Comparison of the efficacy and adverse effects of nifedipine and indomethacin for the treatment of preterm labor

Kashanian, Maryam; Bahasadri, Shohreh; Zolali, Bita

doi:10.1016/j.ijgo.2010.12.019

Cited by 25 publications

(9 citation statements)

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“…The mean prolongation of pregnancy was 11.13░±░5.08 days with nifedipine alone in the present study. Our findings conform to several reported studies on the use of nifedipine for acute tocolysis (10,11,14). Hypotension and tachycardia were the most common side effects observed with nifedipine in our study.…”

Section: Discussionsupporting

confidence: 93%

“…In the present study the mean gestational age at presentation was 32.01░±░1.92 wk in group A and 32.07░±░1.81 in group B patients. The mean gestational ages reported by Moramezi and co-worker (7), Sharami and co-worker (12), Gargari and co-worker (13) and Kashanian and co-worker (14) were 32░±░3 wk, 33.95░±░1.49 wk, 32.2░±░2.8 wk and 30.8░±░2.5 wk respectively. In our study we employed nifedipine for acute tocolysis as this medication is considered as the first-line tocolytic agent for the management of threatened PTL, given its established superiority over β-2 receptors agonists and magnesium sulfate.…”

Section: Discussionmentioning

confidence: 93%

“…This in turn helps to improve clinically important neonatal outcomes. For instance, respiratory distress syndrome, intraventricular hemorrhage, necrotizingenterocolitis, and neonatal jaundice (1–4,14).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of oral nifedipine with or without vaginal progesterone in the management of threatened preterm labor

Ashraf

2019

IJRM

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Background: Preterm labor (PTL) is a serious emergency wherein robust management is imperative for achieving improved outcome. Objective: To evaluate the efficacy and safety of nifedipine alone vs nifedipine with vaginal progesterone in managing threatened PTL. Materials and Methods: This comparative study was carried out at the Pakistan Institute of Medical Sciences, Islamabad over a 2-year’ period, from September, 2013 to August, 2015. The study included 276 patients with threatened PTL. Half of them were allocated to nifedipine alone group whereas the remainder half to the additional progesterone group. In nifedipine alone group (group A), all the patients were given 20mg of rapid release nifedipine orally. If uterine contraction continued, a 10mg dose was repeated every 20 min with a maximum of 40mg within the first hour. After completing the first hour, 20mg was given every 4–6 hr for 72 hr. In the additional vaginal progesterone group (group B), following successful tocolysis with nifedipine, additional - maintenance tocolysis was ensured with vaginal progesterone 200mg daily. Results: Successful acute tocolysis was achieved with nifedipine among 86.23% patients. Mean pregnancy prolongation was 11.13 ± 5.08 days in group A while 29.73 ± 3.10 days in group B. (p0.001). Conclusion: Acute tocolytic therapy with nifedipine was successful in the majority of our patients. The additional daily use of vaginal progesterone suppositories resulted in significant prolongation of pregnancy as well as reduction in the rate of low birth weight and neonatal ICU admissions. Key words: Preterm labor, Tocolytics, Nifedipine, Progesterone.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 93%

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Efficacy and safety of oral nifedipine with or without vaginal progesterone in the management of threatened preterm labor

Ashraf

2019

IJRM

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“…This conclusion is true even when the analysis is limited to studies with the least risk of bias and with the most clinically homogenous participant populations. In the evidence base considered here, however, only one, small (n=79) head to head trial compared prostaglandin inhibitors with a calcium channel blocker 116. The findings in this trial suggest that nifedipine (calcium channel blocker) was more effective than indomethacin (prostaglandin inhibitor) for rapid treatment effect but that the delay in delivery was similar between women in both groups who initially responded to treatment.…”

Section: Discussionmentioning

confidence: 84%

Tocolytic therapy for preterm delivery: systematic review and network meta-analysis

