Ginipral during pregnancy: instructions for use, side effects, analogues

Pregnancy is a trembling and responsible period in the life of every woman. During this period, medications can harm a developing child. It is not always the doctor who patiently and intelligently explains to the future mother the advisability of using this remedy, which, moreover, has many impressive side effects. And there are doubts - is it worth using Ginipral during pregnancy?

It is a drug that depresses the contractile activity of the muscular layer of the uterus and, thereby, prolongs the term of intrauterine development of the fetus. Its active ingredient (hexoprenaline sulfate) belongs to the group of selective β-2 sympathomimetics.

Currently, Ginipral is one of the most commonly used drugs for prolonging the bearing of a child. Its impact is well studied and predictable enough, the measures taken by medical personnel in the event of undesirable reactions from the future mother's body are worked out.

In the ideal case, with a normally proceeding pregnancy, the uterus muscles are in a relaxed state for the entire period of time. However, in reality, modern future mothers often experience stress, suffer from chronic diseases, lead a not very healthy lifestyle. In the last months of pregnancy, an increased tone appears in women with a large fetus or - bearing twins. Many reasons exist that the muscles of the uterus begin to decline actively. Hypertension of the uterus can cause premature delivery, in addition, unfavorable conditions for fetal development - hypoxia, malnutrition, which primarily affects the central nervous system and its main body - the brain.

In order to protect the child and his mother from these dangerous consequences of increased activity of the musculature of the uterus, just apply the aforementioned drug.

[1], [2], [3]

Indications of the ginipral during pregnancy

1. Short-term emergency therapy involving inhibition of early labor (the gestation period is more than three months):
   • for transportation of a woman in labor in a hospital;
   • oppression of labor in the parturient woman during the period of delivery with acute antenatal oxygen deficiency of the fetus, prolapse of the umbilical cord loops and in some other situations complicating the course of labor;
   • provision of immobility and rest of the myometrium before medical manipulations (caesarean section, performed manually by turning the fruit on the head).
2. Massive inhibition of early delivery with symptoms of ripened cervix (shortened, smoothened or slightly open - up to two to three centimeters).
3. Long-term tocolytic therapy to prevent premature delivery with prolonged or massive hypertension without signs of cervical preparedness for labor, ensuring immobility and resting myometrium before, during cervical closure (cerclage) and after the procedure.

[4], [5]

Release form

Produced in the form of tablets with a dosage of 500mkg of hexoprenaline sulfate and a solution in ampoules containing 25mkg; 10 μg of active ingredient.

[6]

Pharmacodynamics

The active component of the drug effectively relaxes the myometrium, as well as the musculature of the bronchi and bronchioles, arresting their spasms. This ingredient suppresses not only spontaneous, but also oxytocin-induced premature labor, threatening miscarriage. In general, the musculature of the uterus reacts by relaxing to the action of the medication, which contributes to the full bearing of the child.

During childbirth can be used as a means of coordinating the labor activity (abnormally strong and unstable contractions).

Additionally, the drug is able to eliminate bronchospasm. Long-term therapy leads to a normalization of the secretion of bronchial secretion, the gas composition of the blood and the parameters of external respiration are normalized. In addition, the influence of the active ingredient on the work of the heart muscle and blood circulation of the mother and the child is practically not revealed.

[7], [8], [9]

Pharmacokinetics

Distribution in the tissues of the human body has not been adequately studied. It is known that a high concentration of active substance is determined in the tissues of the liver, kidneys and skeletal muscles, less significant - in the parenchyma of the brain and the heart muscle with intravenous infusion.

The cleavage process catalyzes the catechol-O-methyltransferase. As a result, two metabolites are formed: mono- and di-3-O-methyl-hexoprenaline.

After the introduction directly into the vein, about 44% of the active substance is eliminated through the urinary tract and only 5% by the intestine. Then, for eight days, the remainder is excreted in the same way and in the same proportions, and also through the gall bladder (about 10%) as O-methylated cleavage products. In the initial stage of excretion, the active substance in its free form and its metabolites in urine are not detected, and after two days only di-3-O-methyl-hexoprenaline can be found there. Considering that the intestine produces less hexoprenaline sulfate than excreted through the biliary tract, one can assume the reabsorption of some part of the injected Ginipral.

[10], [11], [12]

Dosing and administration

The following dosing is indicative, since doses of ginipral during pregnancy are calculated individually for each patient, taking into account a set of indicators of her health status and the reasons for his appointment.

