Drug interactions
The risk of gastrointestinal side effects is increased when misoprostol and NSAIDs are taken together. The response to misoprostol may be altered by concurrent use of additional medications that impact gastric acid secretion.
Inducers of cytochrome P450:
Misoprostol's efficacy may be impacted by the concurrent use of CYP3A4 inducers, such as carbamazepine, efavirenz, griseofulvin, nevirapine, phenytoin, and barbiturates, which may lower plasma concentrations of misoprostol acid. When taking misoprostol alongside CYP3A4 inducers, keep an eye out for any potential reductions in misoprostol's effectiveness and adjust the dosage as necessary.
Inhibitors of cytochrome P450:
When used with misoprostol, CYP3A4 inhibitors (such as macrolide antibiotics, azole antifungals, clarithromycin, erythromycin, fluconazole, HIV protease inhibitors, and ketoconazole) may raise plasma concentrations of misoprostol acid and raise the possibility of gastrointestinal side effects. When using CYP3A4 inhibitors concurrently, keep an eye out for any heightened gastrointestinal side effects and change the misoprostol dosage as necessary.
H2-receptor blockers:
Misoprostol's efficacy may be affected if H2-receptor antagonists like cimetidine, famotidine, nizatidine, and ranitidine are used concurrently, as they may lower the plasma concentrations of misoprostol acid. When misoprostol is administered alongside H2-receptor antagonists, keep an eye out for any potential loss of efficacy and adjust the dosage as necessary.
Anti-proton-pump drugs
Misoprostol and proton pump inhibitors used concurrently may result in lower plasma concentrations of misoprostol acid and possibly less risk its efficacy. When taking misoprostol alongside proton pump inhibitors, keep an eye out for any signs of diminished efficacy and adjust the dosage as necessary.
Anti-proton-pump drugs
Misoprostol's efficacy may be impacted by the concurrent use of proton pump inhibitors (such as omeprazole and lansoprazole), which may result in lower plasma concentrations of misoprostol acid. When taking misoprostol alongside proton pump inhibitors, keep an eye out for any signs of diminished efficacy and adjust the dosage as necessary.
Particular populations
hepatic dysfunction
In patients with mild to moderate hepatic impairment, exercise caution. Patients with severe hepatic impairment should not use.
Renal dysfunction:
In patients with mild to moderate renal impairment, exercise caution. Patients with severe renal impairment should not use.