Nifedipine (3,5-dimethyl 2,6-dimethyl-4-(2-nitrophenyl)-1,4-dihydropyridine-3,5-dicarboxylate [citation needed]), sold under the brand name Adalat and Procardia, among others, is a calcium channel blocker medication used to manage angina, high blood pressure, Raynaud's phenomenon, and premature labor. Indications >Persistent uterine hypercontractility with fetal compromise >Tocolysis before attempting external cephalic version for breech presentation < 37+6 weeks gestation >These are not TGA approved indications Contraindications >Sympathomimetic amine hypersensitivity Women with singleton term breech pregnancies were randomized for nifedipine (group A) and terbutaline (group B) tocolysis for ECV in an outpatient setting. A different tocolytic agent may be considered. [17] Magnesium sulfate has an unresolved mechanism of action regarding uterine contractions, but it has been described to inhibit the entry of calcium into the uterine smooth muscle. All contraindications for the use of any of the two drugs (indomethacin or nifedipine). A common approach is to administer an initial loading dose of 20 mg orally, followed by a second dose of 20 mg orally in 90 minutes. Tocolysis was prescribed, at the discretion of the treating clinical staff, in selected pregnancies with significant uterine contractions after admission of . Nifedipine is used to treat hypertension (high blood pressure) and angina (chest pain). Resp distress syndrome of the newborn. Other drugs that can be used as a tocolytic include: beta-mimetics (for example, terbutaline) Read rest of the answer. Contraindications for Nifedipine Use Patient was educated on contraindications for using Nifedipine as follows: Avoid using Nifedipine along with any other medications that can cause slowdown of heart rate, such as, Beta-blockers. 4. [18] Nifedipine may also be used for purposes not listed in this medication guide. Tocolytic drug. Regimen: Oral (not sublingual) loading dose of 10 mg (immediate Nifedipine is 3,5-pyridinedicarboxylic acid, 1,4-dihydro-2,6-dimethyl-4-(2-nitrophenyl)-, dimethyl ester, C 17 H 18 N 2 O 6, and has the structural formula: If contractions continue 60 minutes after the initial dose, nifedipine therapy should be considered a failure. Volume 102 , Issue 3 September 2008 Nifedipine is a dihydropyridine calcium-channel blocker and is contraindicated in patients with known serious dihydropyridine hypersensitivity. 1B) Back to guidelines homepage. It should not be used concomitantly with magnesium sulfate. physiology of surfactant. Tocolytic medications for preterm labor aren't used before 24 weeks of pregnancy. Medical contraindications to the tocolytic drug. glucocorts and RSD. General contraindications to tocolytic therapy include severe preeclampsia, placental abruption, intrauterine infection, advanced cervical dilation, and evidence of fetal compromise or placental insufficiency. Both calcium channel blockers (Nifedipine) and Atosiban have similar efficacy in delaying pregnancy for up to 7 days but nifedipine may be more likely to delay delivery for 48 hours. Preterm labor leading to preterm birth is a significant cause of morbidity and mortality in infants. 2. Many doctors stop giving . (clinicaltrials.gov) Preferred: terbutaline, indomethacin, nifedipine; other: atosiban, nitroglycerin, magnesium sulfate Indications for tocolysis Arrest labor & prolong pregnancy for steoird administration and/or transport tocolytics. (5) i. Methods: A prospective, randomized, comparative trial was carried out in a tertiary hospital. only work for abo…. Recent research has focused on tocolytic drugs with similar efficacy to beta-mimetics but with less side effects. Contra-indications With systemic use Multiple pregnancy. Serious complications such as pulmonary edema and maternal deaths, though rare, have been reported. Maintenance treatment with tocolytic drugs or repeat tocolytic treatment does not appear to improve perinatal outcome and therefore is not recommended. Tocolysis for Uterine Hypercontractility Terbutaline tocolysis regimen . not enough surfactant with out which the lungs will collapse. Using them together can result in extreme slowdown of heart rate and can present an emergency. Obstet Gynecol. BACKGROUND AND PURPOSE: Hawkins et al. Side effects: Flushing, tachycardia, hypotension and headache. There are no clear first-line tocolytic agents to manage preterm labor (Table 56.1). Exclusion criteria included gestational age > or = 35 weeks, delivery within 24 hours of admission, prior treatment for bleeding or preterm labor, and