Once contractions cease, nifedipine will be maintained at 80120 mg daily in divided doses up to 36 weeks. Preterm birth, or the birth of an infant of less than 37 weeks gestation, is a leading cause of neonatal mortality in the united states. Magnesium sulfate compared with nifedipine for acute tocolysis of preterm labor a randomized controlled trial deirdre j. Currently there is 1 item for tocolysis on the who eml, section 22. Comparison between nitroglycerin dermal patch and nifedipine for treatment of preterm labor kashanian m, zamen z, sheikhansari n iran university of medical sciences, tehran, iran objective preterm delivery is a significant complication of pregnancy and. The aim of present study was to compare the effect of nitroglycerin dermal patch and nifedipine for taking control of preterm labor tocolysis and to. Clinical evaluation of transdermal nitroglycerine in preterm. Nifedipine is a yellow crystalline substance, practically insoluble in water but soluble in ethanol.
The use of tocolytic therapy in the prevention of preterm. Nifedipine inhibits the transmembrane influx of extracellular calcium ions into myocardial and vascular smooth muscle cells, causing dilatation of the main coronary and systemic arteries and decreasing myocardial contractility. Comparison between nitroglycerin dermal patch and nifedipine for treatment of preterm labor. The primary outcome showed an overall ecv success rate of 48. Immediaterelease doses above 120 mgday are usually not needed. Leave the patch in place for a total of 12 to 14 hours. Nifedipine versus terbutaline for tocolysis in external. Comparative study of transdermal nitroglycerin patch. International journal of science and research ijsr issn online. Delaying premature labor with nifedipine consumer reports. Fortynine subjects receiving transdermal nitroglycerine patch nitroderm patch 10 were included in ntg group. Tocolysis should not be used where there is a contraindication to prolonging pregnancy. Then 20 mg orally every 6 hours for at least 24 hours.
In this group, the order of medicine prescription was. When calcium enters these cells, the muscle contracts and tightens. Importance in threatened preterm labor, maintenance tocolysis with nifedipine, after an initial course of tocolysis and corticosteroids for 48 hours, may improve perinatal outcome. Our experience of nifedipine as a tocolytic agent in preterm. The purpose of this study was to compare the mechanism of action of nitroglycerin and nifedipine by measuring the hemodynamic determinants of myocardial oxygen demand and supply during exercise before and after each drug in patients with exerciseinduced angina. Doctors commonly prescribe ccbs to postpone preterm labor. Nifedipine 10 mg sublingual crushed, then 10 mg in 15 min, followed by 10 mg po q 15 mins prn to a maximum of 40 mg in the first hour. Our experience of nifedipine as a tocolytic agent in. Nitroglycerin transdermal route proper use mayo clinic. Although not definitive, typical duration of tocolysis for acute inhibition. Nifedipinemaintained tocolysis doesnt alter birth outcomes. Maintenance of 120160 mgs of slowrelease nifedipine daily for 48 hours. The ng patch is a more effective method for preterm labor control than nifedipine with regard to minimal side effects. However, failure of maintenance tocolysis may have more to do with the agent and its side effects thus compliance than with tocolytic drug efficacy.
Medline 19651998, embase 19881998, current contents 19971998, and the cochrane database for 1998. Otherwise, tocolysis is rarely successful beyond 24 to 48 hours because current medications do. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020. Nifedipine is a dihydropyridine calcium channel blocking agent.
In nitroglycerine group tocolysis was achieved in 80. Calciumchannel blockers such as nifedipine and oxytocin antagonists such as atosiban may delay delivery by 2 to 7 days, depending on how quickly the medication is administered. Ecv was more successful with terbutaline for any parity when compared to nifedipine, although the difference was. The need of today is to select the best agent out of the broad spectrum of available tocolytic agents, for providing maximum benefit to unfortunate sufferers of prematurity. Otherwise, tocolysis is rarely successful beyond 24 to 48 hours because current medications do not alter the fundamentals of labor activation.
We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. There were no significant differences between transdermal nitroglycerin and placebo for delivery within 48 hours of initiation of treatment or before 28, 34 or 37 weeks gestation, adverse neonatal. The use of tocolytic therapy is at the discretion of the obstetric consultant on call. The time average time needed for tocolysis was also similar 6. Clinical evaluation of transdermal nitroglycerine in. The physicochemical parameters such as appearance, thickness, weight, folding endurance, moisture absorption, percentage elongation and tensile strength were evaluated.
