No

Abortifacient; Prostaglandin

Gel: Promote cervical ripening prior to labor induction; usage for gel include any patient undergoing induction of labor with an unripe cervix, most commonly for pre-eclampsia, eclampsia, postdates, diabetes, intrauterine growth retardation, and chronic hypertension

Suppositories: Terminate pregnancy from 12th through 28th week of gestation; evacuate uterus in cases of missed abortion or intrauterine fetal death; manage benign hydatidiform mole

Vaginal insert: Initiation and/or cervical ripening in patients at or near term in whom there is a medical or obstetrical indication for the induction of labor

C

Vaginal insert: Known hypersensitivity to prostaglandins; fetal distress (suspicion or clinical evidence unless delivery is imminent); unexplained vaginal bleeding during this pregnancy; strong suspicion of marked cephalopelvic disproportion; patients in whom oxytoxic drugs are contraindicated or when prolonged contraction of the uterus may be detrimental to fetal safety or uterine integrity (including previous cesarean section or major uterine surgery); greater than 6 previous term pregnancies; patients already receiving oxytoxic drugs

Gel: Hypersensitivity to prostaglandins or any constituents of the cervical gel, history of asthma, contracted pelvis, malpresentation of the fetus

Gel: The following are "relative" contraindications and should only be considered by the physician under these circumstances: Patients in whom vaginal delivery is not indicated (ie, herpes genitalia with a lesion at the time of delivery), prior uterine surgery, breech presentation, multiple gestation, polyhydramnios, premature rupture of membranes

Suppository: Known hypersensitivity to dinoprostone, acute pelvic inflammatory disease, uterine fibroids, cervical stenosis

Dinoprostone should be used only by medically trained personnel in a hospital; caution in patients with cervicitis, infected endocervical lesions, acute vaginitis, compromised (scarred) uterus or history of asthma, hypertension or hypotension, epilepsy, diabetes mellitus, anemia, jaundice, or cardiovascular, renal, or hepatic disease. Oxytocin should not be used simultaneously with Prepidil® (>6 hours of the last dose of Prepidil®).

>10%:

Central nervous system: Headache

Gastrointestinal: Vomiting, diarrhea, nausea

1% to 10%:

Cardiovascular: Bradycardia

Central nervous system: Fever

Neuromuscular & skeletal: Back pain

<1%: Hypotension, cardiac arrhythmias, syncope, flushing, tightness of the chest, vasomotor and vasovagal reactions, dizziness, chills, pain, hot flashes, wheezing, dyspnea, coughing, bronchospasm, shivering

Symptoms of overdose include vomiting, bronchospasm, hypotension, chest pain, abdominal cramps, uterine contractions

Treatment is symptomatic

Increased effect of oxytocics

Suppositories must be kept frozen, store in freezer not above -20°F (-4°C); bring to room temperature just prior to use; cervical gel should be stored under refrigeration 2°C to 8°C (36°F to 46°F)

A synthetic prostaglandin E₂ abortifacient that stimulates uterine contractions similar to those seen during natural labor

Onset of effect (uterine contractions): Within 10 minutes

Duration: Up to 2-3 hours

Absorption: Vaginal: Slow following administration

Metabolism: In many tissues including the kidney, lungs, and spleen

Elimination: Primarily in urine with small amounts excreted in feces

Abortifacient: Insert 1 suppository high in vagina, repeat at 3- to 5-hour intervals until abortion occurs up to 240 mg (maximum dose); continued administration for longer than 2 days is not advisable

Cervical ripening:

Gel:

Intracervical: 0.25-1 mg

Intravaginal: 2.5 mg

Suppositories: Intracervical: 2-3 mg

Vaginal Insert (Cervidil®): 10 mg (to be removed at the onset of active labor or after 12 hours)

Vaginal insert: One vaginal insert is placed transversely in the posterior fornix of the vaginal immediately after removal from its foil package. Patients should remain in the recumbent position for 2 hours after insertion, but thereafter may be ambulatory

May cause dizziness

None reported

No information available to require special precautions

No effects or complications reported

Nausea and vomiting, cramping or uterine pain, or fever may occur. Report acute pain, respiratory difficulty, or skin rash. Closely monitor for vaginal discharge for several days. Report vaginal bleeding, itching, malodorous or bloody discharge, or severe cramping.

Bring suppository to room temperature just prior to use; patient should remain recumbent for 2 hours following insertion; commercially available suppositories should not be used for extemporaneous preparation of any other dosage form of drug

Insert, vaginal (Cervidil®): 10 mg

Gel, endocervical: 0.5 mg in 3 g syringes [each package contains a 10-mm and 20-mm shielded catheter]

Suppository, vaginal: 20 mg

Novakov A, Segedi D, Milasinovic L, et al, "Induction of Labor by Endocervical Application of Prostaglandins and Intravenous Infusion of Oxytocin in Post-term Pregnancy," Med Pregl, 1998, 51(9-10):419-26.