how is dinoprostone administered

Precautions

Dinoprostone comes as a vaginal insert and as a gel that is inserted high into the vagina. It is administered using a syringe, by a health professional in a hospital or clinic setting. After the dose has been administered you should remain lying down for up to 2 hours as directed by your physician.

How do you administer dinoprostone?

How should this medicine be used? Dinoprostone comes as a vaginal insert and as a gel that is inserted high into the vagina. It is administered using a syringe, by a health professional in a hospital or clinic setting. After the dose has been administered you should remain lying down for up to 2 hours as directed by your physician.

What is Dinoprostone and how is it used?

Adults and teenagers—Your doctor will insert 0.5 milligram (mg) (one application) of dinoprostone into the canal of your cervix. You should remain lying on your back for at least ten to thirty minutes after it has been applied.

How much dinoprostone do you put on your cervix?

Rapid metabolism of dinoprostone occurs primarily in the local tissues; any systemic absorption of the medication is cleared mainly in the maternal lungs and, secondarily, at sites such as the liver and kidneys. The major route of elimination of the products of PGE2 metabolism is the kidneys. Less than 5 minutes.

Where does the metabolism of dinoprostone occur?

How do you take dinoprostone tablets?

Adults and teenagers—Your doctor will insert 20 milligrams (mg) (one suppository) into your vagina every three to five hours as needed. You should remain lying on your back for at least ten minutes after it has been inserted.

When is dinoprostone given?

It is used by women who are having a normal pregnancy and who are at or near their delivery due date. Dinoprostone is a natural substance that your body makes in preparation for labor. It relaxes and softens your cervix (cervical ripening) to allow the baby to pass through the birth canal during delivery.

How often can dinoprostone gel be administered?

If there is no cervical/uterine response to the initial dose, a repeat dose may be given (0.5 mg gel every 6 hours). Max cumulative dose: 1.5 mg (7.5 mL of gel) per 24-hour period. One 10 mg vaginal insert administered high into the vagina and placed transversely in the posterior fornix.

Who administers dinoprostone gel?

Dinoprostone is to be administered only by or under the immediate care of your doctor. This product is available in the following dosage forms: Gel/Jelly.

What is the pill that softens the cervix?

Medical cervical ripening Misoprostol comes in tablets that can be given by mouth or placed directly against the cervix. The medicine will be absorbed and will start softening your cervix over time. After several hours and several doses, you might end up 2 or 3 cm dilated, and, if you're lucky, perhaps in early labor.

When do they break your water during induction?

When this sac breaks, it typically happens soon before or during labor. If it breaks before your contractions begin, it's called premature rupture of membranes (PROM). Here's the thing: PROM only happens in 8 to 10 percent of pregnancies. So, in most pregnancies, your water will break after your contractions begin.

How is prostaglandin gel inserted?

Prostaglandin gel This gel is administered to the cervix through a syringe placed in the vagina. The drug helps the cervix dilate so that the birth canal can form. The contractions should begin slowly, and you may be able to go back home for a few hours after the gel has been put in place.

How fast does dinoprostone work?

It takes 30 to 40 minutes for the insert to swell. It may fall out if you stand up too soon, so you'll need to stay in bed for 1 hour. The nurse will check you often during this hour. After the first hour, the checks may stop.

Where is prostin gel inserted?

The Prostin gel is inserted during the vaginal examination. The gel is placed behind the cervix. The Prostin hastens the process of softening the cervix and can cause some contractions, however, most women do not go into labour with gel alone.

Which route would the nurse use to administer dinoprostone for the termination of a pregnancy?

Dinoprostone comes as a vaginal insert and as a gel that is inserted high into the vagina. It is administered using a syringe, by a health professional in a hospital or clinic setting. After the dose has been administered you should remain lying down for up to 2 hours as directed by your physician.

What are the contraindications of dinoprostone?

Dinoprostone Vaginal Insert is contraindicated in:Patients with known hypersensitivity to prostaglandins.Patients in whom there is clinical suspicion or definite evidence of fetal distress where delivery is not imminent.Patients with unexplained vaginal bleeding during this pregnancy.More items...•

What is the side effect of dinoprostone?

Nausea, vomiting, diarrhea, fever, chills, abdominal pain, flushing, and dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

When should a dinoprostone insert be removed?

Dinoprostone Vaginal Insert should also be removed prior to amniotomy. Dinoprostone Vaginal Insert is contraindicated when prolonged contraction of the uterus may be detrimental to fetal safety and uterine integrity.

How long does it take for Dinoprostone to be released?

The dosage of Dinoprostone in the vaginal insert is 10 mg designed to be released at approximately 0.3 mg/hour over a 12 hour period. Dinoprostone Vaginal Insert should be removed upon onset of active labor or 12 hours after insertion.

How long should you be in recumbent position after vaginal insert?

Patients should remain in the recumbent position for 2 hours following insertion, but thereafter may be ambulatory. If the patient is ambulatory, care should be taken to ensure the vaginal insert remains in place. If uterine hyperstimulation is encountered or if labor commences, the vaginal insert should be removed.

