Prostaglandins E1/Misoprostol (Cytotec©)

Revised March 5, 2018

Section 2.1

Midwives may administer this drug after consulting with and on the order of a physician. 

Cytotec© is an orally active synthetic prostaglandin E1 analog that induces uterine contractions. Misoprostol is available as a water soluble tablet.

Indications and Clinical Use:

Misoprostol is considered a safe and effective agent when used off-label for cervical ripening or labour induction on an inpatient basis.


Known hypersensitivity to prostaglandins, any condition that preclude labour and vaginal birth, abnormal fetal status, non-vertex presentation, history of previous cesarean section or major uterine surgery, unexplained vaginal bleeding in pregnancy, >5 term pregnancies, and concurrent use of oxytocic drugs.

Warnings and Precautions:

Misoprostol should be used with caution in those with pre-existing cardiovascular disease. Oxytocin should be started no earlier than 4 hours after the last dose of misoprostol. Misoprostol is can be absorbed through skin and mucous membranes and should not be handled by anyone who is or could possibly be pregnant, lactating or trying to conceive.


Compatible for induction or augmentation of labour; otherwise contraindicated

Human Data Suggest Low Risk (Term Cervical Ripening)


Category L2 – Limited Data – Probably Compatible

Adverse Reactions:

Most common (especially with oral administration): GI – diarrhea (14 – 40%), abdominal pain (13 – 20%), pyrexia and shivering (11%). Pyrexia is more common when the dose exceeds 600 mcg. Greater incidence than 1%: nausea (3.2%), flatulence (2.9%), headache (2.4%), dyspepsia (2 %), vomiting (1.3%) and constipation (1.1%). Serious adverse events with the use of misoprostol are similar to those of other prostaglandins, and include uterine tachysystole with its potential fetal and maternal effects and meconium staining of liquor.

Dosage and Administration

25-50mcg orally with a drink of water (ensure that it is swallowed quickly to avoid sublingual absorption). Repeat every 2 hours as long as contractions are absent or non-painful.

Onset of Action:

Oral – 8 minutes

Sublingual – 11 minutes

Vaginal – 20 minutes

Rectal – 100 minutes


20 to 40 minutes.