contraindications to tocolytic use. SUMMARY: Preterm birth (delivery between 20w0d to 36w6d) is the leading cause of neonatal mortality, affecting 12% of all deliveries, with 50% preceded by preterm labor. Tocolytic drugs and recommended dose regimes Nifedipine is recommended as the first choice in tocolysis. Nifedipine can be used as an alternative for tocolysis in ECV when there are maternal contraindications to beta-sympathomimetics. Nifedipine is 3,5-pyridinedicarboxylic acid, 1,4-dihydro-2,6-. question. Tocolytic Rx: Summation of Evidence •First line: Nifedipine 10-20 mg q 20 min x 3 doses then 10-20 mg q 3-4 hours (max: 120 mg/day) •Second line: Indocin 25-50 mg q 6 hours (max: 200 mg/day) 32-34 weeks 1. Nifedipine is one of the first-line therapies currently recommended by ACOG for treatment of preterm labor. these guys are used to stop premature labor. This study aims to compare the effects of nifedipine, Magnesium sulfate and ritodrine as tocolytic drugs in patients presented with threatened preterm labor. Nifedipine, a calcium channel comparing the rate of cesarean delivery between the 2 blocker, has been used as a tocolytic agent in the treatment of groups, the terbutaline group had fewer cesarean deliveries preterm labor and has been shown to be equally effective as (5 women, 26.3%) compared with the nifedipine group (6 beta-agonists, with . Tocolytic They are given when delivery would result in premature birth . Tocolytics are agents that have been widely used in the treatment of premature labor. The incidence varies from 0.5% to 5%. 1B) Published: 22/02/2011 This guideline has been archived. Preterm Labour, Tocolytic Drugs (Green-top Guideline No. The most commonly used drugs are terbutaline, albuterol, ritodrine, and other β-mimetic drugs. Initially 30 mg daily, increased if necessary up to 90 mg daily. Some authors have proposed that nifedipine, a calcium channel blocker, could be used as a first-line tocolytic agent.18, 19, 20 The most recent substantial update of the Cochrane review regarding calcium channel blockers for acute tocolysis in preterm labor included 12 randomized controlled trials (10 using nifedipine) involving 1029 patients . (Simhan et al, 2019, p. 696) Contraindications: -maternal hypotension -maternal preload-dependent cardiac Consequently, is oxytocin a Tocolytic? The suppression of contractions is often only partial and tocolytics can only be relied on to delay birth for several days. -Some extended-release tablet manufacturers recommend a maximum dose of 90 mg/day. The NICE guideline recommends nifedipine as the first choice, or oxytocin receptor antagonists if nifedipine is contraindicated. METHODS: A prospective, randomized, comparative trial was carried out in a tertiary hospital. All contraindications for tocolysis (fetal distress, abruptio placenta). 1. Contraindications of nifedipine therapy include allergy to nifedipine, hypotension, hepatic dysfunction, concurrent use of beta-mimetics or magnesium sulfate (MgSO4), transdermal nitrates, or other antihypertensive medication. There are many reports of these agents inducing pulmonary edema in otherwise healthy women. Nifedipine can be used as an alternative for tocolysis in ECV when there are maternal contraindications to beta-sympathomimetics. • Tocolytic agents are effective in reducing the likelihood of delivery within 48 hours to permit in-utero transfer to a tertiary perinatal center & to allow the administration of corticosteroids to enhance pulmonary maturity. See NICE's information on prescribing medicines. Contraindications for tocolytic drug therapy: answer. The tocolytic properties of nifedipine have been evaluated in several studies. Maternal: severe preeclampsia, active vaginal bleeding, intrauterine infection, cardiac disease, and medical or OB condition that contraindicates the continuation of pregnancy Fetal: estimated gestational age >37 weeks . If contractions persist, 20 mg can be given orally every 6 hours for 48 hours, with a maximum dose of 180 mg/day. Two Dose Regimens of Nifedipine for the - ClinicalTrials.gov Two Dose Regimens of Nifedipine for the is the most widely used tocolytic at the American University of nifedipine has emerged as an . Nifedipine is widely used as a tocolytic, since it is well tolerated and inexpensive, nonetheless it should be considered that it can cause severe hypotension. Nifedipine 7. 