Remiprostol

Remiprostol is a synthetic prostaglandin analog used primarily for its gastroprotective and abortifacient properties. It is structurally related to other prostaglandin E1 analogs such as misoprostol.

Pharmacology

Remiprostol acts by binding to prostaglandin receptors in the stomach lining, leading to increased secretion of protective mucus and bicarbonate, and decreased secretion of gastric acid. This action helps to prevent gastric ulcers, particularly in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs).

Mechanism of Action

The primary mechanism of action of Remiprostol involves the activation of the EP3 receptor, a subtype of the prostaglandin E receptor. This activation results in:

• Inhibition of gastric acid secretion
• Stimulation of mucus and bicarbonate production
• Enhancement of mucosal blood flow

Pharmacokinetics

Remiprostol is rapidly absorbed after oral administration. It undergoes extensive first-pass metabolism in the liver, resulting in the formation of active metabolites. The elimination half-life is relatively short, necessitating multiple daily doses for sustained therapeutic effect.

Clinical Uses

Remiprostol is used in the following clinical scenarios:

• Prevention of NSAID-induced gastric ulcers
• Medical termination of intrauterine pregnancy
• Cervical ripening and labor induction

Adverse Effects

Common adverse effects of Remiprostol include:

• Diarrhea
• Abdominal pain
• Nausea
• Headache

Serious adverse effects, though rare, may include uterine rupture when used for labor induction.

Contraindications

Remiprostol is contraindicated in:

• Pregnant women (when used for ulcer prevention)
• Patients with known hypersensitivity to prostaglandins

Research and Development

Ongoing research is exploring the potential use of Remiprostol in the treatment of duodenal ulcers and its role in cervical cancer prevention.

Also see

• Misoprostol
• Prostaglandin E1
• Gastric ulcer
• NSAID