We appreciate the comments of Fort and Hoffmann and Gabriel. Fort and Hoffmann state that misoprostol is indicated for nonsteroidal anti-inflammatory drug (NSAID) users with risk factors such as advanced age, history of peptic ulcer disease, and comorbid conditions, but its promotion and perceived indications are not as conservative. For instance, in the current issue of Drug Information for Physicians in Switzerland,1 no mention of these risk factors is made.The combination of misoprostol and a NSAID in fixed doses may increase compliance, but there are disadvantages as well. In patients with rheumatic diseases, the clinically effective dose and the time of administration for NSAIDs vary. With the use of fixed combinations, the effective and minimally necessary dose cannot be adjusted with the same caution as with single drugs. Our review was not about the rational use of misoprostol; it was about the evidence with regard to
Stucki G, Johannesson M, Liang MH. Has the Cost-effectiveness of Misoprostol Been Underestimated?-Reply. Arch Intern Med. 1995;155(13):1451–1452. doi:10.1001/archinte.1995.00430130142018
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