20mg x1, additional 20mg dose in 90min if ctx persist, followed by 20mg q3-8 hrs PRN ctx; Hypertension, Angina, Pulmonary hypertension. Common Trade Names: Procardia, Nifediac, Nifedical, Adalat, Afeditab; Adult Dosing Preterm labor/Tocolysis. Specific contraindications to tocolytic agents Relative contraindications also include if there´s already advanced cervical dilation over 5 cm, maternal heart disease, hyperthyroidism, uncontrolled diabetes, mild abruptio placentae, stable placenta previa, and intrauterine growth restriction. Nifedipine is classified as FDA pregnancy category C. According to the manufacturer, the drug should be used only when its benefits clearly outweigh the risks to the fetus. 30-60mg ER PO daily; Pediatric Dosing Hypertensive emergency. -Maintenance dose: 30 to 90 mg orally once a day. tocolytics general facts. Cardiac disease. Calcium Channel Blockers (Nifedipine) Nifedipine directly inhibits the influx of calcium into the cell membrane and the release of calcium from the sarcoplasmic reticulum. Indomethacin is contraindicated in the presence of aspirin-induced asthma, coagulopathy, or significant liver disease. Preterm birth accounts for a significant burden of poor neonatal outcomes, including 70% of neonatal deaths, 36% […] There are no real contraindications, but preload dependent cardiac lesions will likely worsen with nitroglycerin. General. Recent literature has suggested that nifedipine is the best tocolytic agent because of better neonatal outcomes and fewer side effects. Which tocolytic is the best? Hypotension, preload-dependent cardiac disease. hydrocortisone will intitiate surfactant synthesis in weeks 30…. Nifedipine is 3,5-pyridinedicarboxylic acid, 1,4-dihydro-2,6-. Usual Adult Dose for Hypertension. 22 Nifedipine was the second most commonly used tocolytic for acute preterm labor, after magnesium sulfate, 22 although . Comments: -Doses may be increased gradually every 7 to 14 days. The most common adverse effects include flushing, peripheral edema, dizziness, headache. .25-.5mg/kg PO q4-6h; Max: 10mg/dose . Tocolysis is generally avoided in the presence of fetal distress, chorioamnionitis, or maternal instability.41 Contraindications are listed in Table 4.21 The continuous or long-term use of . The therapy also buys time for the administration of betamethasone , a glucocorticoid drug which greatly accelerates fetal lung maturity, but takes one to two days to work. Contraindications for specific tocolytic agents Beta-mimetic agents Maternal cardiac rhythm disturbance or other cardiac disease Poorly controlled diabetes, thyrotoxicosis or hypertension Magnesium. The most common tocolytic agents used for the treatment of preterm labor are magnesium sulfate (MgSO4), indomethacin, and nifedipine. World Heritage Encyclopedia, the aggregation of the largest online encyclopedias available, and the most definitive collection ever assembled. (clinicaltrials.gov)In spite of its large use in obstetrics as a tocolytic agent, nifedipine is prescribed off-label. These are primarily the result of the vasodilatory properties of nifedipine. 1. Note: Indomethacin may be used as a second-line agent in cases where nifedipine is not effective, or as a first-line agent if certain contraindications to nifedipine exist. It is not currently licenced for use as a tocolytic in the UK. Find out when nifedipine shouldn't be used and who may need extra monitoring or a lower dose Medically reviewed by dr roger henderson Helen Marshall, BPharm, MRPharmS 31/03/2016 Nifedipine inhibits lower esophageal (LES) muscle contraction by blocking cellular calcium uptake and lowers the LES resting pressure by 30% to 60%; side effects (e.g., hypotension, headache, pedal edema) and tolerance may limit its utility. Clinical circumstances and preferences should . In November 2015, this was an off-label use of nifedipine. Extended-release tablets: -Initial dose: 30 to 60 mg orally once a day. Nifedipine can be used as an alternative for tocolysis in ECV when there are maternal contraindications to beta-sympathomimetics. Nifedipine has been used in the majority of studies. Tocolysis. Are there any contraindications to Tocolysis? Haas DM et al., .Tocolytic Therapy: A Meta-Analysis and Decision Analysis Obstetrics & Gynecology .2009 Mar 113(3):585-594 PMID: 19300321 Lyell DJ, et al., Magnesium sulfate compared with nifedipine for acute tocolysis of preterm labor: a randomized controlled trial. Although no tocolytic agent has been shown to be definitively superior(1), nifedipine has a favorable safety and side effect profile compared to the other first-line tocolytic agents (which include beta-adrenergic receptor agonists, calcium channel blockers, and NSAIDS). When used as a