Can you give me all prostaglandin analogies and with where their uses
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I now have comprehensive information from multiple authoritative pharmacology textbooks. Here is a complete overview of all prostaglandin analogues and their clinical uses:
Prostaglandin Analogues — Complete Overview
Prostaglandin analogues are grouped by the endogenous prostaglandin they mimic.
🔵 PGE₁ Analogues
1. Alprostadil (Caverject, MUSE, Prostin VR)
| Use | Details |
|---|---|
| Erectile dysfunction | Intracavernous injection or urethral suppository (MUSE); second-line after PDE5 inhibitors |
| Patent ductus arteriosus (PDA) | IV infusion in neonates with congenital heart defects to maintain ductal patency until surgical correction; ~10% risk of apnea in neonates <2 kg |
| Peripheral vascular disease / ulcers | IV alprostadil used in refractory ischemic ulcers |
2. Misoprostol (Cytotec)
| Use | Details |
|---|---|
| NSAID-induced gastric ulcer prevention | Stimulates mucus/bicarbonate secretion, reduces acid; reduces ulcer incidence to <3% |
| Cervical ripening / Labor induction | Interacts with uterine prostaglandin receptors to stimulate contractions (off-label) |
| Medical abortion | Used with mifepristone (RU-486) for highly effective termination of pregnancy |
| Postpartum hemorrhage | Uterotonic agent when other measures fail |
⚠️ Contraindicated in pregnancy (teratogenic/abortifacient). Common adverse effects: diarrhea, abdominal cramps (dose-dependent).
3. Lubiprostone (Amitiza)
| Use | Details |
|---|---|
| Chronic idiopathic constipation | Stimulates ClC-2 chloride channels → increases intestinal fluid secretion |
| Opioid-induced constipation | |
| Irritable bowel syndrome with constipation (IBS-C) |
Common adverse effects: nausea (reduced by taking with food), diarrhea.
🟢 PGE₂ Analogues
4. Dinoprostone (Cervidil, Prepidil, Prostin E2)
| Use | Details |
|---|---|
| Cervical ripening | Vaginal insert or gel for labor induction at term |
| Second-trimester abortion | Abortifacient via vaginal suppository |
🟡 PGF₂α Analogues (Glaucoma + Obstetrics)
5. Latanoprost (Xalatan)
| Use | Details |
|---|---|
| Open-angle glaucoma / Ocular hypertension | First-line; enhances uveoscleral aqueous outflow; reduces IOP by 27–35%. Once-daily evening drops. ~5–10% of patients are non-responders |
| Alopecia areata (adjuvant) | Some evidence for eyelash/eyebrow regrowth (mixed results) |
6. Latanoprostene bunod (Vyzulta)
| Use | Details |
|---|---|
| Glaucoma | Metabolized into latanoprost + butanediol mononitrate (NO donor); dual IOP-lowering mechanism |
7. Bimatoprost (Lumigan, Latisse)
| Use | Details |
|---|---|
| Open-angle glaucoma | Slightly greater IOP reduction than latanoprost; available in 0.01% and 0.03% formulations; sustained-release intracameral implant under evaluation |
| Hypotrichosis of eyelashes | Latisse 0.03% applied topically to enhance eyelash length, thickness, and darkness |
8. Travoprost (Travatan Z)
| Use | Details |
|---|---|
| Open-angle glaucoma / Ocular hypertension | Similar to latanoprost; fewer non-responders; Polyquad preservative formulation available to reduce ocular surface side effects |
9. Tafluprost (Zioptan)
| Use | Details |
|---|---|
| Open-angle glaucoma | Preservative-free formulation; IOP reduction slightly less than other PG agents but well tolerated with less ocular surface disruption |
10. Carboprost tromethamine (Hemabate) — 15-methyl PGF₂α analogue
| Use | Details |
|---|---|
| Refractory postpartum hemorrhage | Used when oxytocin fails; dose 250 µg IM, can repeat |
| Second-trimester abortion induction |
11. Omidenepag (Eybelis) — EP₂ receptor agonist (selective non-FP)
| Use | Details |
|---|---|
| Open-angle glaucoma | 0.002% once daily; EP₂ agonist (not FP); effective in latanoprost non-responders; does not cause periorbitopathy; hyperemia ~5% |
🔴 PGI₂ (Prostacyclin) Analogues — Pulmonary Arterial Hypertension (PAH)
