Comprehensive medication guide to Misoprostol including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$20 copay for generic misoprostol on most commercial plans; typically Tier 1–2 on commercial and Medicare Part D formularies. Prior authorization may apply for brand-name Cytotec.
Estimated Cash Pricing
$25–$50 retail for a 60-tablet supply (200 mcg) of generic misoprostol; as low as $6.29 with a GoodRx coupon or $12.78 with SingleCare for a standard fill.
Medfinder Findability Score
78/100
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Misoprostol is a synthetic prostaglandin E1 analog — a lab-engineered version of a naturally occurring signaling compound in the body. It was first approved by the FDA on December 27, 1988, under the brand name Cytotec (Pfizer) to prevent stomach ulcers in patients who take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.
Beyond its FDA-approved GI indication, misoprostol is widely used off-label for medical abortion (with mifepristone or alone), labor induction, cervical ripening, miscarriage management, and postpartum hemorrhage prevention or treatment. This breadth of use makes it one of the most versatile — and politically complex — medications in modern clinical practice.
Misoprostol is available as 100 mcg and 200 mcg oral tablets. It can also be administered sublingually, buccally, vaginally, or rectally depending on the clinical indication. Generic versions are available from Greenstone (Viatris) and ANI Pharmaceuticals; brand-name Cytotec is made by Pfizer.
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Misoprostol works by binding to prostaglandin EP receptors throughout the body. Different tissues have different EP receptor subtypes, which is why the same drug produces very different effects in the stomach versus the uterus.
In the stomach, misoprostol replaces prostaglandins that are blocked by NSAIDs. It activates EP3 receptors to increase protective mucus and bicarbonate secretion, reduces acid production by parietal cells, and improves mucosal blood flow — creating a reinforced protective barrier against acid damage. In the uterus, misoprostol activates EP1 and EP3 receptors in smooth muscle cells, triggering contractions and cervical collagen degradation (ripening). These uterotonic effects are the basis for its obstetric uses.
Oral misoprostol reaches peak plasma levels in approximately 12 minutes — one of the fastest-acting oral prostaglandins. Vaginal and sublingual routes produce slower but more sustained uterine exposure and are preferred for obstetric indications. The drug clears the body within 2-4 hours.
100 mcg — tablet
Lower strength for patients who cannot tolerate the 200 mcg dose
200 mcg — tablet
Standard strength; FDA-approved dose for NSAID-induced ulcer prevention is 200 mcg four times daily with food
Misoprostol is not on the FDA's official drug shortage list as of 2026. ASHP confirms all marketed presentations from Pfizer (Cytotec) and Greenstone/Viatris are available at the national level. However, localized availability varies significantly. Some pharmacies keep very limited stock, and state-level laws in places like Louisiana create legal barriers that prevent dispensing in certain contexts — even when the drug is technically available.
The post-2022 Dobbs environment dramatically changed the access landscape. Demand surged, pharmacies in some regions pulled back on stocking, and legal uncertainty created a patchwork of availability. For patients in permissive states, misoprostol is generally accessible; for patients in restrictive states or rural areas, it can be genuinely difficult to fill.
If you're struggling to find misoprostol at a pharmacy near you, medfinder can help. medfinder contacts pharmacies near you on your behalf to identify which ones have your medication in stock and can fill your prescription — delivering results directly to your phone.
Misoprostol is not a federally controlled substance and does not require DEA registration or special prescriber certification to prescribe (except for the mifepristone component of the combination abortion regimen, which has its own REMS). Any licensed prescriber can write for misoprostol within their scope of practice.
OB/GYNs — Primary prescribers for obstetric and reproductive health uses
Primary care physicians (PCPs) and family medicine doctors — Commonly prescribe for NSAID ulcer prevention
Gastroenterologists — For GI-related indications in high-risk NSAID users
Nurse practitioners (NPs) and physician assistants (PAs) — Can prescribe in most states within scope of practice
Certified nurse midwives (CNMs) — Frequently prescribe for obstetric indications
Telehealth prescribing is available for misoprostol in states where it is legally permitted. For GI indications, most general telehealth platforms can prescribe misoprostol. For reproductive health uses, specialized reproductive telehealth services operate in states where applicable laws allow it.