tocolytic: 10 to 20 mg initial dose repeated every 3 to 6 hours until contractions are rare, followed by long-acting formulations of 30 or 60 mg every 8 to 12 hours for 48 hours while antenatal steroids are being administered. In a survey to which 46% of Society for Maternal-Fetal Medicine members responded, 29% reported that they would recommend maintenance tocolysis, of whom 79% reported that nifedipine is their first-line maintenance tocolytic. In certain situations, your doctor may use it when you are at 23 weeks of pregnancy. Nifedipine capsules, USP (nifedipine) is an antianginal drug belonging to a class of pharmacological agents, the calcium channel blockers. (Obstetrics & Gynecology, 2021) evaluated the acute tocolytic effect of nifedipine, and whether it decreases the rate of preterm birth METHODS: Randomized, double-blind, placebo-controlled trial Participants Women with a singleton pregnancy between 28w0d and 33w6d Admitted with uterine activity, intact membranes, and cervical dilatation from 2 to 4 cm […] There are a number of contraindications—or conditions that make a treatment unsafe for a person—for the use of tocolytics. Flushing, headache, dizziness, nausea, transient hypotension. Usual obstetrical contraindications of tocolytic treatments (infection, genital haemorrhage, fetal distress and certain maternal conditions) are often determined on a case by case basis, rather. Nifedipine 2. Indomethacin 2. Please see the NICE guideline [NG25] Preterm labour and birth. A 2002 meta-analysis reviewed 12 randomized-controlled studies involving 1029 women and found that nifedipine is more effective than ritodrine and is clearly safer. 1.8.2 Consider nifedipine for tocolysis for women between 24 +0 and 25 +6 weeks of pregnancy who have intact membranes and are in suspected preterm labour. Tocolysis: lt;p|>|Tocolytics| (also called |anti-contraction medications| or |labor repressants|) are medica. A 18-year-old woman presented with risk of preterm delivery at 24 weeks of gestation; she was given a loading dose of 10 mg of oral nifedipine every 15 minutes, four times. Nifedipine Single agents only Discontinue 48h after ACS administered Tocolysis . Then, is Procardia a Tocolytic? It works by relaxing the muscles of your heart and blood vessels. However, large variability in nifedipine pharmacokinetics and tocolytic effects prevents it from being effective in all cases of preterm labor. Citing Literature Volume 102 , Issue 3 [Adapted from NICE's full guideline on preterm labour and birth] Nifedipine is in a group of drugs called calcium channel blockers. 2007 Jul;110(1):61-7.PMID: 17601897 The contractile processes of cardiac muscle and vascular smooth muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. 31. PROCARDIA ® (nifedipine) is an antianginal drug belonging to a class of pharmacological agents, the calcium channel blockers. Depending on the tocolytic used the mother or fetus may require monitoring, as for instance blood pressure monitoring when nifedipine is used as it reduces blood pressure. What are Tocolytic medications? First line: Nifedipine Unless contra-indicated, the first line tocolytic to be used shall be Nifedipine Immediate Release (IR).4 Other tocolytics which may be used in the event of the failure of Nifedipine tocolysis Contraindications Contraindications to any suppression of labour including antepartum haemorrhage, It should not be used concomitantly with magnesium sulfate: Flushing, headache, dizziness, nausea, transient hypotension. Nifedipine (Procardia, Adalat) CCBs. These include: 7 A gestational age above 34 weeks Intrauterine fetal demise Lethal fetal anomaly Nonreassuring fetal status Severe preeclampsia or eclampsia Maternal bleeding with hemodynamic instability Chorioamnionitis Tocolysis may enable pregnancy prolongation, at least over the short term, and thus provide time for further in utero maturation and interventions that may improve infant outcome. Tocolytics are drugs that are used to delay your delivery for a short time (up to 48 hours) if you begin labor too early in your pregnancy. We conducted a number of studies to evaluate factors contributing to variability in nifedipine pharmacokinetics that could ultimately be used to . Nifedipine treatment dose as a tocolytic agent: Immediate-release: An initial dose of 20 to 30 mg as a loading dose, followed by 10 to 20 mg every 3 to 8 hours for up to 48 hours. Site an intravenous cannula prior to commencement of treatment The BP should be checked prior to administration of each tablet and if the Consequently, nifedipine has emerged as an effective and rather safe alternative tocolytic agent for the management of preterm labor after several studies have shown that the use of nifedipine in comparison with other tocolytics is associated with a more frequent successful prolongation of pregnancy, resulting in significantly fewer admissions . This topic will discuss the use of tocolytic drugs for inhibition . Indomethacin dose: [2015] Tocolytic Agents. 