12. Epoprostenol (Flolan, Veletri)
| Use | Details |
|---|---|
| Pulmonary arterial hypertension (PAH) | Continuous IV infusion; improves symptoms, hemodynamics; can delay/avoid lung transplantation |
| Platelet aggregation inhibition | Potent vasodilator and antiplatelet agent |
13. Iloprost (Ventavis)
| Use | Details |
|---|---|
| PAH | Inhaled (targets pulmonary vasculature) or IV (not available in the US); also used in Raynaud's phenomenon and digital ischemia |
14. Treprostinil (Remodulin, Tyvaso, Orenitram)
| Use | Details |
|---|---|
| PAH | Available as SC infusion, IV infusion, inhaled (Tyvaso), or oral (Orenitram); t½ ~4 h |
15. Selexipag (Uptravi) — non-prostanoid IP receptor agonist
| Use | Details |
|---|---|
| PAH | First approved PGI₂ analogue with a nonprostanoid structure; oral; selective IP receptor agonist |
Summary Table
| Drug | Class | Route | Main Use |
|---|---|---|---|
| Alprostadil | PGE₁ | IV, intracavernous, urethral | Erectile dysfunction, PDA |
| Misoprostol | PGE₁ | Oral, vaginal | Gastric ulcer prevention, abortion, labor |
| Lubiprostone | PGE₁ derivative | Oral | Constipation, IBS-C |
| Dinoprostone | PGE₂ | Vaginal | Cervical ripening, abortion |
| Latanoprost | PGF₂α | Ophthalmic | Glaucoma |
| Latanoprostene bunod | PGF₂α + NO | Ophthalmic | Glaucoma |
| Bimatoprost | PGF₂α | Ophthalmic | Glaucoma, eyelash hypotrichosis |
| Travoprost | PGF₂α | Ophthalmic | Glaucoma |
| Tafluprost | PGF₂α | Ophthalmic | Glaucoma (preservative-free) |
| Omidenepag | EP₂ agonist | Ophthalmic | Glaucoma |
| Carboprost | PGF₂α | IM | PPH, abortion |
| Epoprostenol | PGI₂ | IV | PAH |
| Iloprost | PGI₂ | Inhaled/IV | PAH, Raynaud's |
| Treprostinil | PGI₂ | SC/IV/Inhaled/Oral | PAH |
| Selexipag | IP receptor | Oral | PAH |
Sources: Katzung's Basic & Clinical Pharmacology 16e, Goodman & Gilman's Pharmacological Basis of Therapeutics, Lippincott Illustrated Reviews Pharmacology, Kanski's Clinical Ophthalmology 10e
Gemeprost
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gemeprost prostaglandin analogue clinical uses pharmacology
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Gemeprost
Class: Synthetic PGE₁ analogue (16,16-dimethyl-trans-Δ²-PGE₁ methyl ester)
Brand name: Cervagem
Route: Vaginal pessary
Mechanism of Action
Gemeprost acts on prostaglandin E receptors in the uterus and cervix, causing:
- Cervical softening and dilatation — relaxes the cervical collagen matrix
- Uterine contractions — stimulates myometrial smooth muscle
Clinical Uses
| Use | Details |
|---|---|
| Cervical ripening / dilatation | Pre-operative cervical softening before first-trimester vacuum aspiration or other intrauterine procedures |
| Second-trimester abortion | The only licensed prostaglandin analogue for second-trimester termination of pregnancy in the UK; vaginal pessary used alone or with mifepristone |
| Medical abortion (combined regimen) | Used intravaginally 48 hours after mifepristone (200–600 mg); combined regimen achieves >90% success for pregnancies ≤49 days; mifepristone pretreatment markedly increases gemeprost's abortifacient efficacy |
Comparison with Misoprostol
Gemeprost and misoprostol are both PGE₁ analogues used for abortion, but:
- Gemeprost requires refrigeration and is more expensive
- Misoprostol is cheaper, stable at room temperature, and orally active — largely replacing gemeprost in many countries
- Gemeprost is not FDA-approved in the USA; misoprostol is the preferred PGE₁ analogue in that setting
Adverse Effects
- Vaginal bleeding (lasts 8–17 days; severe requiring transfusion in ~0.1%)
- Abdominal pain and uterine cramps
- Nausea, vomiting, diarrhea
- ⚠️ Myocardial ischemia and infarction have been reported (also seen with sulprostone) — serious cardiovascular risk
Sources: Goodman & Gilman's Pharmacological Basis of Therapeutics; Berek & Novak's Gynecology; DrugBank — Gemeprost
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