People who regularly take aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) are likely to get stomach or duodenal ulcers. Cytotec reduces the amount of acid secreted in the stomach and promotes healing of gastric and duodenal ulcers. In some cases, cytotec is given at the same time as NSAIDS, as a preventive measure against ulcers.
Cytotec contains 200micrograms of misoprostol and is prescribed at a dose of one oral tablet four times daily with food. Cytotec therapy may last for months or for the entire duration of the NSAID therapy. The side effect of cytotec is exploited in the process of inducing an abortion. The most commonly reported side effects are abdominal cramps, diarrhoea, nausea, flatulence (gas) and vomiting. Uterine contraction, menstrual pain and cramps and heavy menstrual bleeding are possible at other doses.
Don't take if pregnant
The manufacturers of cytotec clearly state in the package literature that the product is solely intended for prevention and treatment of NSAID-induced stomach ulcers but should not be taken for those ulcers if the client is pregnant. Pregnancy should be avoided while the client is taking cytotec and the therapy should be stopped for at least one month prior to the client becoming pregnant.
Unlicensed indication of cytotec is to induce abortion or labour in the pregnant female. In such cases, the duration of treatment is very brief, ranging from one single dose to a few doses over a day or two. Cytotec, when compared to surgical evacuation, is not invasive and does not carry as many risks to the client. The drug is cheaper and easier to 'administer' than surgical methods using instruments.
Since abortion is illegal in Jamaica, the medical doctor who prescribes cytotec for the purpose of aborting a foetus and the pharmacist who fills such a prescription are undertaking illegal practices. The law forbids a pharmacist to assist in the procurement of an abortion plus, pharmacists are not legally able to dispense any drug product for use other than that for which it is registered.
Well let's get real. Make no mistake about it, cytotec is being used as we speak for abortifacient purposes. Doctors sometimes write the prescriptions for cytotec in a straightforward pattern, where the intent behind the treatment may be easily recognised by the pharmacist's relatively high dose of the drug and short duration of treatment, spell a-b-o-r-t-i-o-n. However, prescribing patterns for the drug have evolved to satisfy the law. The prescriptions are sometimes written for a month of cytotec, which satisfies the law (indicates treatment for ulcer), and the candidate for abortion presents the prescription and requests two or three days' supply. Purchasing a month's supply in this instance would be an overkill since the client would require only a few doses.
Some pharmacists comply
Some pharmacists will legally comply with this request while others will ask the client about the nature of the medical complaint in order to verify that the prescription is 'legit'. If the client's response bears any semblance to the words such as 'pregnancy', 'belly' or 'abortion', these pharmacists will not fill the prescription. They presumably object in order to satisfy the law and/or their consciences, and to protect the client's health. The law does not prohibit pharmacists from exercising their discretion when filling prescriptions.
However, a client who fills a 'legal' prescription for one month's supply of cytotec also has the option of using the tablets 'illegally' for two days (as an abortifacient) on various occasions. Many pharmacists do not to stock the product, full stop. On the other hand, some doctors stock it in their offices, and supply it or administer it to clients as needed.
Dahlia McDaniel is a pharmacist and final-year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.
The tablet misoprostol (cytotec), when taken by mouth or inserted into the vagina, can cause a chemical abortion. It is used, illegally, in Jamaica as an abortifacient (drug product which induces abortion).