Short-term tocolysis in cases of ensuring a calm state of the myometrium before turning the fetus on the head, and also before transportation to the hospital of the parturient woman with symptoms of the initial stage of pre-term labor.

The medicine is injected into the vein struino and slowly (for five to ten minutes), previously one 2-ml ampoule (10mkg of hexoprenaline sulfate) dissolves into 10ml of NaCl injection (0.9%) or dextrose (5%). If necessary, the patient continues to receive the medication infusion through a dropper at a rate of 0.3 μg / min.

The same scheme is used for short-term prevention of early delivery in the case of severe contractions of the uterine musculature and / or a small (up to 2-3 cm) opening of the uterine throat. As an alternative, Ginipral-IV during pregnancy is used (speed 0.3 mkg / min) without previous jet injection.

To correctly adjust the infusion device, the ratio is taken into account: 1ml is equal to 20 drops.

To ensure the rate of administration of hexoprenaline sulfate 0.3 mkg / min, the required number of ampoules is diluted in 500 ml of NaCl solution (0.9%) or dextrose (5%):

• when diluting one ampoule 5ml (25mkg), the infusion rate should be set at 120 drops (6ml) per minute;
• when diluting two ampoules 5ml (50mkg), the infusion rate should be set at 60 drops (3ml) per minute;
• when diluting three ampoules 5ml (75mkg), the infusion rate should be set at 40 drops (2ml) per minute;
• while diluting 4 ampoules 5ml (100mkg), the infusion rate should be set at 30 drops (1.5ml) per minute.

Short-term tocolysis to a patient with moderate symptoms is performed by continuous dropping in a minute 0.075 μg of hexoprenaline sulfate. To ensure the necessary infusion rate, the prescribed number of ampoules is added to 500 ml of NaCl solution (0.9%) or dextrose (5%):

• when diluting one ampoule 5ml (25mkg of active ingredient in 500ml of any given solution), infusion rate at the level of 30 drops (1.5ml) per minute is established;
• when the dilution of two ampoules of 5 ml (50 μg) is established, the infusion rate at the level of 15 drops (0.75 ml) per minute.

The duration of dropping tocolysis is determined depending on the degree of probability of premature delivery (the tendency to shorten the time interval between contractions, the degree of maturation of the cervix) and manifestations of its undesirable effects (hypotension, arrhythmia, tachycardia).

If the contractions are not renewed within two days, the treatment can continue with the tablet form of the drug. They swallow, squeezed water in the required amount. A tablet (0.5 mg) is taken an hour or two before the end of the drip. First with an interval of every three hours, then it is increased to four to six hours. A day is taken from two to four milligrams of hexoprenaline sulfate. Cancellation is carried out gradually, reducing the dose of half a tablet every three days.

Ginipral in tablets during pregnancy, the doctor can appoint with an unexplained threat of interruption, although in this case more often choose other medicines.

Side effects are stopped as follows:

• appoint two or three tablets of valerian extract simultaneously with a dropper or tablets;
• verapamil, piercing pulse, appoints a doctor.

Unpleasant symptoms will not necessarily be completely eliminated, especially for intravenous infusions. If the negative effects are pronounced and not copied with the help of these agents, it is recommended to cancel this medication and designate another one.

The drug is addressed specifically to pregnant women, in other periods, in particular, lactation is not used.

[16]

Consequences for the child

The results of randomization did not show a significant effect of treatment with gonipralum perinatal mortality or morbidity during this period. It was concluded that the prevention of preterm births allows the use of a prolonged time of bearing for the implementation of measures that improve the health of newborns. However, prolonged and frequent conduction of tocolysis by Ginipralum leads to the fact that newborns have high blood acidity and occasionally hypoglycemia. Sometimes after the infusion the pulse of the fetus increases (by about 20 beats per minute).

[17], [18], [19]

Contraindications

1. Sensitization to any ingredient included in this drug substance.
2. Toxic goiter, increased production of thyroid hormone.
3. Cardiovascular pathologies, including - hypertension, arrhythmia, tachycardia, aortic stenosis and others.
4. Bronchial asthma sensitized to sulfuric acid derivatives.
5. Eye and pulmonary hypertension.
6. Insulin-dependent diabetes mellitus.
7. Pronounced hepatic and renal dysfunction.
8. Inadvisability or danger of prolonging pregnancy.
9. Distress syndrome of the fetus, not associated with hypertension of the uterus.
10. The first three months of pregnancy, the stage of breastfeeding.
11. Traces of blood in the vaginal discharge of a pregnant woman.