No. Misoprostol is not a federally scheduled controlled substance under the Controlled Substances Act. It has no known addiction potential, no abuse liability, and no DEA schedule. Any licensed prescriber — including nurse practitioners and physician assistants — can prescribe it without DEA registration requirements or controlled substance prescribing restrictions.
However, state-level laws have begun to complicate this picture. Louisiana passed legislation attempting to classify mifepristone and misoprostol as controlled dangerous substances for abortion-related use. Other states have similar legislation under consideration. These state laws do not change federal scheduling but create legal exposure for prescribers and pharmacists in those jurisdictions. The regulatory landscape is evolving rapidly in 2026, and providers and patients should verify current state-specific rules.
The most common side effects at the standard ulcer-prevention dose (800 mcg/day) are gastrointestinal and typically dose-dependent:
Diarrhea (14–40% at higher doses; usually self-limiting within 8 days)
Abdominal cramping or pain (13–20%)
Nausea (3.2%)
Flatulence (2.9%)
Headache (2.4%)
Fever and chills (especially at higher obstetric doses)
Uterine rupture — Risk increased with prior uterine surgery (C-section), advanced gestational age, and high doses
Birth defects / fetal harm — Boxed warning: misoprostol must not be used for ulcer prevention in pregnant women
Severe allergic reaction — Seek emergency care for hives, difficulty breathing, or facial/throat swelling
Uterine hyperstimulation — Excessive uterine contractions in obstetric use; requires clinical monitoring
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Mifepristone (Mifeprex)
Progesterone antagonist used with misoprostol for the FDA-approved two-drug medical abortion regimen; not interchangeable for GI ulcer prevention
Dinoprostone (Cervidil, Prepidil)
Prostaglandin E2 agent FDA-approved for cervical ripening and labor induction; hospital use only; more expensive and requires refrigeration
Oxytocin (Pitocin)
IV uterotonic for labor induction and postpartum hemorrhage; requires IV access; long-established safety profile
Omeprazole / PPIs (Prilosec)
Proton pump inhibitors are often preferred over misoprostol for NSAID ulcer prevention — better tolerated (once-daily dosing, fewer GI side effects) and widely available OTC
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Oxytocin
majorAdditive uterotonic effects; combined use can cause uterine hyperstimulation and rupture. Strict clinical sequencing required in obstetric settings.
Carboprost (Hemabate)
majorCombined prostaglandin use amplifies uterotonic effects and systemic toxicity risk. Generally avoided outside controlled clinical settings.
Dinoprostone (Cervidil, Prepidil)
majorAdditive cervical ripening and uterotonic effects; clinical protocols require sequencing, not simultaneous use.
Magnesium-containing antacids (Mylanta, Maalox)
moderateMagnesium worsens misoprostol-induced diarrhea. Avoid magnesium-based antacids; use calcium or aluminum-based alternatives.
NSAIDs (naproxen, ibuprofen)
moderateHigh-dose or multiple NSAIDs can overwhelm misoprostol's gastroprotective effects. Use lowest effective NSAID dose and do not add OTC NSAIDs without prescriber approval.
Quinapril
moderatePotential reduced antihypertensive effect; monitor blood pressure.
Misoprostol is a decades-old, FDA-approved generic medication that remains essential across multiple medical specialties. It is not in formal shortage, and the drugs's generic versions remain widely produced — but the combination of political and legal pressures post-Dobbs, Lupin's market exit, and low baseline retail stocking means that individual patients can face real barriers in 2026, depending on their location and indication.
For most patients, misoprostol is an affordable medication. With GoodRx, it can cost as little as $6.29 for a standard supply. Generic substitution and 90-day fills further reduce costs. If your insurance isn't covering it optimally, GoodRx or SingleCare coupons will likely beat your copay. There is currently no manufacturer patient assistance program, but discount programs fill that gap effectively.
If you have a valid prescription but can't find a pharmacy that has it in stock, medfinder can help you quickly identify which pharmacies near you carry misoprostol — saving you significant time and frustration. medfinder calls pharmacies on your behalf and texts you back with results so you can go directly to the pharmacy that can fill your prescription.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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