Human Reproduction, Vol. 17, No. 10, 2778,
October 2002
© 2002 European Society of Human Reproduction and Embryology
Sublingual misoprostol for first trimester termination of pregnancy: safety concerns
Department of Obstetrics and Gynaecology, University of Hong Kong, Queen Mary Hospital, 6/F Professional Block, 102 Pokfulam Rd, Pokfulam, Hong Kong E-mail: ostang{at}graduate.hku.hk
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Dear Sir,
I would like to thank Dr Chong and colleagues for their interest and their comments on our papers. Caution is required in all new methods of treatment and this is the same for sublingual misoprostol. A pharmacokinetic study has shown that sublingual misoprostol has the highest bioavailability and the shortest time to peak concentration (Tang et al., 2002a
). This may indicate that sublingual misoprostol is the most potent way to administer misoprostol. At the same time, sublingual misoprostol may be associated with a higher incidence of side-effects. Our previous non-randomized studies have reported a high incidence of chills (82%) and fever (72%) (Tang et al., 2002b). This needs to be confirmed by randomized studies with a large number of subjects before we can conclude whether sublingual administration of misorprostol is associated with a higher incidence of side-effects than administration via other routes.
As shown in our previous pharmacokinetic study, the behaviour of sublingual misoprostol is probably different from the other routes of administration (Tang et al., 2002a). More studies are required to find out the optimal dose and dosing interval which gives the best clinical results and least side-effects.
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Tang, O.S., Schweer, H., Seyberth, N.W., Lee, S.W.H. and Ho, P.C. (2002a) Pharmacokinetics of different routes of administration of misoprostol. Hum. Reprod., 17, 332–336.
Tang, O.S., Miao, B.Y., Lee, S.W.H. and Ho, P.C. (2002b) Pilot study on the use of repeated doses of sublingual misoprostol in termination of pregnancy up to 12 weeks gestation: efficacy and acceptability. Hum. Reprod., 17, 654–658.
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