It is undesirable to conduct tocolytic therapy if the integrity of the membranes of the fetal egg is violated or the diameter of the opening of the uterine neck exceeds two to three centimeters.

When prescribing this medication, you should first weigh well the pros and cons of assessing the prevalence of the benefits of its use. Medical measures are carried out under conditions of the possibility to constantly monitor the condition of a pregnant woman and her unborn child:

• control the work of the heart muscle (including ECG, blood pressure, pulse) and respiratory functions;
• water-salt balance;
• serum glucose and potassium levels, blood acidity;
• regularity of defecation.

Patients with hypokalemia are prescribed a substitution therapy with potassium.

The occurrence of pain in the heart or changes in the ectrocardiogram is a signal to stop tocolysis.

The presence of factors of increased likelihood of pulmonary edema (multiple pregnancies, preeclampsia, plethora, the presence of infection) involves the use of jet medication instead of drip.

During the period of therapy, Ginipralam is recommended to limit the use of salt.

The drug acts on the musculature of the arterial wall, has vasodilating properties, so the patient and her future child have a faster pulse and lower blood pressure.

[13], [14]

Side effects of the ginipral during pregnancy

The use of this medication most often causes complaints about:

• the occurrence of headache, anxiety, anxiety, dizziness until loss of consciousness, tremor of fingers, palpitations;
• pain in the chest, passing after stopping drip infusions of the drug;
• phenomena of indigestion - nausea, vomiting, constipation;
• increased sweating, flushing of the skin;
• oliguria;
• puffiness (especially in women with impaired renal function), very rarely - pulmonary edema.

The results of the examination during tocolysis showed hypotension, hypokalemia, stimulation of lipolysis, an increase in the serum index of hepatic transaminases.

In isolated cases, the sulfates present in the composition of the drug caused a sensitization reaction up to the development of shock (especially in patients with bronchial asthma).

If tololiz Ginipralom is given to women with diabetes mellitus immediately before childbirth, it is necessary to trace the presence of symptoms of insufficiency of glucose in the newborn, and also - acidification of blood in connection with overcoming acidic metabolites of the placental barrier.

[15]

Overdose

Antidote are non-selective β-blockers.

Excess dose is manifested by severe tachycardia, trembling of fingers, headache, hyperhidrosis, hypotension, dyspnea. As a rule, it is enough to reduce the dose of Ginipral for relief of overdose symptoms.

[20], [21]

Interactions with other drugs

The result of this medication is:

• significantly reduced or completely leveled when combined with other β-blockers;
• is strengthened in combination with medicines containing methyl derivatives of xanthine (caffeine, euphyllin, theobromine);
• is mutually reinforced in combination with other sympathomimetics and narcotic means of fluorothane (symptoms of cardiac dysfunction and signs of overdose may appear).

In combination with glucocorticosteroids in the liver, cumulation of glycogen decreases.

The effect of hypoglycemic drugs (oral) decreases with simultaneous use with hexaprinoline sulfate.

Because of incompatibility it is not recommended to use simultaneously with

Tricyclic antidepressants, MAO inhibitors, ergot alkaloids, mineralocorticoids, dihydrotachysterol, medicines and vitamin-mineral complexes, which contain vitamin D and calcium.

Since sulfuric acid is contained in the solution packed in ampoules, it is necessary to mix their contents only with the solutions recommended in the instruction (NaCl (0.9%) and glucose (5%)).

To reduce the side effects of ginipral on the side of the heart, prescription of verapamil tablets, in particular - for the normalization of the rhythm and heart rate. How to take ginipral and verapamil during pregnancy should tell the attending physician. Dosage these drugs individually depending on the state of the future mother. It is only necessary to consider that a tablet of Verapamil is recommended to be swallowed during a meal, and an hour later you can take Ginipral. If it is a question of infusion tocolysis, then it is conducted under the supervision of specialists who will make the necessary appointments.

Tablets and ampoules in the original packaging should not be stored for more than three years, observing the temperature regime up to 25 ℃. Keep away from children. Prepared infusion solution used immediately.

