Dosage Guidelines

A simplified dosage chart for non-doctors is available here.

This independent site has been set up to distribute dosage guidelines for the use of
misoprostol in obstetrics and gynaecology. The correct dosage varies greatly according to
gestation, indication and route of administration using the correct dosage is vital for
success and to prevent complications.

These dosage guidelines are produced by FIGO and WHO. They are based on those
originally produced by the Bellagio group in 2007 but updated regularly since. The most
recent 2017 guidelines were publshed in the Int J Gynecol Obstet.
Recommended doses of Misoprostol (Cytotec) are provided in this site along with
instructions for use. The table below can be downloaded as a free A4 wallchart , compact
easy reference cards, gestational calendars and in various languages .
Gynuity have a wide range of useful resources available regarding misoprostol use which
can be found here.
A full pictorial guide on how to safely make up a 200ml batch of a 1 microgram per ml
solution of misoprostol for oral administration can be found here. A 2015 study found that
misoprostol tablets degenerate if they are exposed to air and moisture (5% less misoprostol
content after 2 days), so keep them in their foil packets until needed!

INDICATION DOSAGE NOTES

Pregnancy 800mcg sublingually 3-hrly or Ideally used 48h after

Termination vaginally/buccally every 3-12hrs mifepristone 200mg
a,b,1 (1st (2-3 doses)
Trimester)

Missed abortion 800mcg vaginally 3-hrly (x2) or Give 2 doses and leave
c,2 (1st 600mcg sublingual 3-hourly (x2) to work for 1-2 weeks
Trimester) (unless heavy bleeding
or infection)

Incomplete 600mcg orally single dose or Leave to work for 2

abortion 400mcg sublingual single dose or weeks (unless heavy
a,2,3,4 (1st 400-800mcg vaginally single dose bleeding or infection).
Trimester) A detailed description
of the treatment can
INDICATION DOSAGE NOTES

also be found here

Cervical <13 weeks: 400mcg sublingually Can use also for

ripening for 1 hr before procedure or vaginally insertion of
surgical 3 hrs before procedure intrauterine device,
abortion 13-19 weeks: 400mcg vaginally 3- dilatation and
a,d 4hrs before procedure curettage and
hysteroscopy

Pregnancy 13-24 wks: 400mcg Most effective when

Termination vaginally/sublingually/buccal 3- used 48h after
1,5,6(<26wks) hrly mifepristone 200mg. A
1,5,9(>26wks)
(2nd/3rd Trimester) 25-26 wks: 200mcg detailed document on
vaginally/sublingually/buccal 4- this topic is
hrly available here
2728 weeks: 200g pv/sl/bucc
every 4 hours
>28 weeks: 100g pv/sl/bucc
every 6 hours

Intrauterine 13-26 wks: 200mcg Reduce doses in

fetal death vaginally/sublingually/ buccal 4- women with previous
f,g,1,5,6 6-hrly caesarean section.
27-28 wks: 100mcg
vaginally/sublingually/buccal 4- For fetal death in the
hrly third trimester see
>28wks: 25mcg vaginally 6-hrly 'Induction of Labour'
or 25mcg oral 2-hrly below.

Induction of 25mcg vaginally 6-hrly or 25mcg Do not use if previous

labour orally 2-hrly caesarean section.
h,2,9 Instructions on
preparing the oral
solution can be
foundhere.

PPH 600mcg orally single dose Where oxytocin is not

prophylaxis or for PPH secondary prevention available or storage
i,2,10/j,11 (secondary (approx >350ml blood loss): conditions are
 INDICATION DOSAGE NOTES

preventation) 800mcg sublingual single dose inadequate.

Exclude second twin
before administration.

PPH treatment 800mcg sublingually single dose Where oxytocin is not

k,2,10 available or storage
conditions are
inadequate.

Download the above chart in PDF format click here.

A simplified dosage chart for non-doctors is also available here.
Notes
1. If mifepristone is available (preferable), follow the regimen prescribed for mifepristone +
misoprostola
2. Included in the WHO Model List of Essential Medicines
3. For incomplete/inevitable abortion women should be treated based on their uterine size rather than
last menstrual period (LMP) dating
4. Leave to take effect over 12 weeks unless excessive bleeding or infection
5. An additional dose can be offered if the placenta has not been expelled 30 minutes after fetal
expulsion
6. Several studies limited dosing to 5 times; most women have complete expulsion before use of 5
doses, but other studies continued beyond 5 and achieved a higher total success rate with no safety
issues
7. Including ruptured membranes where delivery indicated
8. Follow local protocol if previous cesarean or transmural uterine scar
9. If only 200g tablets are available, smaller doses can be made by dissolving in water (see
instructions here)
10. Where oxytocin is not available or storage conditions are inadequate
11. Option for community based program
References
a) WHO Clinical practice handbook for safe abortion, 2014
b) v on Hertzen et al. Lancet, 2007; Sheldon et al. 2016 FIAPAC abstract
c) Gemzell-Danielsson et al. IJGO, 2007
d) Sv et al. Human Reproduction, 2015; Kapp et al. Cochrane Database of Systematic
Reviews, 2010
e) Dabash et al. IJGO, 2015
f) Perritt et al. Contraception, 2013
g) Mark et al. IJGO, 2015
h) WHO recommendations for induction of labour, 2011
i) FIGO Guidelines: Prevention of PPH with misoprostol, 2012
j) Raghavan et al. BJOG, 2015
k) FIGO Guidelines: Treatment of PPH with misoprostol, 2012

Warning!
Misoprostol is a very powerful stimulator of uterine contractions in late pregnancy and can
cause fetal death and uterine rupture if used in high doses. Follow the dosage regimes
carefully and do not exceed those doses.

Misoprostol dosage graph

Figure 1: Safe single doses of vaginal misoprostol for producing uterine contractions at
various gestations. For the first trimester 800cg 24 hourly can be safely used. In the
second trimester 200cg 12 hourly is a common dose, whilst beyond 24 weeks 25cg 6
hourly is usually used. If a higher dose than this is used, then uterine hyperstimulation with
uterine rupture or fetal distress might be the result

Francs: Pautas de dosificacin de Misoprostol ici

Espaol: Pautas de dosificacin de Misoprostol aqu