Ulcer prevention<unk>  is used for the prevention of NSAID-induced gastric ulcers. It acts upon gastric parietal cells, inhibiting the secretion of gastric acid by G-protein coupled receptor-mediated inhibition of adenylate cyclase, which leads to decreased intracellular cyclic AMP levels and decreased proton pump activity at the apical surface of the parietal cell. Because other classes of drugs, especially H2-receptor antagonists and proton pump inhibitors, are more effective for the treatment of acute peptic ulcers,<unk>  is only indicated for use by people who are both taking NSAIDs and are at high risk for NSAID-induced ulcers, including the elderly and people with ulcer complications.<unk>  is sometimes coprescribed with NSAIDs to prevent their common adverse effect of gastric ulceration (e.g. with diclofenac in Arthrotec). However, even in the treatment of NSAID-induced ulcers, omeprazole proved to be at least as effective as<unk> , but was significantly better tolerated, so<unk>  should not be considered a first-line treatment.<unk> -induced diarrhea and the need for multiple daily doses (typically four) are the main issues impairing compliance with therapy. Labor induction<unk>  is commonly used for labor induction. It causes uterine contractions and the ripening (effacement or thinning) of the cervix. It can be less expensive than the other commonly used ripening agent, dinoprostone. Oxytocin has long been used as the standard agent for labor induction, but does not work well when the cervix is not yet ripe.<unk>  also may be used in conjunction with oxytocin. Between 2002 and 2012, a<unk>  vaginal insert was studied, and was approved in the EU. It was not approved for use in the United States, and the US FDA still considers cervical ripening and labor induction to be outside of the approved uses for<unk> , because no company has sent the FDA scientific proof that<unk>  is safe and effective for these uses. Myomectomy When administered prior to myomectomy in women with endometriosis,<unk>  reduces operative blood loss and requirement of blood transfusion. Abortion<unk>  is used either alone or in conjunction with another medication (mifepristone or methotrexate) for medical abortions as an alternative to surgical abortion. Medical abortion has the advantage of being less invasive, and more autonomous, self-directed, and discreet. It is preferred by some women because it feels more "natural," as the drugs induce a miscarriage. It is also more easily accessible in places where abortion is illegal. The World Health Organization provides clear guidelines on the use, benefits and risks of<unk>  for abortions.<unk>  is most effective when it is used in combination with methotrexate or mifepristone (RU-486). Mifepristone inhibits the signals of pregnancy hormones, eventually causing the uterine lining to degrade, similar to a period, which cause the embryo to detach from the uterus walls.<unk>  then dilates the cervix and induces muscle contractions which clear the uterus.<unk>  alone is less effective (typically 88% up to eight-weeks gestation). It is not inherently unsafe if medically supervised, but 1% of women will have heavy bleeding requiring medical attention, some women may have ectopic pregnancy, and the 12% of pregnancies that continue after<unk>  failure are more likely to have birth defects and are usually followed up with a more effective method of abortion. Most large studies recommend a protocol for the use of<unk>  in combination with mifepristone. Together they are effective in around 95% for early pregnancies.<unk>  alone may be more effective in earlier gestation. WHO guidelines recommend for pregnancies up to 12 weeks to use 12 tablets of 200 mcg (micrograms). The woman should put 4 tablets of<unk>  under the tongue or far up the vagina and let them dissolve for 30 minutes. The woman should wait 3 hours and repeat with 4 pills under the tongue or in the vagina for 30 minutes. She should wait 3 hours and repeat once more. It works in 90% after first attempt and, in case of failure, the attempt may be repeated after a minimum of 3 days.<unk>  can also be used to dilate the cervix in preparation for a surgical abortion, particularly in the second trimester (either alone or in combination with laminaria stents). Vaginal<unk>  can also be used to facilitate intrauterine device insertion after previous insertion failure.<unk>  by mouth is the least effective treatment for producing complete abortion in a period of 24 hours due to the liver's first-pass effect which reduces the bioavailability of the<unk> . Vaginal and sublingual routes result in greater efficacy and extended duration of action because these routes of administration allow the drug to be directly absorbed into circulation by bypassing the liver first-pass effect. The following tests are recommended before use for abortion confirmation of pregnancy, hematocrit or Hb tests, and Rh testing. Following use, it is recommended that people attend a follow-up visit 2 weeks after treatment. If used for treatment of complete abortion, a pregnancy test, physical examination of the uterus, and ultrasound should be performed to ensure success of treatment. Surgical management is possible in the case of failed treatment. Early pregnancy loss<unk>  may be used to complete a miscarriage or missed abortion when the body does not expel the embryo or fetus on its own. Compared to no medication or placebo, it could decrease the time to complete expulsion. Use of a single dose of<unk>  vaginally or buccally is preferred, with additional doses as needed. It also can be used in combination with mifepristone, with a similar regimen to medical abortion.<unk>  is regularly used in some Canadian hospitals for labour induction for fetal deaths early in pregnancy, and for termination of pregnancy for fetal anomalies. A low dose is used initially, then doubled for the remaining doses until delivery. In the case of a previous Caesarian section, however, lower doses are used. Postpartum bleeding<unk>  is also used to prevent and treat post-partum bleeding. Orally administered<unk>  was marginally less effective than oxytocin. The use of rectally administered<unk>  is optimal in cases of bleeding; it was shown to be associated with lower rates of side effects compared to other routes. Rectally administered<unk>  was reported in a variety of case reports and randomised controlled trials. However, it is inexpensive and thermostable (thus does not require refrigeration like oxytocin), making it a cost-effective and valuable drug to use in the developing world. A randomised control trial of<unk>  use found a 38% reduction in maternal deaths due to post partum haemorrhage in resource-poor communities.<unk>  is recommended due to its cost, effectiveness, stability, and low rate of side effects. Oxytocin must also be given by injection, while<unk>  can be given orally or rectally for this use, making it much more useful in areas where nurses and physicians are less available. Insertion of Intrauterine Contraceptive Device In women with prior caesarean section or prior failure of insertion of an intrauterine contraceptive device, pre-procedure administration of<unk>  reduces the rate of failure of insertion of intrauterine contraceptive device. However, due to a higher rate of adverse effects, routine use of<unk>  for this purpose in other women is not supported by the data. Other For cervical ripening in advance of endometrial biopsy to reduce the need for use of a tenaculum or cervical dilator. There is limited evidence supporting the use of<unk>  for the treatment of trigeminal neuralgia in patients with multiple sclerosis.
Misoprostol
Indometacin farnesil
Chloroxylenol
Transfluthrin
Methylergometrine
Indometacin
Ritodrine
Amixetrine