The safety of tocolytics used for the inhibition of preterm labour

  title={The safety of tocolytics used for the inhibition of preterm labour},
  author={C. D. Lamont and Jan Stener J{\o}rgensen and Ronald F Lamont},
  journal={Expert Opinion on Drug Safety},
  pages={1163 - 1173}
ABSTRACT Introduction: Preterm birth is the major cause of neonatal mortality and morbidity worldwide and a huge cost burden on healthcare. Between 22 and 26 completed weeks of gestation, for every day that delivery is delayed, survival increases by 3%. Areas covered: Following a systematic review of the literature, we have provided an overview of the use of tocolytics for the prevention of preterm birth and have examined the fetal and maternal adverse effects of the various tocolytic agents… 
Safety and Efficacy of Tocolytics for the Treatment of Spontaneous Preterm Labour.
The perfect tocolytic that is uniformly effective and safe does not exist and efforts continue to develop and introduce other or better agents, including novel compounds such as progesterone, PGF2α antagonists and statins.
Aspects of Some Tocolytic Drugs Used in Pregnant Women at Risk of Preterm Birth
It was demonstrated that women with threatened miscarriage had high interindividual variability in nifedipine plasma concentrations depending on CYP3A5 genotype, and certain genetic polymorphisms of CYP2C9 may lead to an increased metabolic rate and an increase in indomethacin clearance resulting in the reduction of its efficacy.
Clinical Pharmacology Aspects of Some Tocolytic Drugs Used in Pregnant Women at Risk of Preterm Birth
The paper presents the results of a scientific literature review on the problem of rational pharmacotherapy of spontaneous preterm labour using tocolytic drugs — calcium channel blockers, cyclooxygenase inhibitors, and summarises specific pharmacokinetic parameters of these drugs during pregnancy.
Evaluation of Atosiban Therapy in the Management of Preterm Labour in Indian Patients
In patients with threatened preterm birth, 48 hour tocolysis with atosiban was found to be safe and effective in preventing imminent pre term birth even when it was a twin pregnancy or associated with co-morbidities.
The effectiveness of nifedipine/indomethacin combination therapy and nifedipine monotherapy for postponing preterm birth (25–34 weeks of gestation) in Sudanese women: a randomized clinical trial study protocol
The aim of this study is to compare the tocolytic effectiveness and tolerability of combination therapy with nifedipine and indomethacin versus nifEDipine monotherapy among Sudanese women with preterm labor (PTL) as well as to comparison the possible neonatal outcomes associated with each drug.
Atosiban efficacy and safety in pregnant women with threatened preterm delivery : systematic review of the literature with network meta-analysis
Atosiban has similar efficacy for delivery delay in patients with risk of preterm delivery as compared to other agents, showing some advantages regarding neonatal mortality (low certainty) versus indomethacin, and compared to fenoterol, nifedipine and terbutaline in terms of maternal adverse events (moderate certainty).
Toxic epidermal necrolysis induced by ritodrine in pregnancy: A case report
When a skin rash appears during the administration of ritodrine, the authors are supposed to consider the risk of TEN, which is a rare but serious side effect–toxic epidermal necrolysis (TEN)–caused by r itodrine.
Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort)
Compared to a unit policy of no-use of tocolysis after PPROM, a liberal or restricted policy is not associated with improved obstetric, neonatal or two-year outcomes, and there was no association between unit policies and prolongation of gestation in a multilevel survival analysis.
Preterm Birth, Inflammation and Infection: New Alternative Strategies for their Prevention.
New alternative strategies involving the use of PDE-4 inhibitors, medicinal plants and probiotics could have a great impact for improving prenatal and neonatal outcomes and give babies the best start in life, ensuring lifelong health benefits.
Effectiveness and Safety of Isoxsuprine Hydrochloride as Tocolytic Agent in Arresting Active/Threatened Preterm Labor and Its Role in Maintenance Tocolysis-A Prospective, Open-Label Study.
  • P. B. Jaju
  • Medicine
    American journal of perinatology
  • 2019
Isoxsuprine was found to be an effective and well-tolerated tocolytic agent in arresting PTL, in turn resulting in the overall improvement in maternal and perinatal outcomes.


Developments in the pharmacotherapeutic management of spontaneous preterm labor
The pathophysiology of preterm labor and the use of antepartum glucocorticoids are reviewed and the perfect tocolytic does not exist, and clinicians move to nifedipine or atosiban, which are as effective but much safer.
The choice of a tocolytic for the treatment of preterm labor: a critical evaluation of nifedipine versus atosiban
Atosiban was developed specifically to treat preterm labor, so the cost is higher than nifedipine or ritodrine, but the balance of evidence indicates that atosiban is as effective as nifesiban and more effective than β-agonists and is significantly safer than both.
Atosiban as a tocolytic for the treatment of spontaneous preterm labor
Atosiban (Tractocile®) is a vasopressin-oxytocin receptor antagonist, which is much more uterospecific than previous tocolytics, and, consequently has placebo-level side effects.
The pathophysiology of pulmonary oedema with the use of beta‐agonists
  • R. Lamont
  • Medicine, Biology
    BJOG : an international journal of obstetrics and gynaecology
  • 2000
The anatomical, biochemical and physiological factors associated with the development of pulmonary oedema in association with beta-agonist therapy which has driven the search for better, safer tocolytic agents are reviewed.
  • Medicine
  • 2003
Preterm birth is the most important single determinant of adverse infant outcome, in terms of both survival and quality of life. Although preterm birth is defined as being before 37 completed weeks,
Atosiban versus betamimetics in the treatment of preterm labour in Germany: an economic evaluation
Compared to betamimetics, use of atosiban was associated with a significantly lower frequency of adverse events for tachycardia, palpitation, vomiting, headache, hyperglycaemia, tremor, dyspnoea, chest pain, hypocalemia and foetal tachycardsia.
Calcium channel blockers for inhibiting preterm labour and birth.
Comparing CCBs (mainly nifedipine) with other tocolytics by type (including betamimetics, glyceryl trinitrate (GTN) patch, non-steriodal anti inflammatories (NSAID), magnesium sulphate and ORAs), no significant reductions were shown in primary outcome measures of birth within 48 hours of treatment or perinatal mortality.
Betamimetics for inhibiting preterm labour.
Betamimetics help to delay delivery for women transferred to tertiary care or completed a course of antenatal corticosteroids and multiple adverse effects must be considered, but the data are too few to support the use of any particular betamimetic.
Comparison of nifedipine and progesterone for maintenance tocolysis after arrested preterm labour
  • S. Kamat, P. Veena, R. Rani
  • Medicine
    Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
  • 2014
It is concluded that when compared with nifedipine, progesterone significantly prolongs pregnancy in women with arrested preterm labour with better neonatal outcomes and fewer side-effects.