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maternal death:difference between misoprostol and mefipristoneFrom: emilio porro (sanbonav@hotmail.com)Sat Mar 18 14:05:04 2006
From: emilio porro <sanbonav@hotmail.com> To: ob-gyn-l@obgyn.net Subject: Re: Maternal deaths, misoprostol and mefipristone (ru 486) Sent: Saturday, March 18, 2006 9:52 PM I am surprised nobobody have noticed the chemical and clinical difference between misoprostol and mefipristone (ru486) yours faithfully Emilio Porro M.D. Ob.Gyn. Como Italy http://www.sanbonaventura.com who,whose, with,what,why,where,when,while,watch world wide web Mefipristone vs. ketoconazole for high cortisol Posted by dannen on December 12, 2003, at 17:52:46 Has anybody tried mefipristone RU 486 (M) successfully? I am thinking of trying it, instead of ketoconazole (K). Wolkowitz (spelling?) at UC-SF seems to suggest in one article that K is the preferred medication for treating hypercortisolemia. But I have heard K may be hepatoxic. W seems to suggest that M is not as good a choice as K(b/c/M blocks cortisol receptors instead of blocking cortisol production). Has anybody tried K or M--successfully? Has anybody looked at this issue? I have super high cortisol (diurnal variation intact; very probably not Cushing's), for over one year. I am looking at ways to calm the HPA axis and get the cortisol down. I have tried (and continue with) yoga (including pranayama breathing), meditation, prayer, massage, ashwagandha (spelling?), phosphaditylserine (spelling?), lots of fish oil, daily swimming. But it won't come down. Morning anxiety is really terrible (4 am to 8 am especially). I could not tolerate any of the SSRIs, nortrip, remeron, lamictal, or depakote. And so on. Neurontin worked for a while, but I had problems with it after a few months. I (male, late 40s) have never had any problems with anxiety or depression until summer of 2002, when my wife of over 20 years left me for reasons I still to not understand. Any help on bring cortisol down would help--alternative or mainstream. Thanks. Dannen Brand name: Cytotec Pronounced: SITE-oh-tek Generic name: Misoprostol ________________________________________ Why is this drug prescribed? -- ________________________________________ Return to top Cytotec, a synthetic prostaglandin (hormone-like substance), reduces the production of stomach acid and protects the stomach lining. People who take nonsteroidal anti-inflammatory drugs (NSAIDs) may be given Cytotec tablets to help prevent stomach ulcers. Aspirin and other NSAIDs such as Motrin, Naprosyn, Feldene, and others, which are widely used to control the pain and inflammation of arthritis, are generally hard on the stomach. If you must take an NSAID for a prolonged period of time, and if you are elderly or have ever had a stomach ulcer, your doctor may want you to take Cytotec for as long as you take the NSAID. ________________________________________ Most important fact about this drug ________________________________________ Return to top You must not become pregnant while using Cytotec. This drug causes uterine contractions that could lead to a miscarriage. If you do have a miscarriage, there is a risk that it might be incomplete. This could lead to bleeding, hospitalization, surgery, infertility, or even death. It is vitally important to use reliable contraception while taking Cytotec. ________________________________________ How should you take this medication? ________________________________________ Return to top Take Cytotec with meals, exactly as prescribed. Take Cytotec for the full course of NSAID treatment, even if you notice no stomach problems. Take the final dosage at bedtime. --If you miss a dose... Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once. --Storage instructions... Store at room temperature in a dry place. ________________________________________ What side effects may occur? ________________________________________ Return to top Cytotec may cause abdominal cramps, diarrhea, and/or nausea, especially during the first few weeks of treatment. These symptoms may disappear as your body gets used to the drug. Taking Cytotec with food can help minimize diarrhea. If you have prolonged difficulty (more than 8 days), or if you have severe diarrhea, cramping, or nausea, call your doctor. • Other side effects may include: Constipation, gas, indigestion, headache, heavy menstrual bleeding, menstrual disorder, menstrual pain or cramps, paleness, spotting (light bleeding between menstrual periods), stomach or intestinal bleeding, vomiting Cytotec may cause uterine bleeding even if you have gone through menopause. However, postmenopausal bleeding could be a sign of some other gynecological problem. If you experience any such bleeding while taking Cytotec, notify your doctor at once. ________________________________________ Why should this drug not be prescribed? ________________________________________ Return to top Do not take Cytotec if you are sensitive to or have ever had an allergic reaction to it or to another prostaglandin medication. Do not take Cytotec if you are pregnant or might become pregnant while taking it. ________________________________________ Special warnings about this medication ________________________________________ Return to top Since Cytotec may cause diarrhea, you should use this drug very cautiously if you have inflammatory bowel disease or any other condition in which the loss of fluid caused by diarrhea would be particularly dangerous. To reduce the risk of diarrhea, take Cytotec with food and avoid taking it with a magnesium-containing antacid, such as Di-Gel, Gelusil, Maalox, Mylanta, and others. Have frequent medical checkups. Never give Cytotec to anyone else; the dosage might be wrong, and if the other person is pregnant, the drug might harm the unborn baby or cause a miscarriage. ________________________________________ Possible food and drug interactions when taking this medication ________________________________________ Return to top Cytotec does not interfere with arthritis medications such as aspirin and ibuprofen. ________________________________________ Special information if you are pregnant or breastfeeding ________________________________________ Return to top If you are pregnant or plan to become pregnant, inform your doctor immediately. Because Cytotec can cause dangerous cases of miscarriage, sometimes leading to the mother's death, it should not be taken during pregnancy. If you are a woman of childbearing age, you should not take Cytotec unless you have thoroughly discussed the risks with your doctor and believe you are able to take effective contraceptive measures. You will need to take a pregnancy test about 2 weeks before starting to take Cytotec. To be sure you are not pregnant at the start of Cytotec treatment, your doctor will have you take your first dose on the second or third day of your menstrual period. Even the most scrupulous contraceptive measures sometimes fail. If you believe you may have become pregnant while taking Cytotec, stop taking the drug and contact your doctor immediately. It is not known if Cytotec appears in breast milk. Because of the potential for severe diarrhea in a nursing infant, your doctor may have you stop breastfeeding until your treatment is finished. ________________________________________ Recommended dosage ________________________________________ Return to top ADULTS ________________________________________ The recommended oral dose of Cytotec for the prevention of NSAID-induced ________________________________________ stomach ulcers is 200 micrograms 4 times daily with food. Take the last dose of the day at bedtime. If you cannot tolerate this dosage, your doctor can prescribe a dose of 100 micrograms. You should take Cytotec for the duration of NSAID therapy, as prescribed by your doctor. For People with Kidney Impairment You will not normally need an adjustment in the dosing schedule, but your doctor can reduce the dosage if you have trouble handling the usual dose. ________________________________________ Overdosage ________________________________________ Return to top Any medication taken in excess can have serious consequences. If you suspect symptoms of an overdose of Cytotec, seek medical attention immediately. • Symptoms of Cytotec overdose may include: Abdominal pain, breathing difficulty, convulsions, diarrhea, fever, heart palpitations, low blood pressure, sedation (extreme drowsiness), slowed heartbeat, stomach or intestinal discomfort, tremors
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