A drug that reduces the tone and contractile activity of the myometrium
Active substance
Hexoprenaline sulfate (hexoprenaline)
Release form, composition and packaging
Solution for intravenous administration transparent, colorless.
Excipients: sodium pyrosulfite, disodium edetate dihydrate, 2N sulfuric acid (to maintain pH level), water for injection.
2 ml - ampoules (5) - plastic trays (1) - cardboard boxes.
pharmachologic effect
Selective beta 2-adrenomimetic, reduces the tone and contractile activity of the myometrium. Reduces the frequency and intensity of uterine contractions, suppresses spontaneous and oxytocin-induced labor contractions. During childbirth, it normalizes excessively strong or irregular contractions.
Under the influence of the drug, premature contractions in most cases stop, which allows you to prolong pregnancy until the normal due date.
Due to its beta 2 selectivity, the drug has little effect on the activity and blood flow of the pregnant woman and the fetus.
Pharmacokinetics
Metabolism
The drug consists of two catecholamine groups that are methylated by COMT. Hexoprenaline becomes biologically inactive only if both catecholamine groups are methylated. This property, as well as the drug’s high ability to adhere to surfaces, are considered the reasons for its long-lasting effect.
Removal
It is excreted mainly in the urine unchanged and in the form of metabolites. During the first 4 hours after administration of the drug, 80% of the administered dose is excreted in the urine in the form of free hexoprenaline and monomethyl metabolite. Then the excretion of dimethyl metabolite and conjugated compounds (glucuronide and sulfate) increases. A small part is excreted in the bile in the form of complex metabolites.
Indications
Acute tocolysis
- inhibition of labor contractions during childbirth with acute intrauterine asphyxia, with immobilization of the uterus before caesarean section, before turning the fetus from a transverse position, with umbilical cord prolapse, with complicated labor;
— emergency measure in case of premature birth before taking the pregnant woman to the hospital.
Massive tocolysis
- inhibition of premature labor contractions in the presence of a smoothed cervix and/or dilatation of the uterine pharynx.
Long-term tocolysis
- prevention of premature birth during intensified or frequent contractions without cervical effacement or dilatation of the uterus;
— immobilization of the uterus before, during and after cervical cerclage.
Contraindications
- thyrotoxicosis;
- tachyarrhythmias;
- myocarditis;
- vice mitral valve And aortic stenosis;
- severe liver and kidney diseases;
- angle-closure glaucoma;
— uterine bleeding, premature placental abruption;
- intrauterine infections;
— I trimester of pregnancy;
- lactation (breastfeeding);
- hypersensitivity to the components of the drug (especially in patients with bronchial asthma and a history of sulfite hypersensitivity).
Dosage
The contents of the ampoule must be administered intravenously slowly over 5-10 minutes using automatically dosing infusion pumps or using conventional infusion systems - after diluting with isotonic sodium chloride solution to 10 ml. The dose of the drug should be selected individually.
At acute tocolysis the drug is prescribed in a dose of 10 mcg (1 amp. 2 ml). In the future, if necessary, treatment can be continued with infusions.
At massive tocolysis administration of the drug begins with 10 mcg (1 amp. 2 ml), followed by infusion of Ginipral at a rate of 0.3 mcg/min. As alternative treatment it is possible to use only infusions of the drug at a rate of 0.3 mcg/min without prior bolus administration of the drug.
At long-term tocolysis the drug is prescribed as a long-term drip infusion at a rate of 0.075 mcg/min.
If contractions do not resume within 48 hours, treatment with Ginipral 500 mcg tablets should be continued.
Side effects
From the nervous system: headache, dizziness, anxiety, slight tremor of fingers.
From the cardiovascular system: tachycardia in the mother (heart rate in the fetus remains unchanged in most cases), arterial hypotension (mainly diastolic); rarely - rhythm disturbances (ventricular extrasystole), cardialgia (quickly disappear after discontinuation of the drug).
From the outside digestive system: rarely - nausea, vomiting, decreased intestinal motility, intestinal obstruction(it is recommended to monitor bowel regularity), temporary increase in transaminase levels.
