Talk:Misoprostol
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The specific risks of labor induction should be on the page for that topic. There is no need to repeat the information here. In addition, the deleted paragraph was a violation of NPOV. 67.169.30.207 06:18, 30 August 2006 (UTC)
[edit] specific risks of misoprostol...
are what the paragraph refer to; the controversy re "convenience inductions" is cited from numerous reliable sources/merely reported. if there's another side of the controversy you want to present, find a reliable source who states it. Cindery 06:27, 30 August 2006 (UTC)
The specific risks of labor induction should be on the page for that topic. There is no need to repeat the information here. In addition, the deleted paragraph was a violation of NPOV. And while we're at it, you don't need to do a separate edit for each individual item that you want to change--you can do them all in one edit. 67.169.30.207 13:49, 30 August 2006 (UTC)
[edit] figure out what NPOV is
as i said, marsden wagner etc. reliable sources/the controversy is reported on. if you think there is another side/you have seen it from a reliable source, go find that source and cite it. i suggest you read the wikipedia text re NPOV, edit warring, etc. if you don't like what marsden/cbs new have to say: too bad. you can't just delete accurate information because you don't like it. if you think a point of view hasn't been represented, you can include it, but you can't just delete information you don't like. Cindery 17:23, 30 August 2006 (UTC)
Perhaps I need to say this in a different manner. The risks that the article ascribes to misoprostol are, in fact, common to any labor-induction drug. That the article discusses misoprostol does not mean that only misoprostol has these problems. This isn't a question of me "liking" or "disliking" information. I'm also not really sure how a huge rant about how doctors are lazy bastards qualifies as NPOV. 192.91.171.42 20:53, 30 August 2006 (UTC)
again, you don't seem clear on NPOV. a significant point of view with adherents who can be cited from reliable sources can't be deleted. if you think there's another point of view that's been left out--making article unbalanced--find it and cite it. NPOV is never the elimination of viewpoints. a viewpoint you don't like can be balanced by another viewpoint, but not deleted. and re cbs, if misoprostol is in the news and oxytocin isn't, the article can be included in the misoprostol article.
you should also probably go over wikipedia info re "edit warring"--if you think the article can be improved--improve it. but not by deleting info from reliable sources because you disgree/don't like the info. Cindery 21:05, 30 August 2006 (UTC)
Information specific to labor induction has been moved to the article regarding labor induction, which is where it should have gone in the first place. 192.91.171.42 23:10, 31 August 2006 (UTC)
[edit] moving cytotec article
the article and the quote are specifically about cytotec, not induced labor in general. (cytotec is harsher/faster and much, much cheaper). hence i will be moving it back. Cindery 00:12, 1 September 2006 (UTC)
Cytotec is the brand name of a specific formulation containing misoprostol and labeled as an antacid. Cytotec and misoprostol are not the same thing. Using Cytotec to induce labor is dangerous because of the uncontrolled fashion in which the drug is introduced; there is not some magic evil power in misoprostol that makes it more dangerous than other prostaglandins. An article about the dangers of using Cytotec to induce labor is not necessary in light of the link to the FDA warning. I recognize that you very badly want us all to know that labor induction is an evil horrible terrible thing that should never ever be done ever but this is not the forum for it.67.169.30.207 03:56, 1 September 2006 (UTC)
no, cytotec and misoprostol are the same thing (although there are now generics since searle's patent ran out). the article you keep deleting does not address labor induction in general, it specifically addresses cytotec, as i have pointed out. (perhaps you noticed this when you tried to transfer it to labor induction, and you had to blank out the word "cytotec.") whether or not you agree doen't change the fact that the article spcefically addresses cytotec.
it is generally considered bad form to summarily revert edits in a dispute without addressing points in a discussion--such as: the article refers to cytotec.
i don't really have an opinion about labor induction--i just researched cytotec, and reported what i found. (i am a big fan of informed consent, though. i'm definitely not a fan of big pharma--but that doesn't really come into play here, as the drug is so cheap/searle disowned the drug for its off-label uses.)
