A 29-year-old nulliparous woman requires gastroprotection during long-term naproxen therapy for juvenile idiopathic arthritis. Her physician deliberately avoids prescribing misoprostol. What is the reason?

• A It precipitates pancreatitis when combined with NSAIDs
• B It causes irreversible ototoxicity at prophylactic doses
• C It is an abortifacient that induces uterine contractions ✓
• D It antagonises the analgesic effect of prostaglandin synthesis inhibitors

Explanation

Misoprostol is a synthetic PGE1 analogue that replaces protective prostaglandins suppressed by NSAIDs, increasing mucus and bicarbonate secretion and maintaining mucosal blood flow. The same prostaglandin activity contracts uterine smooth muscle, so the drug can cause abortion and is absolutely contraindicated in pregnancy and used cautiously in women of reproductive potential. It does not interfere with NSAID analgesia and has no ototoxicity.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.