Allergic reactions: difficulty breathing, bronchospasm, impaired consciousness up to coma, anaphylactic shock(in patients with bronchial asthma or patients with hypersensitivity to sulfites).
From the laboratory parameters: hypokalemia, hypocalcemia at the beginning of therapy, increased plasma levels.
Others: increased sweating, oliguria, edema (especially in patients with kidney disease).
Side effects in newborns: hypoglycemia, acidosis.
Overdose
Symptoms: severe tachycardia in the mother, arrhythmia, finger tremor, headaches, increased sweating, anxiety, cardialgia, decreased blood pressure, shortness of breath.
Treatment: the use of Ginipral antagonists - non-selective, which completely neutralize the effect of the drug.
Drug interactions
At joint use with beta-blockers, the effect of Ginipral is weakened or neutralized.
When used together with methylxanthines (including ) the effectiveness of Ginipral increases.
When Ginipral is used together with GCS, the intensity of glycogen accumulation in the liver decreases.
When used together, Ginipral weakens the effect of oral hypoglycemic drugs.
When Ginipral is used together with other drugs with sympathomimetic activity (cardiovascular and bronchodilator drugs), it is possible to enhance the effect of the drugs on cardiovascular system and the appearance of overdose symptoms.
When used together with ftorotan and beta-agonists, they increase side effects Ginipral from the cardiovascular system.
Incompatible with ergot alkaloids, MAO inhibitors, tricyclic antidepressants, as well as with drugs containing calcium and vitamin D, dihydrotachysterol and mineralocorticoids.
Sulfite is a highly active component, so you should refrain from mixing Ginipral with solutions other than isotonic sodium chloride solution and 5% dextrose (glucose) solution.
special instructions
Patients with hypersensitivity In addition to sympathomimetics, Ginipral should be prescribed in small doses, selected individually, under constant medical supervision.
If there is a significant increase in the mother's heart rate (more than 130 beats/min) and/or with a significant decrease in blood pressure, the dose of the drug should be reduced.
If difficulty breathing, pain in the heart, or signs of heart failure occur, the use of Ginipral should be stopped immediately.
The use of Ginipral may cause an increase in blood glucose (especially in initial period treatment), therefore indicators should be monitored carbohydrate metabolism in mothers with diabetes mellitus. If childbirth occurs immediately after a course of treatment with Ginipral, it is necessary to consider the possibility of hypoglycemia and acidosis in newborns due to transplacental penetration of lactic and ketone acids.
When using Ginipral, diuresis decreases, so you should carefully monitor symptoms associated with fluid retention in the body.
In some cases, simultaneous use of GCS during Ginipral infusions may cause pulmonary edema. Therefore, when infusion therapy Constant close clinical monitoring of patients is necessary. This is especially important when combination treatment GCS in patients with kidney diseases. Strict limitation of excess fluid intake is necessary. Risk possible development Pulmonary edema requires limiting the volume of infusions as much as possible, as well as using dilution solutions that do not contain electrolytes. You should limit your salt intake from food.
Before starting tocolytic therapy, it is necessary to take potassium supplements, because with hypokalemia, the effect of sympathomimetics on the myocardium is enhanced.
Simultaneous use of drugs for general anesthesia(halothane) and sympathomimetics can lead to cardiac arrhythmias. Ginipral should be discontinued before using halothane.
With prolonged tocolytic therapy, it is necessary to monitor the condition of the fetoplacental complex and ensure that there is no placental abruption. Clinical symptoms premature placental abruption can be smoothed out with tocolytic therapy. When the membranes rupture and when the cervix is dilated by more than 2-3 cm, the effectiveness of tocolytic therapy is low.
During tocolytic therapy with the use of beta-agonists, the symptoms of concomitant dystrophic myotonia may intensify. In such cases, the use of diphenylhydantoin (phenytoin) drugs is recommended.
