Snapshot A 60-year-old woman with a history of chronic pain presents to her primary care physician for an annual check-up. She follows a pain specialist regularly and had recently weaned off all opioid pain medications. She is chronically taking ibuprofen and naproxen. She reports occasional heartburn but denies any abdominal pain. Her physician is concerned about NSAID-induced peptic ulcer disease. After confirming that she is post-menopausal, her physician discusses using misoprostol with her to prevent peptic ulcer disease. Introduction Drugs misoprostol Mechanism of action misoprostol is a prostaglandin E1 (PGE1) analog, which strengthens the gastric mucous barrier and ↓ acid production it may also ↓ degree of fat malabsorption in patients with fat malabsorption disorder mechanism is unclear but misoprostol is thought to stimulate duodenal bicarbonate production Clinical use non-steroidal anti-inflammatory drug (NSAIDs) -induced peptic ulcer prophylaxis NSAIDs block PGE1 production induction of labor PGE1 ripens the cervix Adverse effects diarrhea abdominal pain abortive contraindicated in women of childbearing age