but, now that you appear to have a slightly better grasp of NPOV, i suggest you read up on edit warring, research, etc.--nothing is stopping you doing research and adding content to the article. there are, however, policies and guidelines about deleting content once you're having a dispute with another editor or editors that you might want to read. (in general, i favor the laissez-faire approach to invoking the rules, and my favorite policy guideline is the unofficial humorous one, "don't be a dick.") meanwhile, i'm going to leave the dispute tag on ther article for a day or whatever, and then put back the content you keep deleting. Cindery 04:38, 1 September 2006 (UTC)
No, Cytotec and misoprostol are not the same thing. I have already explained why; read the entire sentence that I wrote and think about it for five minutes before you reply. The article that I "keep deleting" does address the issues inherent to labor induction--the fact that it only mentions Cytotec is due to sloppy writing by the article's author, who didn't bother to mention the fact that there are several other labor-induction drugs on the market and that they all have the same problem. Cytotec only exacerbates those issues because it contains a very high dose of misoprostol, and the delivery method does not allow this dose to be controlled.
[edit] differences between cytotec and pitocin
this article points out some differences. it's juts an example of the differences between cytotec/other labor inducing drugs. and a simple google search will inform you that cytotec and misoprostol are synonymous. *you need to do research and cite facts/sources.* your opinions cannot be cited in the article as references/are not sufficient. and whether you think marsden wagner is "sloppy" for calling cytotec "cytotec" is compeltely irrelevant. also, when you repeatedly delete disputed text, you are supposed to remove it to the talk page until the dispute is resolved. http://archive.salon.com/health/feature/2000/07/11/cytotec/index.html Cindery 07:16, 1 September 2006 (UTC)
[edit] differences between misoprostol and other prostaglandin analogues
ABSTRACT TOP
ABSTRACT MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES
OBJECTIVE: To characterize the frequency and timing of cardiotocographic abnormalities associated with the use of 3 commercially available prostaglandin analogues, misoprostol, dinoprostone gel, and dinoprostone pessary, as labor preinduction agents.
METHODS: One-hundred and eleven women undergoing induction of labor with an unfavorable cervix were randomized to receive either misoprostol 50 µg every 6 hours x 2 doses, dinoprostone gel 0.5 mg every 6 hours x 2 doses, or dinoprostone pessary 10 mg x 1 dose for 12 hours intravaginally. Oxytocin induction was initiated per standardized protocol. Cardiotocographic tracings were blindly reviewed, with abnormalities coded using established definitions.
RESULTS: Fifty-five percent of women treated with misoprostol demonstrated an abnormal tracing event within the initial 24 hours of induction, compared with 21.1% with dinoprostone pessary and 31.4% with the dinoprostone gel. The mean (± standard deviation) number of abnormal events was significantly greater in women treated with misoprostol (5.0 ± 5.9) versus the dinoprostone pessary (1.6 ± 2.5) and gel (2.2 ± 3.1) (P < .05). In addition, these events occurred earlier after initial misoprostol dosing (5.0 ± 4.0 hours), compared with the dinoprostone pessary (9.4 ± 5.6 hours) and gel (7.7 ± 6.6). Thirty-nine percent of the misoprostol-treated women had abnormal patterns within 6 hours of initial dosing, compared with those treated with the dinoprostone pessary (7.9%) and gel (17.1%).
CONCLUSION: Cardiotocographic abnormalities are more frequent after misoprostol administration compared with the dinoprostone analogues. The early onset and frequent nature of the tracing abnormalities associated with misoprostol raises concern for the potential use of misoprostol for outpatient cervical ripening.
LEVEL OF EVIDENCE: II-1
Prostaglandins are effective agents that are useful in promoting cervical ripening and facilitating labor induction.1–3 Currently, the prostaglandin E2 analogues (dinoprostone gel [Prepidil, Upjohn, Kalamazoo, MI] and dinoprostone pessary [Cervidil, Forest Pharmaceuticals, St. Louis, MO]) are currently the only regimens for cervical ripening in the United States approved by the U.S. Food and Drug Administration (FDA). A great deal of interest has, however, focused on the use of misoprostol, a synthetic prostaglandin E1 analogue, for cervical ripening and labor induction. Misoprostol (Cytotec, Searle, Chicago, IL) is currently marketed in the United States for the prevention of gastric ulceration in patients at high risk for developing peptic ulcerative disease. Misoprostol also has potent uterotonic properties.
