What Is Misoprostol? Uses, Dosage, and What You Need to Know in 2026

Misoprostol is one of those medications that shows up in very different medical contexts — which can make it confusing for patients. Your doctor might prescribe it to protect your stomach from arthritis medication. Your OB/GYN might use it during a procedure. A reproductive health provider might recommend it as part of a medical abortion. Same drug, very different situations. This guide explains exactly what misoprostol is, what it does, and what you need to know in 2026.

What Is Misoprostol?

Misoprostol is a synthetic prostaglandin E1 analog — a lab-made version of a naturally occurring compound in the body called prostaglandin E1. It was developed by G.D. Searle & Company (now part of Pfizer) and first approved by the FDA on December 27, 1988 under the brand name Cytotec.

Misoprostol is available as:

Brand name: Cytotec (Pfizer)

Generic: Misoprostol tablets (Greenstone/Viatris; ANI Pharmaceuticals)

Strengths: 100 mcg and 200 mcg oral tablets

Combination product: Arthrotec (diclofenac + misoprostol) for arthritis with ulcer protection

What Is Misoprostol FDA-Approved For?

The FDA-approved indication for misoprostol is straightforward: prevention of NSAID-induced gastric ulcers in patients at high risk, such as elderly patients and those with a history of ulcers. NSAIDs (like ibuprofen and naproxen) can damage the stomach lining by blocking prostaglandins that normally protect it. Misoprostol replaces those prostaglandins, keeping the stomach lining healthy.

What Is Misoprostol Used for Off-Label?

Misoprostol is much more broadly used in practice than its single FDA indication suggests. Off-label uses are medically established and widely accepted:

Medical abortion — Used with mifepristone (FDA-approved combination) or alone (off-label) for early pregnancy termination up to approximately 10-13 weeks

Miscarriage management — To help pass tissue in cases of early pregnancy loss; 800 mcg vaginally is the ACOG-recommended dose

Labor induction and cervical ripening — 25-100 mcg vaginally or orally in a hospital setting to ripen the cervix and initiate contractions

Postpartum hemorrhage — 600-1000 mcg orally, sublingually, or rectally to prevent or treat heavy postpartum bleeding

Cervical preparation before procedures — To soften and dilate the cervix before IUD insertion or other gynecologic procedures

Standard Dosage for NSAID Ulcer Prevention

The standard FDA-approved dose for preventing NSAID-induced ulcers is 200 mcg four times daily with food (total 800 mcg/day). If this dose isn't tolerated due to GI side effects, it may be reduced to 100 mcg four times daily. Take the last dose at bedtime. Misoprostol is taken for as long as you're taking the NSAID — it's not a short-term course.

Who Should NOT Take Misoprostol?

Pregnant women (for non-pregnancy/ulcer uses) — can cause miscarriage, birth defects, and uterine rupture

Anyone allergic to misoprostol or other prostaglandins

Patients with prior uterine surgery or cesarean delivery (for obstetric uses — increased uterine rupture risk)

Is Misoprostol a Controlled Substance?

No. Misoprostol is not a federally scheduled controlled substance. It has no addiction potential and no abuse liability. However, some individual states have passed or are attempting to pass laws that reclassify it as a controlled substance for abortion-related use — most notably Louisiana. Laws are changing rapidly, so check your state's current regulations.

How Much Does Misoprostol Cost?

Generic misoprostol is one of the more affordable prescription medications. At retail, a 60-tablet supply (200 mcg) typically costs $25-$50. With a GoodRx coupon, that can drop to as low as $6.29. Most insurance plans cover generic misoprostol with low copays of $0-$20. Always use generic rather than brand-name Cytotec to save money.

If you have a prescription but are struggling to find it locally, see our guide on how to find misoprostol in stock near you.