title: Misoprostol versus methylergometrine: pharmacokinetics in human milk.
abstract: OBJECTIVE
  The purpose of this study to compare breast milk pharmacokinetics between misoprostol 200 mug and methylergometrine 250 mug after single oral dosing in women who require postpartum uterotonic therapy.
  
  
  METHODS
  Open prospective randomized phase I study measuring misoprostol and methylergometrine on postpartum days 3 to 6 in milk 0.5, 1, 2, 3, 4, and 5 hours postdose, and in maternal serum at 0.5 and 1 hours (misoprostol) and 1 and 2 hours (methylergometrine) in 10 lactating women per group.
  
  
  RESULTS
  Milk misoprostol levels rose and declined rapidly, which gave a milk elimination half-life of less than one half that of methylergometrine (mean +/- SE, 1.1 +/- 0.3 hours [median, 0.6 hours] vs 2.33 +/- 0.3 hours [median, 1.9 hours]; P = .003). Milk/plasma ratios for misoprostol were one third of those for methylergometrine at 1 hour ( P < .0001) and 2 hours ( P < .0015).
  
  
  CONCLUSIONS
  Misoprostol warrants further investigation as an alternative to postpartum methylergometrine because it enters and leaves breast milk at twice the rate, with one third of the milk/plasma ratio, which significantly lowers infant exposure and facilitates a timed dosing regimen.
authors.affiliation: Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland.
authors.forename: Danièle
authors.initials: D
authors.lastname: Vogel
authors.forename: Tilo
authors.initials: T
authors.lastname: Burkhardt
authors.forename: Katharina
authors.initials: K
authors.lastname: Rentsch
authors.forename: Horst
authors.initials: H
authors.lastname: Schweer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Watzer
authors.forename: Roland
authors.initials: R
authors.lastname: Zimmermann
authors.forename: Ursula
authors.initials: U
authors.lastname: Von Mandach
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001682:Biological Availability; D001942:Breast Feeding; D005260:Female; D006801:Humans; D008755:Methylergonovine / Q000493:pharmacokinetics* / Q000627:therapeutic use; D008895:Milk, Human / Q000737:chemistry*; D016595:Misoprostol / Q000493:pharmacokinetics* / Q000627:therapeutic use; D010120:Oxytocics / Q000493:pharmacokinetics* / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D011336:Probability; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D008755:Methylergonovine