Calcium channel blockers for tocolysis: A review of their role and safety following reports of serious adverse events

Oei, S.G.

doi:10.1016/j.ejogrb.2006.03.001

Cited by 60 publications

(66 citation statements)

References 57 publications

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“…However, there is growing concern regarding the overall neonatal outcome as well as the possible adverse maternal and fetal events (27,28). Nikolov et al (29) published the results of their survey of PTL women treated with oral nifedipine in 2007.…”

Section: Discussionmentioning

confidence: 99%

Transdermal Nitroglycerin Versus Oral Nifedipine for Suppression of Preterm Labor

et al. 2015

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Background: One of the most serious complications of pregnancy is preterm labor (PTL) and delivery. Further, there are different tocolytic agents available to enhance the time of delivery. Objectives: The aim of this study was to compare the effectiveness of transdermal nitroglycerin (glyceryl trinitrate, GTN) and oral nifedipine for managing preterm labor. Patients and Methods:This was a randomized clinical trial involving women who were admitted to our hospital with a diagnosis of PTL. Group one received transdermal GTN, whereas group two received oral nifedipine. All vital signs, fetal heart rate (FHR), contractions, dilation, and effacement, as well as gestation age at the time of delivery, have been monitored and evaluated in both groups of patients. Our main goal was the postponement of delivery so as to secure the most beneficial effect of primary corticosteroid administration for the fetus. Results: Both groups were matched regarding age, gestational age at the time of tocolytic therapy, height of fundus, history of pregnancy, abortion, delivery, and stillbirth, primary body temperature, and systolic and diastolic blood pressure. Those who received GTN had a more prolonged delay of delivery. Also, the GTN group had infants with better one-and five-minute Apgar scores. Although both groups reported minimal side effects, tachycardia and nausea were reported more frequently in GTN patients. Conclusions: Transdermal GTN was shown to be more effective in controlling PTL compared to oral nifedipine in terms of both maternal and neonatal effects.

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Section: Discussionmentioning

confidence: 99%

Transdermal Nitroglycerin Versus Oral Nifedipine for Suppression of Preterm Labor

et al. 2015

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“…Eligible participants were Brazilian women aged 18-40 years, with singleton pregnancies, presenting to the labour ward with all of the following: at least four painful and regular uterine contractions in each 20-min. interval, cervical dilatation of 0-3 cm (for nulliparous) or 1-3 cm (for multiparae), cervical effacement of ≥50%, [24][25][26][27][28][29][30][31][32][33] +6 weeks of gestation and intact membranes who were diagnosed as threatened preterm labour. Gestational age was confirmed by either a documented first-trimester ultrasound scan or a reliable menstrual date confirmed by ultrasonography performed before 20 weeks of gestation [27].…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, hesitations about its use arise from reports of maternal hypotension [25] and concerns about placental perfusion [26]. Finally, some have suggested that as calcium channel blockers are not licensed for tocolysis, under-reporting of adverse events may be occurring [8].…”

mentioning

confidence: 99%

Nifedipine versus Terbutaline, Tocolytic Effectiveness and Maternal and Neonatal Adverse Effects: A Randomized, Controlled Pilot Trial

Padovani

Guyatt

Lopes

2014

Basic Clin Pharma Tox

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Although previous evidence suggests advantages of nifedipine over terbutaline as tocolytic agents, in some jurisdictions, terbutaline is approved for use and nifedipine is not. In women in preterm labour, we compared the impact of terbutaline versus nifedipine on inhibition of uterine contractions, preterm birth, neonatal sepsis, intracranial haemorrhage or necrotizing enterocolitis, death or admission to a neonatal intensive care unit and maternal adverse reactions. We randomized 32 women to nifedipine and 34 to terbutaline. We found no difference between groups in tocolysis or preterm birth. No serious maternal adverse effects or serious neonatal adverse outcome occurred in either group. Less serious maternal adverse effects less common with terbutaline included flushing (2.94% versus 43.7%) and headache (5.9% versus 31.2%). The administration of terbutaline increased tremor (76.4% versus 0%), nausea (58.8% versus 9.4%) and dizziness (29.4% versus 6.25%). The total number of side effects, and the proportion of women experiencing one or more side effects, proved greater with terbutaline. In this study, terbutaline and nifedipine performed similarly in their tocolytic effects. Each drug has specific side effects, although overall, nifedipine was associated with fewer adverse effects.Premature birth is common (over 5% and, in some countries, over 10%) [1,2] and is responsible for approximately 75% of all neonatal deaths and 50% of childhood neurological morbidities [3,4]. Preterm infants often require intensive care that is associated with emotional and economic costs to both the family and society [5].Approximately 75% of preterm birth is attributable to spontaneous preterm labour [1]. Delay in preterm labour therefore provides a potential opportunity for decreasing neonatal morbidity and mortality [6].The optimal medical management of threatened preterm labour is controversial [7]. Despite theoretical benefits of keeping the foetus in utero long enough to enable administration of a full course of corticosteroids to assist in foetal lung maturation, and to organize transfer to an appropriate neonatal care unit, no agent has been shown to improve neonatal outcome [2,7]. Thus, the choice of therapy has focused on delay in delivery and minimization of adverse effects.The drugs registered for tocolysis include the b adrenoceptor agonist ritodrine (United States and Europe), terbutaline (Brazil) and the oxytocin receptor antagonist atosiban (Europe) [8]. Calcium channel blockers (nifedipine) and cyclooxygenase inhibitors (indomethacin) are also used for inhibiting preterm labour although, in many countries, they are not currently registered for this indication [9].Betamimetics (isoxsuprine, ritodrine, terbutaline, fenoterol and salbutamol) delay labour [10][11][12], but their use has been limited by a high incidence of maternal adverse effects [10,13,14]. Many centres use nifedipine, which also has established effectiveness in delaying labour [15] and has advantages of oral administration and relatively low...

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“…β 2 -AR agonists were considered the drugs of choice to treat threatened PTL based on randomised controlled trials and several subsequent meta-analyses, which showed β-agonists to delay PTL for at least the required 48 hours. Although there are convincing data indicating effective prolongation of pregnancy, β-mimetics have the most undesirable side effect profile of all currently employed tocolytics (Oei, 2006;Pryde et al, 2001). …”

Section: Tocolytic Therapymentioning

confidence: 99%

“…Nifedipine and its analogs have recently been considered as tools for tocolytic therapy (Moynihan et al, 2008;Oei, 2006). To date, the changes in myometrial contractility to nifedipine during pregnancy have not been investigated in experimental studies.…”

Section: The Role Of L-type Ca 2+ Channels In Uterine Contractionmentioning

confidence: 99%

Modification of the myometrial relaxing effect of nifedipine in vitro and in vivo

Hajagos-Tóth¹

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Calcium channel blockers for tocolysis: A review of their role and safety following reports of serious adverse events

Cited by 60 publications

References 57 publications

Transdermal Nitroglycerin Versus Oral Nifedipine for Suppression of Preterm Labor

Transdermal Nitroglycerin Versus Oral Nifedipine for Suppression of Preterm Labor

Nifedipine versus Terbutaline, Tocolytic Effectiveness and Maternal and Neonatal Adverse Effects: A Randomized, Controlled Pilot Trial

Modification of the myometrial relaxing effect of nifedipine in vitro and in vivo

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