[22], [23]

Analogues of ginipral during pregnancy

The therapy of hypertension of the uterus, which can lead to premature birth, is very individual. Medicines are prescribed, and sometimes combined, only by the doctor, based on the examination and complaints of the woman. Therefore, which drug to prescribe, Ginipral or Metacin in pregnancy, should decide a specialist. Ginipral is a specific medicine, acting mainly on the myometrium, and very pronounced. Metacin has a broader spectrum of action, it is used for spasms of any internal organs, more often with chronic gastritis with increased acidity and gastroduodenal ulcers, because it reduces the secretion of gastric, and also - salivary and bronchial glands. Metacin also found wide application as a tocolytic. Contraindications and side effects also resonate, because both cause similar effects. Therefore, when prescribing the medicine, the doctor will be guided by the features of the patient's anamnesis.

Magnesium salt of sulfuric acid or Magnesia is a good alternative to Ginipral, although its effect on the myometrium is more moderate. Magnesia is prescribed when the threat of premature birth is so significant. Magnesium sulphate in tablets (preparation Magnesium B6) can be prescribed in the first trimester of pregnancy with the threat of miscarriage when Ginipral is useless, since the receptors on which it acts by relaxing the myometrium appear at the end of the third month of pregnancy. Magnesia, in contrast to previous drugs, is indicated in gestosis. Therefore, the doctor will choose Ginipral or Magnesia, proceeding from the specifics of a particular case. Sometimes these drugs are prescribed in one treatment regimen: the patient is given a dropper with Magnesia in one day, the next with Ginipral. And although Magnesia is currently considered a weak tocolytic compared to more modern drugs, but in a recent meta-analysis (2009), it was concluded that the use of this remedy in the event of the threat of premature birth leads to a reduction in the frequency of infantile cerebral paralysis and neonatal mortality . However, with innocent, at first glance, Magnesia, it is necessary to exercise caution. Her overdose can cause respiratory paralysis. Antidote in this case are calcium preparations.

The calcium channel blocker Nifedipine or Corinfar, as practice shows, is not inferior to other tocolithics in effectiveness. Its ability to relax smooth muscles in general, including in the uterus, is used. Nevertheless, in the instructions for use this "heart" drug is contraindicated during pregnancy. It is used in case of threat of early childbirth, when other tocolytics do not help or the future mother does not tolerate them. Practical observations indicate that the use of Nifedipine helps to reduce neonatal mortality. The drug itself has a relatively small number of side effects, and also - they do not appear very often and their strength is not great. True, the long-term effects of Nifedipine in tocolytic therapy have not yet been studied properly. However, doctors are interested in the new quality of the drug and consider it promising.

Nifedipine is used in the first half of pregnancy, when Ginipral is not effective, and then often complete therapy with Ginipral. Nevertheless, the safety of Nifedipin for the future mother and her unborn baby is not yet proved, he has not yet been recognized as an official tocolytic. The instruction does not recommend taking this remedy during the period of bearing the child. In addition, during various studies, it was found that the drug exhibits teratogenicity, embryotoxicity and fetotoxicity. Therefore, consider it safe not worth it, especially in the first half of pregnancy. And a study conducted by the American National Heart Institute found that oral administration of Nifedipine by people with a heart condition (which it is supposed to cure) increases their risk of developing a stroke, a heart attack and, thus, increases the likelihood of death. Therefore, the choice between the means for tocolysis, Ginipral or Nifedipine, uniquely for the doctor. And no initiative in this case is not appropriate.

Completely safe medications do not happen, you just need to be well aware of what the consequences of admission may threaten the pregnant patient. With the help of all these drugs, it was possible to delay childbirth and prevent a pregnancy from becoming disrupted. Many women have given birth to healthy babies and are grateful to the doctors for their intervention.

The doctors' comments, as usual, are ambiguous. They have instructions and recommendations on how to deal with complications of pregnancy, have experience with future mothers and experience with the use of drugs. There are even "favorite" medicines. Many patients notice that a particular doctor likes to prescribe a single drug, which he considers to be the most effective and safe. And the opinion of a doctor is often worth listening to. In addition, every future mother feels her condition and, if there are doubts, it is worth taking pills at all, that is, several options - to consult with another of the doctors. More rest, less nervous. There are cases when one suppository with Papaverin removed the tone of the myometrium and this state did not return any more.

To take or not to take ginipral during pregnancy will tell you your health, especially since this drug is intended for hospital conditions. Discuss with your doctor your doubts, if they exist, ask questions - the answer is born in the dialogue. So think with your head, be guided by your feelings and healthy children!