[edit] paragraph under dispute
"The "routine" use of Cytotec is controversial. Speeding delivery can be medically necessary when the mother is overdue or at risk because of high blood pressure or diabetes, but critics charge that doctors often rely on Cytotec for "convenience inductions," using the drug to induce labor during office hours rather than letting nature take its course. "Cytotec enables doctors to practice daylight obstetrics," says Dr. Marsden Wagner, a neonatologist who served for 15 years as a director of women's and children's health in industrialized countries for the World Health Organization. "It means that as a doctor, I can come in at 9 a.m., give you the pill, and by 6 p.m. I've delivered a baby and am home having dinner." [1] In May, 2005, the FDA sent out an alert to women, warning them against the use of Cytotec.[2]"
Saying that Cytotec and misoprostol are "synonymous" is like saying that gasoline should be called "Exxon". Citing Google is not convincing (and it's amusing that you're citing Google to try and settle an argument on Wikipedia!) "*you need to do research and cite facts/sources.*" No shit! Perhaps if you had posted the Salon.com article instead of the Mother Jones screed, we wouldn't have gotten into this whole mess. My point about the Mother Jones article still stands--the problems it describes are problems caused by labor induction, and the reason that it's such a concern for Cytotec is that the formulation is not intended for labor induction and contains far more misoprostol than is appropriate for that use. "your opinions cannot be cited in the article as references/are not sufficient." Jesus, you're saying that it's my opinion that a formulation and the drug it contains are two different things? 192.31.106.34 15:24, 1 September 2006 (UTC)
1. saying that cytotec and misoprostol are the same thing is common knowledge in the context of this article, as the first paragraph tells us that cytotec and misoprostol are the same thing, and the reference provided at the bottom of the page confirms this. if you wanted to dispute this, you would need to do so, and provide some reference challenging the assertion and reference in the article. but if you did a simple google search (i.e., began the rudiments of research) you would find that cytotec and misoprostol are the same thing. i don't have to do any research or "cite google," as the research has already been done and provided in the article. perhaps it is a simple misunderstanding on your part, and we can let it go. but please keep in mind in the future that if you dispute something in an article, and what you dispute has a reference, you are obligated to dispute the reference by doing and providing alternate research, not insisting that the reference is wrong and your opinion is correct--wikipedia uses references, not opinions. (you will not have any luck, by the way, finding any reference stating that misoprostol and cytotec cease to become synonymous at a different dosages.)
2. your insistence that cytotec=labor induction is not suppported by any references. if you want to make this argument, you have to do research and provide references, as your opinions--nor my opinions, nor the opinions of any other editor--are sufficient for making assertions in the article. i have already provided references clearly indicating that cytotec is different from other labor inducing drugs, including cervidil, the one it is closest to (another prostaglandin analogue). the facts clearly show that cytotec has differences from other labor induction drugs.
3. your opinion that marsden wagner is conflating high doses and low doses of cytotec is not supported by any references or research.