Oct 22, 2015 transdermal nitroglycerin and nifedipine in preterm labor the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Nifedipine concentration in maternal and umbilical cord blood. Oral nifedipine versus nitroglycerine patch for tocolysis in. Nifedipine nifedipine dose, indications, adverse effects. Importance in threatened preterm labor, maintenance tocolysis with nifedipine, after an initial course of tocolysis and corticosteroids for 48 hours, may improve perinatal outcome objective to determine whether maintenance tocolysis with nifedipine will reduce adverse perinatal outcomes due to premature birth design, setting, and participants apostelii assessment of perinatal outcome. In our study comparison between nitroglycerine transdermal patch and oral nifedipine is compared for the tocolysis in preterm labor. Aug 30, 2005 maintenance of 120160 mgs of slowrelease nifedipine daily for 48 hours. Transdermal nitroglycerin and nifedipine in preterm labor the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Maternal tachycardia was more common in nifedipine group compared to ntg group p0. Ritodrine, nifedipine, magnesiumsulphate, prostaglandin. Trials up to 8 weeks have shown reduced angina frequency. Pharmacologic management of preterm labor and prevention. Hemodynamically stable parturients requiring acute tocolysis were treated with intravenous ntg and closely monitored.
Nifedipine is used in the treatment of vasospastic angina and occasionally for chronic unstable angina as an addon to other treatments. There were no differences between groups with regard to the number who received maintenance tocolysis with nifedipine. It is a major contributor to perinatal mortality and morbidity, and affects 67% of births in developed countries1. The investigators found a reduced risk of delivery within 7 days and at. The release of the new who recommendations october, 20151 for preterm birth interventions is welcome. Comparison between nitroglycerin dermal patch and nifedipine for. Two dose regimens of nifedipine for the management of. Oct 26, 2004 other investigations that have focused on the maternal and fetal safety of nifedipine tocolysis have yielded conflicting results. If contractions persisted after 6 hours, a second patch of 10 mg was placed maximum dose of 20 mg24 h. Comparative study of nitroglycerin dermal patch versus nifedipine in. Nifedipine gits gastrointestinal therapeutic system tablet is formulated as a onceaday controlledrelease tablet for oral administration designed to deliver 30, 60, or 90 mg of nifedipine. Other investigations that have focused on the maternal and fetal safety of nifedipine tocolysis have yielded conflicting results.
Definition preterm birth is the birth occurring between 20 and 36 weeks of gestation. Tocolysis with nifedipine or betaadrenergic agonists. This study was done to compare the efficacy in terms of achievement of successful tocolysis and prolongation of pregnancy with the use. More than 40 studies have been published on nifedipine s effectiveness as a tocolytic. Two studies evaluated transdermal nitroglycerin versus placebo n186, 9 evaluated transdermal nitroglycerin versus. Apr 10, 2020 nifedipine is used in the treatment of vasospastic angina and occasionally for chronic unstable angina as an addon to other treatments. Original article isra medical journal volume 9 issue 5. Effect of maintenance tocolysis with nifedipine in threatened. Nitroglycerin ntg and nifedipine nif relieve exertional angina via different modes of action 19. Safety, efficacy, fetal outcome and adverse effects of both the drugs are compared.
After one hour of the first patch application, the uterine contractions were evaluated. Nifedipine tocolysis regime maty072 hutt maternity. One of the most serious complications of pregnancy is preterm labor ptl and. When used in preterm labor, it relaxes the uterine wall muscle, decreasing contractions and prolonging the time to delivery. Formulation and evaluation of nifedipine transdermal patches. Nifedipine 5 mg is an unlicensed medication in new zealand. A prospective, randomized, comparative trial was carried out in a tertiary hospital. For all patients, the first diagnosis suspected was. Transdermal nitroglycerin and nifedipine in preterm labor. Nifedipine and other tocolytic drugs might stop preterm labor for two to seven days, providing time to use corticosteroids to help reduce complications in the fetus associated with preterm. In 1994, lees et al reported that transdermal nitroglycerin patches. There is also an effect of the route of delivery of the tocolytic drug on efficacy and compliance. Maintenance tocolysis with nifedipine beyond 48 hours does not reduce adverse perinatal outcomes, according to a new randomized controlled trial.
Oral nifedipine versus nitroglycerine patch for tocolysis in preterm. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. Doses may be increased gradually every 7 to 14 days. When a woman goes into labor at 37 weeks or earlier, its called preterm labor and the baby is said to be premature. The use of nifedipine for tocolysis is also unlicensed. Preterm labour 2015 hourly observations respiratory rate level of consciousness monitoring monitor deep tendon check reflexes more often when there is oliguria, woman is also taking nifedipine and dose of magnesium sulphate has needed adjustment oxygen saturation continuously with a pulse oximeter. Adverse effects were similar, minimal and negligible in both groups. Dermal nitroglycerin patch in treatment of preterm labour. We also sought unpublished trials and abstracts submitted to major international congresses. Transdermal nitroglycerin versus oral nifedipine for suppression of. Our estimate of 77% placental transfer after nifedipine administration as gits tablets is consistent with earlier studies using capsules or non. Two dose regimens of nifedipine for the management of preterm. Therefore every woman who receives nifedipine tocolysis must be able to make an informed decision regarding its use. Nifedipine concentration in maternal and umbilical cord.