Pregnancy and lactation
The drug is contraindicated for use in the first trimester of pregnancy and lactation ( breastfeeding). In the second and third trimesters of pregnancy, the drug is used according to indications.
Instructions for medical use drug
Description of pharmacological action
Indications for use
Injection
Acute tocolysis:
- inhibition of labor contractions during childbirth with acute intrauterine asphyxia;
- immobilization of the uterus before cesarean section, before turning the fetus from a transverse position, with umbilical cord prolapse, with complicated labor;
- as an emergency measure in case of premature birth before taking the pregnant woman to the hospital.
Massive tocolysis
- inhibition of premature labor contractions in the presence of a smoothed cervix and/or dilatation of the uterine pharynx.
Long-term tocolysis
Prevention of premature birth when contractions intensify or become more frequent in the absence of shortening of the cervix or dilatation of the uterus;
- immobilization of the uterus before, during and after cervical cerclage.
Release form
tablets 0.5 mg; blister 10 cardboard pack 2;
Tablets 0.5 mg; drum 125000 aluminum foil bag (bag) 1;
Pharmacodynamics
Relaxes the muscles of the uterus, reduces the frequency and intensity of contractions, suppresses spontaneous and oxytocin-induced labor contractions. During childbirth, it normalizes the strength and regularity of contractions, suppresses (in most cases) premature contractions and helps prolong pregnancy until the normal due date. Has little effect on the cardiovascular system of the pregnant woman and fetus.
Pharmacokinetics
When taken orally, it is well absorbed. It is excreted in the form of a dimethylated derivative in the urine and in the bile - in the form of complex metabolites.
Ginipral® consists of 2 catecholamine groups, which in the human body undergo methylation via catecholamine-O-methyltransferase. Hexoprenaline becomes biologically inactive only if both of its catecholamine groups are methylated. When administered intrabronchially, 3H-labeled hexoprenaline is excreted in the urine in the form of a biologically active substance for a relatively long time. Part of the injected substance remains active at the injection site for quite a long time.
Use during pregnancy
Contraindicated in the first trimester of pregnancy. Breastfeeding should be stopped during treatment.
Contraindications for use
Hypersensitivity (especially in patients suffering from bronchial asthma and hypersensitivity to sulfites);
- thyrotoxicosis;
- cardiovascular diseases, especially cardiac arrhythmias occurring with tachycardia; myocarditis, mitral valve disease and aortic stenosis;
- IHD;
- arterial hypertension;
- severe liver and kidney diseases;
- angle-closure glaucoma;
- premature placental abruption, uterine bleeding, intrauterine infections;
- pregnancy (first trimester);
- lactation period.
Side effects
Dizziness, anxiety, slight tremor of the fingers, increased sweating, tachycardia, headache, increased activity of liver enzymes.
A decrease in blood pressure, especially diastolic, is possible. In some cases, nausea and vomiting develop.
In rare cases - ventricular extrasystole, pain in the heart (cardialgia). These symptoms disappear quickly after stopping the drug.
Blood sugar levels increase due to the glycogenolytic effect of the drug (especially in diabetes).
Diuresis decreases at the beginning of treatment. In patients with a tendency to retain fluid in the tissues, this can lead to edema.
During treatment with Ginipral®, the intensity of intestinal motility may decrease (pay attention to the regularity of stool).
In newborns - hypoglycemia, acidosis, bronchospasm, anaphylactic shock.
Directions for use and doses
Inside, with a small amount of water.
Threat of premature birth: 1–2 hours before the end of the Ginipral® infusion, start taking tablets at a dose of 0.5 mg (1 tablet) every 3 hours, then every 4–6 hours (4–8 tablets per day).
Overdose
Symptoms: anxiety, tremor, increased sweating, severe tachycardia, arrhythmia, headaches, cardialgia, decreased blood pressure, shortness of breath.
Treatment: use of Ginipral® antagonists - non-selective β-blockers that completely neutralize its effect.
Interactions with other drugs
A number of drugs that lower blood pressure (β-blockers) weaken the effect of Ginipral® or neutralize it.