6. Nifedipine is used for the treatment of chronic anal fissure, but is not licensed for this indication. Terbutaline 24-32 weeks: 1. Because each individual trial has been small, this is the best evidence to date that nifedipine can be used for tocolysis. Preterm labor includes regular uterine contractions with cervical dilation, effacement or both. Administration of calcium channel blockers should be used with care in . Drugs used to stop or delay the progress of labour. Nifedipine is a powerful tocolytic, and may occasionally mask early chorioamnionitis presenting as preterm labour. Background: Preterm labor is a serious cause of neonatal morbidity and mortality. Administration of calcium channel blockers should be used with care in patients with renal disease and hypotension. ministration of tocolytic substances such as calcium chan- nel blockers (nifedipine), nonsteroidal anti-inflammatory drugs (indomethacin) and oxytocin inhibitors (atosiban). Nifedipine (Procardia, Adalat) Ca 2+ channel blocker: Is one of the most commonly used tocolytic agents. It is one of the treatments of choice for Prinzmetal angina. Beta-mimetics have many contraindications, and side-effects are frequent. Choice of first-line therapy 24 to 32 weeks: indomethacin 32 to 34 weeks: nifedipine Choice of second-line therapy 24 to 32 weeks: nifedipine 32 to 34 weeks: terbutaline For those who received nifedipine as a first-line agent at 24 to 32 weeks, we switch to . Tolerance is better with the extended-release preparations than the immediate-release preparations of nifedipine. Specific tocolytic agents should not be used whenever known allergies exist. The American College of Obstetricians and Gynecologists as well as the Royal College of Obstetricians and Gynaecologists recommend nifedipine as a first-line tocolytic in case of acute threatened preterm labour. The oxytocin receptor antagonist atosiban and the calcium antagonist nifedipine appear to be effective in postponing delivery. indomethacin magnesium sulfate nifedipine terbutaline. -Maximum dose: Up to 120 mg/day. Objective: To study the efficacy of nifedipine compared with terbutaline as a tocolytic agent in external cephalic version (ECV). Preterm Labour, Tocolytic Drugs (Green-top Guideline No. Nifedipine Mechanism : Nifedipine is a calcium channel blocker and inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle. The efficacy, side effects, and complications were analyzed and compared. The choice of first-line tocolytic agent is a topic of worldwide debate. Type: Calcium Channel Blocker, Dihydropyridine Dosage Forms: 10,20; 30,60,90 ER PO; Common Trade Names: Procardia, Nifediac, Nifedical, Adalat, Afeditab; Adult Dosing Preterm labor/Tocolysis. Nifedipine: An optimal nifedipine dosing regimen for treatment of preterm labor has not been defined. 5. 2. Patients receiving Nifedipine therapy should be observed in hospital for a minimum of 72 hours, and should be followed closely following discharge. 1. In the present study, 20 mg of nifedipine was used, as recommended for preterm labor tocolysis [18] . Nifedipine, a calcium channel blocker, has been used as a tocolytic agent in the treatment of preterm labor and has been shown to be equally effective as beta-agonists, with fewer side effects . 20mg x1, additional 20mg dose in 90min if ctx persist, followed by 20mg q3-8 hrs PRN ctx Patients and Methods: The current study was randomized controlled trial conducted in Sohag Teaching Hospital between November 2015 and September 2016. Women with singleton term breech pregnancies were randomized for nifedipine (group A) and terbutaline (group B) tocolysis for ECV in an outpatient setting. Is one of the most commonly used tocolytic agents. • Preterm delivery is a major cause of perinatal morbidity and mortality. Nifedipine Dosage Guide with Precautions - Drugs.com Detailed Nifedipine dosage information for adults and children. Unlicensed use With systemic use Not licensed for use in postponing premature labour. Tocolytic-Induced Pulmonary Edema. Volume 102 , Issue 3 September 2008
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