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dinoprostone (prostaglandin E2, PGE2)
Pharmacologic class: Oxytocic, prostaglandin
Therapeutic class: Abortifacient, cervical ripening agent
Pregnancy risk category C
FDA Box 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.
Initiates strong contractions of uterine smooth muscle by stimulating myometrium and promoting cervical softening, effacement, and dilation
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).
➣ Nonmetastatic gestational trophoblastic disease (benign hydatidiform mole)
Adults: Insert one 20-mg suppository high into vagina; may repeat at 3- to 5-hour intervals for up to 2 days if necessary.
• Hypersensitivity to prostaglandins or additives in gel or suppository
• When vaginal delivery isn't indicated, such as with vasa previa or active genital herpes infection (Prepidil)
• Acute pelvic inflammatory disease
• Ruptured membranes, placenta previa, marked cephalopelvic disproportion, or unexplained vaginal bleeding during pregnancy
• When oxytocics are contraindicated or when prolonged contraction of uterus may be detrimental to fetal safety or uterine integrity, such as with previous cesarean section or major uterine surgery
• Concurrent use of I.V. oxytocics (Cervidil)
• Clinical suspicion or definite evidence of fetal distress when delivery isn't imminent (Cervidil, Prepidil)
• History of difficult labor or traumatic delivery, hyperactive or hypertonic uterine patterns (Prepidil)
• Obstetric emergencies in which benefit-to-risk ratio for either fetus or mother favors surgical intervention (Prepidil)
• Active cardiac, pulmonary, renal, or hepatic disease (Prostin E2 Vaginal Suppository)
• Multipara with six or more previous term pregnancies (Cervidil)
• Grand multipara with six or more previous term pregnancies with non-vertex presentation (Prepidil)
Use cautiously in:
• history of pulmonary, cardiac, renal, or hepatic disease; asthma; jaundice, anemia; cervicitis; infected endocervical lesions; acute vaginitis; compromised (scarred) uterus; hypertension; hypotension; adrenal disorders; diabetes mellitus; epilepsy; glaucoma
• women age 30 or older, those with complications during pregnancy, and those with gestational age of more than 40 weeks are at increased risk of post-partum disseminated intravascular coagulation
• concurrent use of other oxytocics (not recommended).
• 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.
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
Drug-drug. Other oxytocics: increased oxytocic effects
☞ 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.
• 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.