Assessing the global availability of misoprostol

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Objective: To assess the worldwide availability of misoprostol. Documenting the extent of misoprostol use in
obstetrics-gynecology is difcult because the drug typically is unregistered for such indications. Methods: Data for
20022007 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-inammatory drug (NSAID); regional and country-specic trends were identied. 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
signicantly reduce maternal deaths due to postpartum hemorrhage and unsafe abortion.