Cytotec (Misoprostol) in Kenya

Product Description

Product Summary

Cytotec contains misoprostol, a prostaglandin E1 analog used for:

• Ulcer Prevention: Reduces gastric ulcers caused by NSAIDs (e.g., diclofenac, ibuprofen).
• Labor Induction: Softens the cervix and induces contractions in pregnancy.
• Miscarriage Management: Treats incomplete miscarriage or postpartum hemorrhage.
• Medical Abortion: Off-label use with mifepristone for pregnancy termination (legally restricted in Kenya).

Prescription Status: Prescription-only (regulated due to obstetric risks).

Composition

• Active Ingredient: Misoprostol (200μg per tablet).
• Formulation:
  • Tablets for oral use.
  • Vaginal/rectal administration (off-label for obstetric use).
• Inactive Ingredients: Microcrystalline cellulose, hydrogenated vegetable oil, hypromellose.

Approved Uses in Kenya

1. Ulcer Prevention

• Dosage: 200μg orally 2–4 times daily with NSAIDs.
• Duration: Continue as long as NSAID therapy lasts.

2. Labor Induction

• Dosage: 25μg vaginally every 3–6 hours (max 50μg/dose).
• Setting: Hospital-only with fetal monitoring.

3. Postpartum Hemorrhage (PPH)

• Dosage: 600μg orally/rectally after delivery.
• Use: First-line PPH management in low-resource settings.

4. Incomplete Miscarriage

• Dosage: 600μg sublingually/vaginally (single dose).
• Efficacy: 90% success in expelling tissue without surgery.

Off-Label Use: Medical Abortion

• Legality in Kenya:
  • Restricted to cases of rape, incest, or life-threatening risk to the mother (Constitution, Article 26(4)).
  • Elective abortion is illegal; penalties include imprisonment.
• Protocol (where legally permitted):
  • Mifepristone (200mg) + Misoprostol (800μg) vaginal/sublingual 24–48 hours later.
  • Effectiveness: 95–98% for pregnancies ≤12 weeks.
• Risks of Self-Use:
  • Incomplete abortion, hemorrhage, infection, infertility, or death.
  • Never use without medical supervision.

Potential Side Effects

Common

• Nausea, diarrhea, abdominal cramps.
• Uterine contractions (intended in obstetric use).
• Fever/chills (transient).

Serious Risks

• Uterine Rupture: If used in late pregnancy or prior C-section.
• Hemorrhage: Excessive bleeding if misused for abortion.
• Birth Defects: Teratogenic if used in pregnancy (avoid if continuing pregnancy).
• Allergic Reactions: Rash, swelling, breathing difficulties.

Precautions & Contraindications

• Avoid if:
  • Pregnancy (unless for approved obstetric use).
  • History of C-section, uterine surgery, or placenta previa.
  • Severe anemia, cardiovascular disease, or glaucoma.
• Drug Interactions:
  • Antacids/Magnesium: Reduce misoprostol absorption.
  • Oxytocin: Increases uterine rupture risk.
• Pregnancy/Breastfeeding:
  • Category X: Avoid if pregnancy continuation desired.
  • Excreted in breast milk (use caution).

Frequently Asked Questions

1. Is Cytotec available over-the-counter in Kenya?
   No – prescription-only. Some pharmacies sell it illegally, but this is unsafe and unlawful.

2. Can I use it for abortion at home?
   No – self-use is dangerous and illegal. Seek legal medical care if eligible under Article 26(4).

3. What are the legal alternatives for abortion?
   Only permitted in rape/incest/life-threatening cases. Consult hospitals like Nairobi Women’s Hospital or Aga Khan for confidential care.

4. How is it used for miscarriage?
   Hospitals administer 600μg vaginally/sublingually under supervision. Never self-treat.

5. Where can I access it safely?
   Licensed hospitals/clinics for approved uses (e.g., PPH, miscarriage). Avoid street vendors.