Snapshot A 55-year-old man with a history of chronic NSAID use and recent hospitalization for a soft tissue infection presents to his primary care physician for diarrhea. His long-term medication list also includes ibuprofen, metoprolol, and most recently misoprostol given his long-term NSAID use. His physician is worried about C. difficile diarrhea, but the patient reports that this diarrhea started soon after starting misoprostol, which pre-dated his recent hospitalization and antibiotic use. Introduction Drugs misoprostol Mechanism of action misoprostol is a prostaglandin E1 (PGE1) analog, which strengthens the gastric mucous barrier and ↓ acid production it also ↓ degree of fat malabsorption 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