What is the use of Cytolog (misoprostol) 25 µg tablet?

Cytolog (Misoprostol) 25 µg Tablet: Clinical Uses

Cytolog 25 µg is primarily used for cervical ripening and labor induction in pregnant women at term, though its FDA-approved indication is actually for preventing NSAID-induced gastric ulcers. 1

FDA-Approved Indication

• Gastric ulcer prevention: The only FDA-approved use is reducing the risk of NSAID-induced gastric ulcers in high-risk patients (elderly, those with debilitating disease, or history of ulcers) 1
• This tablet should be taken for the duration of NSAID therapy 1

Off-Label Obstetric Uses (Most Common in Practice)

Labor Induction and Cervical Ripening

The 25 µg dose is specifically recommended by the American Academy of Family Physicians as the optimal starting dose for labor induction, administered orally every 2-6 hours. 2

• Oral administration: 20-25 µg every 2-6 hours results in fewer cesarean sections and lower uterine hyperstimulation rates compared to vaginal dinoprostone 2, 3
• Vaginal administration: 25 µg every 3-6 hours is recommended by ACOG as the most effective route, with median time to vaginal delivery of 20.1 hours 3
• Oral route causes 31% less hyperstimulation than vaginal misoprostol 3

Cost Advantage

• Misoprostol costs only $0.36-$1.20 per 100 µg tablet, compared to $65-$75 for dinoprostone gel or $165 for dinoprostone insert 2
• Stable at room temperature, unlike dinoprostone which requires refrigeration 2

Critical Contraindications

Misoprostol is absolutely contraindicated in women with prior cesarean delivery or uterine scar when used in the third trimester for cervical ripening or labor induction. 4, 2, 3

• Uterine rupture risk with scarred uterus is 13% with misoprostol, compared to only 1.1% with oxytocin and 2% with prostaglandin E2 3
• The American College of Obstetricians and Gynecologists explicitly states misoprostol should not be used for cervical preparation or induction in women with previous cesarean delivery 4

Safe Alternatives for Scarred Uteri

• Foley catheter transcervical ripening: no reported uterine ruptures 3
• Oxytocin: 1.1% rupture risk 3
• Prostaglandin E2 (dinoprostone): 2% rupture risk 3

Monitoring Requirements

• Continuous fetal heart rate and uterine activity monitoring is mandatory from 30 minutes to 2 hours after each dose 2, 3, 5

Other Off-Label Gynecologic Uses

• First-trimester pregnancy termination: Combined with mifepristone 200 mg, followed by misoprostol 800 µg vaginally, sublingually, or buccally 6
• Second-trimester termination: 800-2400 µg in 24 hours after mifepristone 6
• Postpartum hemorrhage prevention: 600 µg sublingual 6
• Postpartum hemorrhage treatment: 800 µg sublingual 6
• Cervical dilatation before procedures: Beneficial for premenopausal women but not postmenopausal women 6

Common Pitfalls to Avoid

• Never use in women with hepatic failure, as misoprostol requires hepatic metabolism to convert from E1 to active E2 prostaglandin 2
• Higher doses increase cramping, particularly in nulliparous patients 5
• The 50 µg dose every 6 hours carries increased complication risk; stick with 25 µg dosing 2