dinoprostone

dinoprostone /di·no·prost·one/ (di″no-pros´tōn) name given to prostaglandin E when used pharmaceutically; used as an oxytocic for induction of abortion or labor, to aid ripening of the cervix, and in the treatment of missed abortion or hydatidiform mole.

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dinoprostone [di″no-prōst´ōn]

name given to prostaglandin E₂ when used pharmaceutically; used as an oxytocic for induction of abortion or of labor, to evacuate the uterus in the management of missed abortion, to aid ripening of the cervix prior to the induction of labor, and in the treatment of hydatidiform mole; administered intravaginally or intracervically.

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dinoprostone (prostaglandin E2, PGE2) Warning - Hazardous drug!

Cervidil Vaginal Insert, Prepidil Endocervical Gel, Propress (UK), Prostin E2 Vaginal Suppository

Pharmacologic class: Oxytocic, prostaglandin

Therapeutic class: Abortifacient, cervical ripening agent

Pregnancy risk category C

FDA Boxed Warning

• Dinoprostone vaginal suppository should be given only by trained personnel who adhere strictly to recommended dosages, in hospital that can provide immediate intensive care and acute surgical facilities.

Action

Initiates strong contractions of uterine smooth muscle by stimulating myometrium and promoting cervical softening, effacement, and dilation

Availability

Endocervical gel: 0.5 mg in 3-g gel vehicle in prefilled syringe with catheter

Vaginal insert: 10 mg

Vaginal suppositories: 20 mg

⊘Indications and dosages

➣ Cervical ripening

Adults: 0.5 mg endocervical gel vaginally; if response is poor, may repeat in 6 hours (not to exceed 1.5 mg in 24 hours). Or one 10-mg vaginal insert.

➣ To induce abortion

Adults: One 20-mg vaginal suppository; repeat q 3 to 5 hours (not to exceed total dosage of 240 mg or duration of 48 hours).

Off-label uses

• Drug-induced GI bleeding

Contraindications

• Hypersensitivity to prostaglandins or additives in gel or suppository
• Active genital herpes infection
• Acute pelvic inflammatory disease
• Ruptured membranes, placenta previa, or unexplained vaginal bleeding during pregnancy

Precautions

Use cautiously in:
• pulmonary, cardiac, renal, or hepatic disease; asthma; hypotension; adrenal disorders; diabetes mellitus; epilepsy; glaucoma
• multiparity.

Administration

• Keep patient supine for 15 to 30 minutes after gel administration and for 10 minutes after administering suppository to prevent drug expulsion.
• Store suppositories in freezer; bring to room temperature before using.

Route	Onset	Peak	Duration
Vaginal (gel)	Rapid	30-45 min	Unknown
Vaginal (insert)	Rapid	Unknown	12 hr
Vaginal (suppository)	10 min	Unknown	2-3 hr

Adverse reactions

CNS: headache, drowsiness, syncope

CV: hypotension, hypertension

GI: nausea, vomiting, diarrhea

GU: urinary tract infection, vaginal or uterine pain, uterine contractile abnormalities, warm vaginal sensation, uterine hypertonicity, uterine rupture

Musculoskeletal: back pain

Respiratory: cough, dyspnea, wheezing

Other: allergic reactions including chills, fever, and anaphylaxis

Interactions

Drug-drug. Other oxytocics: increased oxytocic effects

Patient monitoring

☞ Monitor uterine contractions and observe for excessive vaginal bleeding and cramping. Record sanitary pad count.
• Monitor vital signs and assess for drug-induced fever. Report significant blood pressure and pulse changes.
• Assess for wheezing, chest pain, and dyspnea.
• Evaluate for GI upset. To minimize, give antiemetic before dinoprostone therapy.

Patient teaching

• Advise patient to stay in supine position, as prescribed, after administration.
• Instruct patient to report fever, bleeding, or abdominal cramps.
• Tell patient to avoid douches, tampons, tub baths, and sexual intercourse for at least 2 weeks after receiving drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.