misoprostol is typically given for the duration of NSAID therapy in high-risk patients (elderly patients, history of peptic ulcer disease, concomitant corticosteroid or anticoagulant use). The most common side effect of misoprostol is dose-related diarrhoea and abdominal cramping, which affects a significant proportion of patients and can limit compliance. Taking the drug with food reduces GI side effects. Note: misoprostol alone is less effective than a PPI (proton pump inhibitor) for ulcer prevention and is generally reserved for specific cases.

Price of Generic Misoprostol

Generic misoprostol 200 mcg tablets are available at major US pharmacies and carry a moderate cost. The drug is inexpensive per tablet. However, the QID dosing regimen (4 tablets per day) makes monthly supply costs add up. Pharmacy discount programs (GoodRx, RxSaver) can reduce prices significantly for uninsured patients.

Frequently Asked Questions

Why is misoprostol used with NSAIDs instead of just using a PPI?

PPIs are now more commonly used than misoprostol for NSAID gastroprotection because they are better tolerated (less diarrhoea) and equally or more effective. Misoprostol remains an alternative for patients who cannot take PPIs, or in situations where prostaglandin-mediated protection is specifically desired. Some combination preparations (e.g., Arthrotec, combining diclofenac + misoprostol in one tablet) are still prescribed for convenience in appropriate patients.

Can misoprostol be used for cervical ripening before a procedure?

Yes — misoprostol is widely used off-label in gynaecology for cervical ripening before IUD insertion, hysteroscopy, and other uterine procedures, and for labour induction in obstetrics. These are specialist-directed uses that fall outside the FDA-approved GI indication and should always be supervised by a licensed healthcare professional in an appropriate clinical setting.

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