How should I use misoprostol after the mifepristone?
24h after using mifepristone women are advised to use misoprostol between the cheek and gums, let it dissolve and swallow the remains 30 minutes later.
Women are advised to use the pills buccally (in the cheek) because the side effects (like nausea, vomiting, diarrhea, abdominal pain) tend to be less intense when compared to using misoprostol under the tongue.
However, there are other ways to use the misoprostol:
Misoprostol is very effective when administered buccally, sublingually (under the tongue) or vaginally (inside the vagina)1 Misoprostol is NOT very effective when swallowed. 26 It is digested in the stomach and does not work very well.
When misoprostol is used buccally, sublingually or vaginally the medicine is directly absorbed into the blood. However, since pills used in the vagina may be found by a doctor, and since under the tongue (sublingual) causes more nausea and stomach problems, the buccal method is most recommended.
- Buccal use: Tablets are placed inside the cheek, next to the gums and swallowed after at least 30 minutes
- Sublingual use: tablets are placed under the tongue and swallowed after at least 30 minutes;
- Vaginal use: tablets are placed in the vagina as deep as possible next to the cervix (you should wash your hands before inserting the pills). The woman should lie down for 30 minutes so that the tablets are absorbed and don’t fall out.
If a woman decides to use the pills vaginally, it is important to know that in most countries it is illegal to self-induce an abortion and that the pills can stay up to 4 days in vagina before being totally dissolved. In case of a complication or if she wants to see a doctor or go to the hospital she should make sure to take out all the remains of the medicines before she sees the doctor or she could face legal problems. If she does not have a doctor she trusts, she can say she was having a miscarriage; the symptoms of a natural miscarriage and a medical abortion are exactly the same.