If any of this information causes you concern or if you want additional information about your medicine and its use, please check with your doctor or pharmacist.

Remember to keep all prescription drugs beyond the sight and reach of children when not in use. Store all drugs in their original labeled containers; the place of storage should be cool, dry, and away from light. Always read the label before each use.

What is Cytotec?

Introduced in 1990, Cytotec, or misoprostol (my-sew-prost-ul), is a unique synthetic compound primarily used to prevent stomach ulcers due to aspirin and other prescription anti-inflammatory drugs. Cytotec is under protected patent and not yet available in generic form. It is available in both 100 and 200 mg. tablets.

Cytotec is non-narcotic and is not habit-forming. It does not cause sexual dysfunction. It is not an antacid. It has not been found useful in prevention or treatment of duodenal ulcers.

How does Cytotec work?

Your stomach has a protective mucous layer that allows food to be digested by strong digestive juices. Without this protective layer, these digestive juices could damage your stomach. Arthritis medicines can be very helpful in decreasing pain and swelling in your joints. But like every medication, they can also cause unwanted side effects. Certain arthritis drugs, also known as NSAIDs (nonsteroidal anti-inflammatory drugs), can damage your stomach's protective mucous layer. If this protective layer becomes weakened, stomach ulcers could occur. In some cases, this could result in serious complications such as bleeding, hospitalization, and surgery.

Prostaglandins are natural substances found in many parts of the body. They help control the amount of acid in your stomach as well as the thickness of the protective mucous lining of the stomach. Arthritis medications can decrease the amount of prostaglandins in the lining of your stomach. If there is not enough prostaglandin in your stomach, your stomach cannot protect itself from these acids and you could develop an ulcer.

Cytotec, a man-made prostaglandin, has been proven to help prevent stomach ulcers by increasing the amount of prostaglandin in the stomach. This decreases the amount of acid that the stomach makes and also builds up a thick layer of mucous on the stomach lining.

Who should take Cytotec?

Patients on chronic NSAID therapy should be considered at high risk. Common NSAIDs include aspirin, ibuprofen, Anaprox, Ansaid, Clinoril, Feldene, Indocin, Meclomen, Motrin, Naprosyn, Nalfon, Orudis, Tolectin, and Voltaren. Certain individuals who take NSAID arthritis medicines are at greater risk. These would include patients over the age of 60, those with other medical problems, and individuals with a previous history of ulcer disease.

Taking Cytotec properly

1. Always take Cytotec with food. To help prevent diarrhea from the medication, it is very important that you take each Cytotec tablet with a meal. If you have been prescribed a dose at bedtime, be sure to take it with a snack.

2. Do not stop Cytotec if you develop diarrhea. Diarrhea commonly occurs during the first week of treatment because the body is adjusting to the medication. For most patients the diarrhea goes away on its own within the first week without further problems. Take each dose with food. If you continue to have loose stools and you feel you are losing too much water, call your doctor. Certain magnesium-containing antacids (Di-Gel, Gaviscon, Gelusil, Maalox, Mylanta, WinGel) can worsen the diarrhea and should be avoided. If antacids are needed use AlternaGel, Amphojel, Titralac, Tums, or Rolaids. 3. Take the dose as prescribed. Initially, your doctor will determine the optimal dose for you on the basis of your current dose of NSAIDs, age, weight, any other medical conditions that you may have. Generally, most adults are instructed to take a 200 mg. tablet four times per day.

Do not increase the prescribed dosage on your own. Your doctor will routinely review your case and adjust the dose accordingly. The goal, of course, is to prevent stomach ulcers with the lowest effective dose of Cytotec possible.

4. Do not miss doses. If you do miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Although an occasional extra dose is unlikely to cause harm, you should not intentionally double doses.

5. Do not stop taking Cytotec. In order for Cytotec to protect you from stomach ulcers, you must take it for the full length of time that you are taking the arthritis medicine. This may be for many years.

As with all prescription medications, Cytotec can cause side effects. In general, the risk of side effects depends on the dosage of Cytotec. You can help limit side effects by taking the medication exactly as prescribed and promptly reporting any problems to your doctor. Always take it with food. It is important that you keep all your appointments with your doctor so that he can be sure the medication is working and check for possible side effects.

These side effects should be reported to your doctor:

• Severe watery diarrhea
• Postmenopausal vaginal bleeding

• Nausea
• Bloating
• Abdominal cramps
• Persistent Diarrhea

Precautions

No foods or beverages are restricted while taking Cytotec.

Do not take Cytotec if you are pregnant or if there is any chance that you could be pregnant. Do not become pregnant while taking Cytotec. If a woman is pregnant and takes Cytotec, she could have a miscarriage or dangerous bleeding. This could result in hospitalization, surgery, infertility, or death. If you feel you have become pregnant while taking Cytotec, discontinue the medication and call your doctor immediately. In general, women of child-bearing age should not take Cytotec.

Cytotec should not be used when breast-feeding since it could cause significant diarrhea in a nursing infant. Cytotec is not recommended for children.

Never share Cytotec with anyone. Cytotec has been prescribed for your specific condition. It may not be correct treatment for another person, and may be dangerous to another person if she should become pregnant.

Remember

Your doctor believes that you are in a group of patients at high risk for developing an ulcer from your arthritis medication. By taking Cytotec you are helping to protect your stomach from ulcers. Cytotec decreases the amount of acid your stomach produces and helps to strengthen the barrier of protective mucous in your stomach. As with all medications, however, side effects may occur. You can best limit problems by taking Cytotec exactly as prescribed. If you have any questions or concerns, do not hesitate to discuss them with your doctor.