Abstract
Objective: To assess the worldwide availability of misoprostol. Documenting the extent of misoprostol use in
obstetrics-gynecology is difficult because the drug typically is unregistered for such indications. Methods: Data for
2002–2007 on annual sales (measured inweight) to hospitals and retail pharmacies, plus manufacturerprices per
20 0-µg misoprostol, were analyzed for medications containing misoprostol alone or combined with a
nonsteroidal anti-inflammatory drug (NSAID); regional and country-specific trends were identified. Consumer
prices per pill are documented for all formulations of registered medications. Results: Of the misoprostol sold
worldwide, 70% was misoprostol-NSAID-combination drugs; of this, 91% was sold in North America and Western
Europe. Asia sold the most misoprostol-only drugs; sales increased dramatically in Bangladesh (by 128%) and
India (646%), where various low-price brands are sold. Misoprostol sales decreased in Latin America but increased
in the Middle East-North Africa and Sub-Saharan Africa; these regions generally had low amounts sold per
population. Conclusion: Availability is improving in some low-income regions where misoprostol could
significantly reduce maternal deaths due to postpartum hemorrhage and unsafe abortion.