Haas

Caldwell

Kirkpatrick

et al. 2012

BMJ

360

242

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Objective To determine the most effective tocolytic agent at delaying delivery.Design Systematic review and network meta-analysis. Study selection Randomised controlled trials of tocolytic therapy in women at risk of preterm delivery. Data sources Data extractionAt least two reviewers extracted data on study design, characteristics, number of participants, and outcomes reported (neonatal and maternal). A network meta-analysis was done using a random effects model with drug class effect. Two sensitivity analyses were carried out for the primary outcome; restricted to studies at low risk of bias and restricted to studies excluding women at high risk of preterm delivery (those with multiple gestation and ruptured membranes). ResultsOf the 3263 titles initially identified, 95 randomized controlled trials of tocolytic therapy were reviewed. Compared with placebo, the probability of delivery being delayed by 48 hours was highest with prostaglandin inhibitors (odds ratio 5.39, 95% credible interval 2.14 to 12.34) followed by magnesium sulfate (2.76, 1.58 to 4.94), calcium channel blockers (2.71, 1.17 to 5.91), beta mimetics (2.41, 1.27 to 4.55), and the oxytocin receptor blocker atosiban (2.02, 1.10 to 3.80). No class of tocolytic was significantly superior to placebo in reducing neonatal respiratory distress syndrome. Compared with placebo, side effects requiring a change of medication were significantly higher for beta mimetics (22.68, 7.51 to 73.67), magnesium sulfate (8.15, 2.47 to 27.70), and calcium channel blockers (3.80, 1.02 to 16.92). Prostaglandin inhibitors and calcium channel blockers were the tocolytics with the best probability of being ranked in the top three medication classes for the outcomes of 48 hour delay in delivery, respiratory distress syndrome, neonatal mortality, and maternal side effects (all cause).Conclusions Prostaglandin inhibitors and calcium channel blockers had the highest probability of delaying delivery and improving neonatal and maternal outcomes.

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“…In another investigation, nifedipine was found to be more effective than indomethacin in inhibiting uterine contractions during the ﬁrst 2 hours; however, there was no difference between indomethacin and nifedipine in delaying delivery for up to 7 days [39]. …”

Section: The Efficacy Of Ccbs Against Ptbmentioning

confidence: 99%

Calcium Channel Blockers as Tocolytics: Principles of Their Actions, Adverse Effects and Therapeutic Combinations

Gáspár

Hajagos-Tóth

2013

Pharmaceuticals

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Dihydropyridine Ca2+ channel blockers (CCBs) are widely accepted in the treatment of premature labour. Their mechanism of action in tocolysis involves the blockade of L-type Ca2+ channels, influenced by the Ca2+-activated K+ channels, beta-adrenergic receptors (β-ARs) and sexual hormones. In clinical practice, most experience has been gained with the use of nifedipine, whose efficacy is superior or comparable to those of β-agonists and oxytocin antagonists. Additionally, it has a favourable adverse effect profile as compared with the majority of other tocolytics. The most frequent and well-tolerated side-effects of CCBs are tachycardia, headache and hypotension. In tocolytic therapy efforts are currently being made to find combinations of tocolytic agents that yield better therapeutic action. The available human and animal studies suggest that the combination of CCBs with β-AR agonists is beneficial, although such combinations can pose risk of pulmonary oedema in multiple pregnancies and maternal cardiovascular diseases. Preclinical data indicate the potential benefit of combinations of CCBs and oxytocin antagonists. However, the combinations of CCBs with progesterone or cyclooxygenase inhibitors may decrease their efficacy. The CCBs are likely to remain one of the most important groups of drugs for the rapid inhibition of premature uterine contractions. Their significance may be magnified by further clinical studies on their combined use for tocolysis.

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Comparison of the efficacy and adverse effects of nifedipine and indomethacin for the treatment of preterm labor

Abstract: Indomethacin was less effective than nifedipine for the fast treatment of preterm labor. For women who responded to treatment within 2 hours, however, the delaying of delivery by indomethacin was similar to that by nifedipine.

Cited by 25 publications

References 25 publications

Efficacy and safety of oral nifedipine with or without vaginal progesterone in the management of threatened preterm labor

Efficacy and safety of oral nifedipine with or without vaginal progesterone in the management of threatened preterm labor

Tocolytic therapy for preterm delivery: systematic review and network meta-analysis

Calcium Channel Blockers as Tocolytics: Principles of Their Actions, Adverse Effects and Therapeutic Combinations

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