Dinoprostone

Labour Inducer/Inhibitor · Prostaglandin

Indications

For the induction of labour where there are no foetal or maternal contraindications, termination of pregnancy.

Dosage

Vaginal Gel: Adults: By vagina, induction of labour, inserted high into posterior fornix (avoid administration into cervical canal), 1 mg (unfavourable primigravida 2 mg), followed after 6 hr by 1-2 mg if required; max gel 3 mg (unfavourable primigravida 4 mg). Vaginal Pessary/Tab: Adults: By vagina, induction of labour, inserted high into posterior fornix; 3 mg, followed after 6-8 hr by 3 mg if labour is not established; max 6 mg (vaginal tab/pessary). Inj 1 mg: Induction of labour: Adults: By IV: See literature. Inj 10 mg: Termination of pregnancy: Adults: By IV: See literature. Children: Not applicable.

Administration

Continuous IV infusion: Administered either centrally or peripherally. Do not administer bolus and take care not to quickly flush lines that may contain dinoprostone. Reconstitution: Dilute 500 mcg (0.5 mL) of the 1 mg in 1 mL injection solution to 5 mL with 0.9% NaCl to give 100 mcg in 1 mL. Use this 100 mcg in 1 mL solution to make up a 50 mL syringe for infusion.

Adverse Effects

Uterine hypercontractility, hypertonus; altered fetal heart rate; postpartum haemorrhage; post-op infection; vaginal irritation; amniotic fluid embolism; GIT disturbances.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: Ruptured membranes; where presenting part is above the pelvic inlet; previous uterine surgery; cephalopelvic disproportion; abnormal cardiotocography; suspected fetal compromise; malpresentation; unexplained vaginal bleeding; where vaginal delivery not indicated (vasa previa, herpes genitals); intracervical administration; concomitant oxytocics; grand multiparity (5 or more than 5 previous deliveries). Precautions: Cardiovascular, hepatic, renal dysfunction; asthma; epilepsy; glaucoma, raised intraocular pressure; monitor uterine pain, fetal heart rate.

Interactions

Oxytocin.

Advice to Patient

Monitor closely for vaginal discharge for few days. Contact prescriber if there is continuous fever/chills/shivering, itching, bloody discharge, foul-smell, vaginal bleeding or severe abdominal cramps.

Pharmacokinetics

Onset: Vag Supp: Slight uterine contractions begin within 10 mins (first and second trimester pregnancies). Duration: Vag Supp: Contractions continue for 2-3 hrs (first and second trimester pregnancies). Absorption: Absorbed systemically as suppositories. A small amount of drug is absorbed directly by the uterus through the cervix or local lymphatic or vascular channels. Metabolism: Rapidly metabolized in the maternal lungs, kidneys, spleen and other tissues. Half-life elimination: 2.5-5 mins. Time to peak, plasma: Cervical gel: 30-45 mins. Excretion: Urine (principally). Faeces (small amount).

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.