Cytotec vs. Other Prostaglandins: Comparing Efficacy and Side Effects

Cytotec vs. Other Prostaglandins: Comparing Efficacy and Side Effects

Cytotec (misoprostol) is a synthetic prostaglandin E1 analogue used to prevent stomach ulcers. It also has off-label uses like medical abortion.

However, Cytotec has a different safety and efficacy profile than other prostaglandins designed for specific indications.

This article compares Cytotec to other prostaglandins for treating ulcers, abortion, and obstetric uses.

Overview of Prostaglandins

Prostaglandins are hormones that regulate various body processes like inflammation, blood flow, secretion, and smooth muscle contraction.

Pharmaceutical prostaglandins are used for:

  • Preventing stomach ulcers
  • Medical abortion
  • Cervical ripening/labor induction
  • Controlling postpartum hemorrhage

Examples include:

  • Misoprostol (Cytotec) – PGE1 analog
  • Dinoprostone (Cervidil, Prepidil) – PGE2 analog
  • Gemeprost – PGE1 synthetic
  • Carboprost (Hemabate) – PGF2a analog

While chemically similar, each prostaglandin has unique properties influencing its efficacy and safety profile.

For Preventing Stomach Ulcers

Cytotec (misoprostol)

  • Approved for ulcer prevention and treatment
  • Reduces acid secretion
  • Strengthens mucosal defense
  • Effective for NSAID-induced ulcers

Side effects: Diarrhea, cramping, headache


  • Not used for ulcers
  • Dinoprostone – for obstetric indications
  • Gemeprost – for medical abortion
  • Carboprost – for postpartum hemorrhage

So for ulcer prevention and treatment, original Cytotec is the only prostaglandin approved and commonly used. The others have no role in treating gastric ulcers.

For Medical Abortion

Cytotec (misoprostol)

  • Used off-label with mifepristone
  • Up to 98% effective in first trimester

Side effects: Cramping, bleeding, chills, fever


  • Approved for medical abortion with mifepristone
  • Similar efficacy to Cytotec

Side effects: Lower GI side effects than Cytotec


  • Dinoprostone – for cervical ripening
  • Carboprost – for postpartum hemorrhage

Cytotec or gemeprost are the prostaglandin options for medical abortion in conjunction with mifepristone. Gemeprost may have slightly fewer GI side effects.

For Labor Induction

Cytotec (misoprostol)

  • Used off-label for cervical ripening
  • Less effective than dinoprostone

Side effects: Uterine rupture, fetal distress, postpartum hemorrhage


  • Approved for cervical ripening and induction
  • Better efficacy and safety than Cytotec

Side effects: Uterine tachysystole, meconium passage


  • Gemeprost – for medical abortion
  • Carboprost – for postpartum hemorrhage

Dinoprostone is the recommended prostaglandin for cervical ripening and labor induction. Cytotec is associated with more risks in pregnant women.

For Postpartum Hemorrhage

Carboprost (hemabate)

  • Approved to treat postpartum hemorrhage
  • Can rapidly constrict uterine blood vessels

Side effects: Nausea, vomiting, diarrhea

Cytotec (misoprostol)

  • Used off-label to prevent/treat PPH
  • Slower onset than carboprost

Side effects: Lower GI side effects


  • Dinoprostone – for cervical ripening
  • Gemeprost – for medical abortion

Carboprost is more effective for treating severe postpartum bleeding. Cytotec may be used prophylactically to prevent PPH.

Side Effect Differences

The most common side effects for each prostaglandin are:

Cytotec: Diarrhea, cramping, nausea

Gemeprost: Nausea, vomiting, diarrhea

Dinoprostone: Uterine tachysystole, hyperstimulation

Carboprost: GI upset, nausea/vomiting

While all can cause GI effects like nausea and diarrhea, Cytotec seems most prone to cramping. Dinoprostone has more effects on uterine contractility.

Risk Differences

Some serious risks unique to each prostaglandin are:


  • Pregnancy: uterine rupture, fetal distress, birth defects, bleeding
  • Rare: anaphylaxis


  • Pregnancy: bleeding, incomplete abortion


  • Pregnancy: uterine rupture, hyperstimulation
  • Rare: bronchospasm


  • Severe hypertension
  • Bronchoconstriction

Cytotec and dinoprostone pose the most serious risks in pregnancy. Each prostaglandin has rare unique severe reactions.


While chemically similar, prostaglandins have different efficacy and safety profiles based on their specific molecular properties.

Cytotec is best for ulcer prevention. Gemeprost and dinoprostone are favored for abortion and obstetric indications respectively. Understanding the differences allows proper prostaglandin selection for given clinical needs.

Key Differences Summary

Use Cytotec Gemeprost Dinoprostone Carboprost
Ulcers Yes No No No
Abortion Off-label Approved No No
Labor induction Off-label No Approved No
PPH Off-label No No Approved
Side effects Diarrhea, cramping Nausea/vomiting Uterine stimulation Nausea/vomiting
Serious risks Uterine rupture (pregnancy) Bleeding (pregnancy) Uterine rupture (pregnancy) Hypertension

Frequently Asked Questions

Which prostaglandin is best for ulcers?

Cytotec (misoprostol) is the only prostaglandin used for preventing and treating stomach ulcers.

What is the most common side effect of Cytotec?

The most frequently reported side effect with Cytotec is diarrhea, seen in up to 28% of people. Nausea, cramping, and stomach pain are also common.

Is Cytotec or gemeprost better for abortion?

Both are effective, but gemeprost may have slightly fewer GI side effects. However, Cytotec is more widely available and affordable.

Why shouldn’t Cytotec be used to induce labor?

It is associated with serious risks like uterine rupture and fetal distress. Dinoprostone is safer and more effective for cervical ripening.

Which prostaglandin is used to stop postpartum hemorrhage?

Carboprost (hemabate) is the preferred prostaglandin for treating severe postpartum bleeding due to its rapid onset of action.

Do prostaglandins interact with each other?

Yes, concurrent use of two prostaglandins can lead to enhanced, reduced, or otherwise altered effects. Combinations should be avoided.

Can prostaglandins be used during breastfeeding?

With caution. Small amounts enter breast milk. Monitor infants for diarrhea and drowsiness.

Are prostaglandins safe for gastrointestinal disorders?

No, they may further worsen diarrhea and intestinal inflammation. They are contraindicated with GI diseases.