4. in general, the onus is on you if you dispute cited material in an article--you have to do research and cite references to make your case/dispute the reference/material. it is not sufficient to claim that, according to you, the reference is wrong. Cindery 16:52, 1 September 2006 (UTC)
I guess that at this point I'm going to have to give up, because it's clear that you won't stop putting wrong information on the page. Congratulations! Your persistence is rewarded. Wikipedia proudly salutes your insistence on inaccuracy. 67.169.30.207 00:48, 2 September 2006 (UTC)
[edit] gynuity
gynuity is a spin-off company of the population council. (both danco and gynuity were set up by the pop council, and winikoff, lead exec of gynuity, appears all over the media as a spokesperson for mifepristone, and along with hausknecht--lead exec of danco--publishes papers in medical jounals supporting mifepristone.) having three orgs instead of one does make it appear that three orgs support this or that, as opposed to one source making assertions/supporting something...it's a kind of pr strategy/definitely influences public opinion. let's call it "corporate sockpuppetry." :-) but, that aside, i have no problem with gynuity compiling studies in a biblio. but they are not an authoritative/unbiased resource for a synthesis interpretation of studies to date. "instructions for use" is a little misleading--it apes product insert packaging, but is not in fact product insert packaging and has not been approved as PPI by any regulatory agency in any country. you are correct that gynuity's synthesis is not "one study," per se, but it is one selective synthesis (based on studies deemed too small by everyone else, including ibis and cochrane, too establish any conclusive claims for efficacy.) in the absence of adequate studies, i do not object to citing the range of efficacy based on small studies to date, or even to gynuity's observation that of the small studies, gestational age is associated with higher efficacy. (higher efficacy in general is associated with lower gestational age for chemical abortion drugs.) Cindery 17:05, 8 September 2006 (UTC)
[edit] Half-life
The DrugBank entry for misoprostol says the half-life is 20-40 minutes. A salon.com article (popular source, not scholarly) from 6 years ago says the half-life is unknown. I think we need to change this contradiction in the article, and I personally would prefer removing the salon.com info, but I wanted to see what other editors felt before editing.--Andrew c 20:47, 11 September 2006 (UTC)
i think that the problem with establishing a half-life for it is that no dosing protocol has been established for it. what gaskin thinks--based on studies contained here: [1] is that when it is continually administered in separate doses over a few hours to induce labor, it has a cumulative effect and degrades more slowly. (this is believed to explain why some women can take several doses, and then not have problems like fetal distress or uterine rupture until hours later). i do not object to including the half-life established for miso as ulcer med, but i think info clarifiying why it may be different for labor should be included.
re salon: article was included after anon insisted that it should be (presumably because it accessibly clarified diff between pitocin and miso?) Cindery 21:40, 11 September 2006 (UTC)
...also, there's this: "the systemic bioavailability of vaginal misoprostol is 3-fold that of the orally administered drug. " (and since "half life" isn't always a term understood by lay people, perhaps we should clarify/wikilink it if possible. for example, the half-life of mifepristone is 24 hrs--but that doesn't mean the body excretes it in 24 hrs. excretion takes 5 days. "half life" means peak concentration, not "gone.") Cindery 01:45, 18 September 2006 (UTC)
[edit] The misoprostol entry should be rewritten from scratch.
Overall this is a very biased and poor entry on misoprostol. The drug's important role in preventing and treating post partum hemorrahge in the developing world is not even mentioned. The impression that the drug has no legitimate routine use in obstetrics is also way behind the times. How about quoting some scientific and clinical trials rather than silly anecdotal scare stories?—The preceding unsigned comment was added by 24.128.216.162 (talk • contribs) 15:45, 7 December 2006.
I think that it's about as good as it needs to be. Heck, go back and look at some of the earlier versions where Cindery kept pushing her Mother Jones screed right into the middle of the article. Now that she's taken her ball and gone home we're past that. 71.202.217.229 05:35, 7 January 2007 (UTC)
[edit] paragraph on Labor Indutcion
Cites Cochrane Collaboration results without caveats; the abstract summary for that research states, "misoprostol also increases hyperstimulation of the uterus. The trials reviewed are too small to determine whether the risk of rupture of the uterus is increased. More research is needed into the safety and best dosages of misoprostol.", as well as "meconium-stained liquor more common". Perhaps this should be reflected in the article... http://www.cochrane.org/reviews/en/ab000941.html Ybanrab 15:01, 27 July 2007 (UTC)
[edit] WHO essential drug list
The WHO suggests the drugs use as complimentary and that it "requires close medical supervision", the only medicine on the list to do so AFAIK, current list at http://www.who.int/medicines/publications/EssMedList15.pdf Ybanrab 15:01, 27 July 2007 (UTC)
