Route of administration Author Dose (n) Oral Sublingual Rectal Vaginal

* Estimated from published graph. ** 10 non-pregnant women only. Time to peak concentration (minutes) Zieman et al.3 Danielsson et al. Tang et al.5 Abdel-Aleem et al.6 Khan and El-Refaey
7 4

400 g (20) 400 g (12) 400 g (40) 600 g (20) 600 g (20)

34 (17) 30 28 (15) 20 18 (8.8) 41 (16) 26 (12)

80 (27) 60120 longer

Peak concentration (pg/mL) Zieman et al.3 Danielsson et al. Tang et al.5 Abdel-Aleem et al.
6 4

400 g (20) 400 g (12) 400 g (40) 600 g (20) 600 g (20) 400 g (10)

227 (124) 280

*

165 (86) 65* 575 (251) 125 (54)

288 (144) 345 (269) 328 (103) 381

Khan and El-Refaey7 Andolina et al.

8

184 (65)

Area under curve to 4 hours (pg/hours/mL) Zieman et al.3 Khan and El-Refaey7 400 g (20) 600 g (20) 273 (110) 190 (125) 503 (297) 311 (141)

Area under curve to 6 hours (pg/hours/mL) Zieman et al.3 Tang et al.5 400 g (20) 400 g (40) 300 (103)** 403 (152) 744 (291) 957 (542)** 434 (183)

able 1. Serum misoprostol values and time course expressed as mean (standard deviation) following misoprostol administration by various routes.

The data tabulated in Table 2 suggest a more rapid time to peak concentration with oral and sublingual than vaginal or rectal administration, highest peak concentrations with sublingual, and greatest area under the time curve with sublingual and vaginal administration. Route Oral Pharmacokinetic studies Onset Peak Duration Total bioavailability Rapid High Short Low Slower Lower Long 23 oral Slower Lower Long 1.5 oral Rapid Highest Long Highest Vaginal Rectal Sublingual Intrauterine

Clinical studies for induction of labour Efficacy Moderate Better than oral Similar to vaginal Better than oral

Intrauterine pressure studies First trimester Rapid onset. Rapid time to peak Rapid onset (6 minutes). Duration 75 minutes. Slower onset and time to peak. More prolonged activity Rapid onset. Prolonged activity.

After delivery

Route Oral Vaginal Rectal Sublingual Intrauterine

Clinical studies prophylactically after delivery Efficacy Pyrexia and shivering Less than syntocinon Common No studies Insufficient data Less than oral

Theoretical considerations: use for treatment of PPH Administration Likely efficacy Advantages Easy Fast onset, limited duration Convenient, rapid onset of action Prominent Unknown Not feasible Slow onset Easy even if not conscious Slow onset Relatively convenient Apparently less than oral Relatively easy if conscious Good Best pharmacokinetic profile Unknown Invasive Unknown Possible local effect Likely to be low relative to effec

Side effects

Table 2. Qualitative comparisons of various routes of administration of misoprostol.