What is Dinoprostone 10 mg?

Dinoprostone Vaginal Insert 10 mg is indicated for the initiation and/or continuation of cervical ripening in patients at or near term in whom there is a medical or obstetrical indication for the induction of labor.

Is Dinoprostone safe for pregnant women?

The safety and efficacy of Dinoprostone Vaginal Insert has been established in women of a reproductive age and women who are pregnant. Although safety and efficacy has not been established in pediatric patients, safety and efficacy are expected to be the same for adolescents.

Can you remove a dinoprostone insert before oxytocin?

Since prostaglandins potentiate the effect of oxytocin, Dinoprostone Vaginal Insert must be removed before oxytocin administration is initiated and the patient's uterine activity carefully monitored for uterine hyperstimulation. If uterine hyperstimulation is encountered or if labor commences, the vaginal insert should be removed. Dinoprostone Vaginal Insert should also be removed prior to amniotomy.

Is Dinoprostone soluble in water?

It has a melting point within the range of 65° to 69°C. Dinoprostone is soluble in et hanol and in 25% ethanol in water. Each insert contains 10 mg of Dino prostone in 241 mg of a cross-linked polyethylene oxide/urethane polymer which is a semiopaque, beige colored, flat rectangular slab measuring 29 mm by 9.5 mm and 0.8 mm in thickness.

How is Dinoprostone administered?

It is administered using a syringe, by a health professional in a hospital or clinic setting.

Why is Dinoprostone prescribed?

Why is this medication prescribed? Expand Section. Dinoprostone is used to prepare the cervix for the induction of labor in pregnant women who are at or near term. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What to tell your doctor before taking Dinoprostone?

tell your doctor and pharmacist what prescription and nonprescription medications you are taking, including vitamins.

How long should you wait to take a second syringe?

A second dose of the gel may be administered in 6 hours if the first dose does not produce the desired response.

Boxed Warning

Use dinoprostone, as with other potent oxytocic agents, only with strict adherence to recommended dosages.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Pharmacology

Dinoprostone (prostaglandin E 2) is an endogenous hormone found in low concentrations in most tissues of the body. When administered as an abortifacient, it stimulates uterine contractions similar to those seen during natural labor.

Use: Labeled Indications

Endocervical gel (Prepidil): Promote cervical ripening in patients at or near term in whom there is a medical or obstetrical indication for the induction of labor

Contraindications

Generally, labor induction is contraindicated whenever spontaneous labor or vaginal delivery is contraindicated (ACOG 2009); manufacturer specific contraindications are listed by dosage form.

Dosage and Administration

Note: In the United States, dinoprostone is available as an endocervical gel (Prepidil), insert (Cervidil), and suppository (Prostin E2). Additional dosage forms and products with similar names but different indications are also available in Canada. The pharmacokinetic properties vary by dosage form and are, therefore, not interchangeable.

Storage

Endocervical gel should be stored under refrigeration at 2°C to 8°C (36°F to 46°F).

Where does dinoprostone go in the body?

Rapid metabolism of dinoprostone occurs primarily in the local tissues; any systemic absorption of the medication is cleared mainly in the maternal lungs and, secondarily, at sites such as the liver and kidneys. Route of elimination. The major route of elimination of the products of PGE2 metabolism is the kidneys.

What is Dinoprostone used for?

Dinoprostone is a naturally occurring prostaglandin E2 (PGE2). It has important effects in labour. It also stimulates osteoblasts to release factors which stimualtes bone resorption by osteoclasts. As a prescription drug it is used as a vaginal suppository, to prepare the cervix for labour and to induce labour.

What is the prostaglandin used for?

Dinoprostone. Dinoprostone is a prostaglandin used to induce labor or abortion as well as to treat nonmetastatic gestational trophoblastic disease.

Does dinoprostone cause diarrhea?

This activity may be responsible for the vomiting and/or diarrhea that is not uncommon when dino prostone is used to terminate pregnancy. Mechanism of action.

Does carboprost increase uterotonic activity?

Carboprost tromethamine may increase the uterotonic activities of Dinoprostone. The excretion of Dinoprostone can be decreased when combined with Carprofen. The excretion of Dinoprostone can be decreased when combined with Caspofungin. The excretion of Dinoprostone can be decreased when combined with Cefaclor.

Does dinoprostone affect the uterus?

It is believed that dinoprostone exerts its uterine effects via direct myometrial stimulation, but the exact mechanism of action is unkown. Other suggested mechanisms include the regulation of cellular membrane calcium transport and of intracellular concentrations of cyclic 3',5'-adenosine monophosphate.

DOSAGE AND ADMINISTRATION

NOTE: USE CAUTION IN HANDLING THIS PRODUCT TO PREVENT CONTACT WITH SKIN. WASH HANDS THOROUGHLY WITH SOAP AND WATER AFTER ADMINISTRATION.

