DINOPROSTONE (PGE2, PROSTAGLANDIN E2)

DINOPROSTONE (PGE2, PROSTAGLANDIN E2)
(dye-noe-prost'one)
Cervidil, Prostin E2 , Prepidil
Classifications: oxytocic;
Therapeutic:oxytocic
; prostaglandin
Prototype: Oxytocin
Pregnancy Category: C

Availability

20 mg suppository; Prepidil: 0.5 mg gel; Cervidil: 10 mg vaginal insert

Action

Synthetically prepared member of the prostaglandin E2 series that appears to act directly on myometrium and on gastrointestinal, bronchial, and vascular smooth muscle. Stimulation of gravid uterus in early weeks of gestation is more potent than that of oxytocin.

Therapeutic Effect

Contractions are qualitatively similar to those that occur during term labor. Has high success rate when used as abortifacient before twentieth week and for stimulation of labor in cases of intrauterine fetal death.

Uses

To terminate pregnancy from twelfth week through second trimester as calculated from first day of last regular menstrual period; to evacuate uterine contents in management of missed abortion or intrauterine fetal death up to 28 wk gestational age; to manage benign hydatidiform mole; cervical ripening prior to labor induction.

Contraindications

Acute pelvic inflammatory disease; abnormal fetal position; history of pelvic surgery, uterine fibroids, cervical stenosis, active cardiac, pulmonary, renal, or hepatic disease; pregnancy (category C).

Cautious Use

History of hypertension, hypotension, asthma, epilepsy, anemia, diabetes mellitus; jaundice, history of hepatic, renal, or cardiovascular disease; cervicitis, acute vaginitis, infected endocervical lesion; previous history of caesarean section.

Route & Dosage

Induction of Labor
Adult: Endocervical Place Prepidil 0.5 mg endocervically, may repeat q6h (max: of 1.5 mg);  Place Cervidil insert 10 mg transversely in the posterior fornix of the vagina, remove on onset of active labor or 12 h after insertion

Evacuation of Uterus
Adult: Intravaginal Insert suppository high in vagina, repeat q2–5h until abortion occurs or membranes rupture (max: total dose 240 mg)

Administration

Endocervical & Intravaginal
  • Antiemetic and antidiarrheal medication may be prescribed to be given before dinoprostone to minimize GI side effects.
  • Place vaginal insert in the vagina immediately after removal from the foil package. DO NOT use without retrieval system.
  • Keep patient in supine position for 10 min after administration of suppository to prevent expulsion and enhance absorption.
  • Store suppositories in freezer at temperature not exceeding –20° C (–4° F) unless otherwise specified.

Adverse Effects (≥1%)

CNS: Headache, tremor, tension. CV: Transient hypotension, flushing, cardiac arrhythmias. GI: Nausea, vomiting, diarrhea. Urogenital: Vaginal pain, endometritis, uterine rupture. Respiratory: Dyspnea, cough, hiccups. Body as a Whole: Chills, fever, dehydration, diaphoresis, rash.

Interactions

Drug: oxytocics used with extreme caution.

Pharmacokinetics

Absorption: Slowly absorbed from vagina; Cervidil insert releases approximately 0.3 mg/h. Onset: 10 min. Duration: 2–3 h. Distribution: Widely distributed in body. Metabolism: Rapidly metabolized in lungs, kidneys, spleen, and other tissues. Elimination: Mainly in urine; some in feces.

Nursing Implications

Assessment & Drug Effects

  • Observe patient carefully, after insertion of the drug. Rupture of the membranes is not a contraindication to drug, but be aware that profuse bleeding may result in expulsion of the suppository. Report wheezing, chest pain, dyspnea, and significant changes in BP and pulse to the physician.
  • Monitor uterine contractions and observe for and report excessive vaginal bleeding and cramping pain. Keep pad count. Save all clots and tissues for physician inspection and laboratory analysis.
  • Abortion usually occurs within 30 h. When used in conjunction with oxytocin, time may be shortened to 12–14 h.
  • Monitor vital signs. Fever is a physiologic response of the hypothalamus to use of dinoprostone and occurs within 15–45 min after insertion of suppository. Temperature returns to normal within 2–6 h after discontinuation of medication.

Patient & Family Education

  • Continue taking your temperature (late afternoon) for a few days after discharge. Contact physician with onset of fever, bleeding, abdominal cramps, abnormal or foul-smelling vaginal discharge.
  • Avoid douches, tampons, intercourse, and tub baths for at least 2 wk. Clarify with physician.
  • Note: Dinoprostone may exacerbate joint pain and limitation due to its effect on the inflammatory process.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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