malignant hyperthermia, cardiac dysrhythmia and hypertension crisis in sublingual misoprostol: educational policy for adverse drug reaction organization

Pyrexia and shivering are the most popular side effects of postpartum administration of misoprostol, but other side effects of this drug are very rare. a 27-year-old pregnant female patient was admitted to ayatollah mousavi hospital (zanjan, iran), complaining about severe headache and the primary diagnosis of cerebral venous thrombosis. treatment was successful after primary investigations and planed therapy for cerebral venous thrombosis (cvt). following the decision on terminating the pregnancy, five tablets of sublingual misoprostol (200 mg) was used once evacuation of pregnancy remnants was done. about thirty minutes after the administration of misoprostol, onset of severe shivering and tachycardia (201/min) with high fever (about 41°c) and hypertension (182/123 mmhg) was observed. national adverse drug reaction (adr) form was completed. all of symptoms were alleviated 30 minutes after administration of paracetamol 1gram (intravenous infusion) followed by metoprolol 50 mg (orally). according to the literature, we listed the various side effects of misoprostol. even though the side effects of misoprostol are diverse and rare, the simultaneous occurrence of these side effects is not cited till date. these incidents are reported to the authorities as per adr policy; nonetheless, no preventive measures are implemented. this necessitates medical educational policies to be taken into consideration to educate healthcare providers throughout their professional career as well as research.