INDICATIONS AND USAGE

PREPIDIL Gel is indicated for ripening an unfavorable cervix in pregnant women at or near term with a medical or obstetrical need for labor induction.

DOSAGE AND ADMINISTRATION

NOTE: USE CAUTION IN HANDLING THIS PRODUCT TO PREVENT CONTACT WITH SKIN. WASH HANDS THOROUGHLY WITH SOAP AND WATER AFTER ADMINISTRATION.

CONTRAINDICATIONS

Endocervically administered PREPIDIL Gel is not recommended for the following:

WARNINGS

Dinoprostone, as with other potent oxytocic agents, should be used only with strict adherence to recommended dosages. Dinoprostone should be administered by...

ADVERSE REACTIONS

PREPIDIL Gel is generally well-tolerated. In controlled trials, in which 1731 women were entered, the following events were reported at an occurrence of ≥ 1%:

DRUG ABUSE AND DEPENDENCE

No drug abuse or drug dependence has been seen with the use of PREPIDIL Gel.

How is dinoprostone administered?

Dinoprostone is administered intravaginally. Dinoprostone distributes widely throughout the body and is metabolized extensively on first pass through the lungs (about 95%). The delivery rate of dinoprostone from the vaginal insert in vivo is approximately 0.3 mg/per hour over a period of 12 hours. The metabolites are then further metabolized by the spleen, kidneys, and other tissues to inactive metabolites, which are excreted primarily by the kidneys. Dinoprostone's half-life is approximately 2.5 to 5 minutes. The rate-limiting step for inactivation is regulated by the enzyme 15-hydroxyprostaglandin dehydrogenase (PGDH). Any dinoprostone that escapes local inactivation is cleared to the extent of 95% on the first pass through the pulmonary circulation. No correlation could be established between the release of dinoprostone from the vaginal insert and plasma concentrations of metabolite of dinoprostone (PGEm). The relative contributions of endogenously and exogenously released dinoprostone to the plasma levels of the metabolite PGEm is not known. Specific pharmacokinetic data for dinoprostone endocervical gel and vaginal suppository products are not available.

What happens if you put dinoprostone in your vagina?

The placement of dinoprostone endocervical and vaginal products, respectively) may result in inadvertent disruption and subsequent embolization of antigenic tissue causing in rare circumstances the development of anaphylactoid syndrome of pregnancy (amniotic fluid embolism).

What is the Synthetic form of Prostaglandin E2?

Synthetic form of prostaglandin E2; has oxytocic actions; use requires specialized care facilities and monitoring#N#Vaginal suppositories used clinically to induce abortion or to evacuate uterine contents following intrauterine fetal death, missed abortion, or benign hydatidiform mole#N#Endocervical gel or vaginal inserts are used for cervical ripening during labor in term pregnancies

How long does dinoprostone stay in your system?

Dinoprostone's half-life is approximately 2.5 to 5 minutes. The rate-limiting step for inactivation is regulated by the enzyme 15-hydroxyprostaglandin dehydrogenase (PGDH). Any dinoprostone that escapes local inactivation is cleared to the extent of 95% on the first pass through the pulmonary circulation.

How long should a suppository be inserted?

An additional suppository should be inserted vaginally at 3 to 5 hour intervals until abortion occurs. Administration time within the 3 to 5 hour interval should be determined by clinical progress, uterine contractility response, and by patient tolerance.

When to remove insert after amniotomy?

Remove the insert upon onset of active labor or 12 hours after insertion. Remove at least 30 minutes prior to administering an oxytocic agent. Also remove prior to an amniotomy, occurrence of uterine tachysystole, uterine hypersystole/hypertonicity, or fetal distress.

Is dinoprostone contraindicated?

Dinoprostone use is contraindicated in patients with a known dinoprostone hypersensitivity or sensitivity to product excipients. Dinoprostone use carries a risk of serious hypersensitivity reactions or anaphylaxis. Anaphylactoid reactions, anaphylaxis, and angioedema have been noted to occur with dino prostone.

Where is dinoprostone placed?

Dinoprostone is a gel or suppository that is placed directly onto the cervix through the vagina using a special applicator. A healthcare provider will insert this medicine at the correct time best prepare your cervix. Dinoprostone is usually given while you are lying on your back.

What is a dinoprostone?

Dinoprostone is a prostaglandin, a hormone-like substance that is naturally produced by tissues in the body. Dinoprostone topical is used in a pregnant woman to relax the muscles of the cervix (opening of the uterus) in preparation for inducing labor at the end of a pregnancy.

Is Dinoprostone harmful to the unborn baby?

if your pregnancy is at full term (40 weeks). Dinoprostone is not expected to be harmful to the unborn baby when used to induce labor.

Dinoprostone Description

Dinoprostone - Clinical Pharmacology

Indications and Usage For Dinoprostone

Contraindications

Warnings

Precautions

Adverse Reactions

Overdosage

Dinoprostone Dosage and Administration

How Is Dinoprostone Supplied