Hospitals Restrict Misoprostol Use

OB/GYN News, Nov 15, 2000 by Greg Borzo

It's the lack of study that is at the heart of the disagreement about misoprostol's use in obstetrics, said Dr. Thomas Benedetti, director of perinatal medicine at the University of Washington, Seattle. But Searle, which is being sued for the death of a woman given misoprostol, said in a statement that it has "no plans to study the product for any other indication."

Some physicians suggested that the anger over Searle's hard stance against off-label use of the drug may be related to money A 100-mcg tablet costs 25 cents, and only one-quarter or one-half of a tablet is typically used at a time in pregnant women. Anecdotal reports suggest that misoprostol saves money by reducing the need for other drugs, shortening lengths of stay, and lowering the number of cesarean sections.

Dr. Benedetti and others suggested that there are safer alternatives to misoprostol for cervical ripening and/or labor induction, including dinoprostone, gemeprost, and oxytocin, although some of these agents cost $90 per dose.

Physicians fear that Searle will be pressured into dropping misoprostol, although Pharmacia says that possibility has not been discussed. Searle's stance on Cytotec may not be the end of the story. The drug went off patent in July, and generic versions are available overseas.