Objective to clarify the relative efficacy of nifedipine and betaagonists for tocolysis data sources the literature was searched in the following databases. Comparison between nitroglycerin dermal patch and nifedipine for treatment of preterm labor kashanian m, zamen z, sheikhansari n iran university of medical sciences, tehran, iran objective preterm delivery is a significant complication of pregnancy and has a major role in neonatal mortality and morbidity. Significantly more patients assigned to receive magnesium sulfate achieved the primary outcome of prevention of preterm delivery for 48 hours with uterine quiescence 87% compared with 72%, p. Her informed consent must be obtained and documented in the clinical notes by obstetric team.
Effect of maintenance tocolysis with nifedipine in. Oral nifedipine versus nitroglycerine patch for tocolysis. Childrenuse and dose must be determined by your doctor. The characteristics and ultrasound findings were similar in the 2 groups of patients. Pdf oral nifedipine versus nitroglycerine patch for tocolysis in. Clinical effect and mechanism of nitroglycerin patch on arresting preterm labor. If you miss a dose of this medicine, apply it as soon as possible. This agent also inhibits the drug efflux pump pglycoprotein which is overexpressed in some multidrug. The uterus is a large muscle made up of thousands of muscle cells.
Compared with betaagonists, nifedipine is associated with improvement in neonatal outcome, although there are no longterm data. Obstetric guideline 11 hypertension in pregnancy 3 1. Because each individual trial has been small, this is the best evidence to date that nifedipine can be used for tocolysis. Oral nifedipine and transdermal nitroglycerine have similar efficacy as tocolytic agent in patients with. Preterm labor and delivery are of the most important complications of pregnancy and have a major role in neonatal mortality and morbidity. Druzin, md, usha chitkara, md, demetra burrs, md, aaron b. Nifedipine should not be used to rapidly drop blood pressure as this may be fatal.
Lyell, md, kristin pullen, md, laura campbell, md, suzanne ching, md, maurice l. The methodology of each trial was then assessed by two authors vt and bc according to a score based on the criteria established by chalmers et al5 and dickersin and berlin6 maximum score 22 points. Listing a study does not mean it has been evaluated by the u. Nitric oxide donors for treating preterm labour duckitt, k 2014. Objective to determine whether maintenance tocolysis with nifedipine will reduce adverse perinatal outcomes due to premature birth. Nifedipine and atosiban have comparable effectiveness in delaying birth for up to 7 days. Clinical severity justified hospitalization in intensive care unit icu each time. Aug 03, 2014 tocolysis should not be used where there is a contraindication to prolonging pregnancy.
Sensitivity or contraindication to tocolysis will be. Transdermal nitroglycerin and nifedipine in preterm labor full. It is not usually utilised from 35 weeks gestation. Some extendedrelease tablet manufacturers recommend a maximum dose of 90 mgday. Tocolysis is not associated with any clear effects on perinatal death or on any measure of neonatal morbidity, such as respiratory distress syndrome or intraventricular haemorrhage. Magnesium sulfate compared with nifedipine for acute. The potential detrimental effect on uterine perfusion and fetal oxygenation suggested by clinicians 15 has been confirmed in some animal experiments 4, 5 while others could not find any change 16, 17. A comparison of tocolysis with nifedipine or ritodrine. For the nifedipine group, nifedipine 5 mg softgel daana pharma co. The efficacy of ntg tocolysis for obstetric emergencies is clinically evaluated. Longterm follow up of children exposed in utero to nifedipine or ritodrine for the management of preterm labour. Transdermal nitroglycerin versus oral nifedipine for. The role of tocolytic therapy in the prevention of preterm labour is still controversial.
Tablet nicardia retard was started 12 hours after last dose of capsule nifedipine. Transdermal nitroglycerin versus oral nifedipine administration for tocolysis. Pdf transdermal nitroglycerin versus oral nifedipine. To compare efficacy of nifedipine and nitroglycerine as tocolytic agent in preterm labor patients 82 p j m h s vol. The immediaterelease nifedipine formulation has been associated with serious side effects see precautions and adverse reactions when used to treat adult patients with hypertension, hypertensive urgency, hypertensive emergency, or coexisting myocardial infarction. With regard to the place of tocolysis, the guidelines present a balanced view of the current uncertainties and indicate a preference for nifedipine as the drug of choice when tocolysis is considered, while emphasising the need for further research. Similarly oral nifedipine maintenance tocolysis has not been shown to be beneficial. Comparative study of transdermal nitroglycerin patch versus. Fiftyone subjects in nifedipine group received oral nifedipine tab depin 10mg.
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