Methylxanthines (for example theophylline) enhance the effect of Ginipral®.
The effect of oral hypoglycemic agents during therapy with Ginipral® is weakened.
General anesthesia (halothane) and adrenergic stimulants (cardiovascular and anti-asthmatic drugs) increase side effects from the cardiovascular system.
Ginipral® is incompatible with ergot alkaloid, MAO inhibitors, tricyclic antidepressants, as well as mineralocorticoids, dihydrotachysterol and preparations containing calcium and vitamin D.
Special instructions for use
Blood pressure, pulse and cardiac activity should be under constant medical supervision.
In patients with diabetes, blood sugar levels should be monitored.
Under the influence of Ginipral®, diuresis decreases, so you should carefully monitor symptoms reflecting fluid retention in the body (for example, swelling of the legs, difficulty breathing). This is especially important in the case of simultaneous use of corticosteroids or in cases of kidney disease.
Strict limitation of excess fluid intake is necessary.
You should limit your salt intake from food.
During tocolytic treatment, it is necessary to monitor bowel movements.
With prolonged tocolytic therapy, it is necessary to monitor the state of the fetoplacental complex. When the membranes rupture and when the cervix is dilated by more than 2–3 cm, the effectiveness of tocolytic therapy is low.
If necessary surgical intervention the anesthesiologist should be informed about therapy with Ginipral®.
It is necessary to take into account the use of any other drugs when prescribing therapy with Ginipral®.
Coffee and tea may increase the side effects of Ginipral®.
You should immediately inform your doctor about contraindications or the development of side effects.
Storage conditions
List B.: In a dark place, at a temperature of 18–25 °C.
Best before date
ATX classification:
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Many pregnant women think with horror about increasing the tone of the uterus - and for good reason. This is very dangerous condition during gestation. It may be accompanied by pathology - strong contractions of the uterine muscles. To treat this condition, doctors usually prescribe medications such as Ginipral during pregnancy. After all, uterine contractions can lead to trouble.
Most often, spontaneous miscarriage or premature birth occurs. It is impossible to prevent or even predict such a problem. It is important to carefully look and listen to changes in your body in order to recognize the alarm bell in time.
Timely seeking help from doctors will help avoid dire consequences. Gynecologists have been practicing the use of the drug "Ginipral" for many years - it is approved for women, but has a number of contraindications and some side effects if taken incorrectly. Most often, it is taken as insurance for maintaining a pregnancy or postponing an unplanned birth.
Uterine tone in late pregnancy is a pressing issue
Features of the drug Ginipral for pregnant women: composition, therapeutic properties, dosage forms
The pharmaceutical group is a tocolytic agent that relaxes the smooth muscles of the uterine cavity due to the synthesis of the hormone norepinephrine (secreted by the adrenal glands). It is thanks to this substance that the appearance of hypertension can be avoided. The uterus returns to its usual relaxed state, which reduces the risk of miscarriage or premature birth.
If you start a course of treatment with the drug on time, there is a good chance of carrying and giving birth to a child on time, since the drug is able to suppress early contractions. This in turn helps stimulate the baby's lungs to develop faster. Hexoprineline sulfate is the active component of the drug; if you ensure a sufficient amount of it in the blood, you can get a longer effect from use.
When first treating hypertension, doctors often use a drug concentrate - an infusion liquid is prepared using it. After treatment in case of positive results, the patient is prescribed a course of pills to further maintain the uterus in a normal condition.
Ginipral is an excellent absorbent; the effect of taking it appears 5 to 10 minutes after injection into a vein and lasts about half an hour.
The maximum effect occurs between 10 and 20 minutes after administration. The drug will be excreted from the pregnant woman’s body within a week, with bile and urine. The medicine comes in three forms: tablets, intravenous solution and concentrate used for droppers. The active substance remains the same, but the excipients are different.
The tablets are produced in round shape, white, 10 pieces in a blister. In the composition you can find such auxiliary known substances as:
- magnesium;
- talc;
- glycerol;
- starch;
- lactose.
Solution for intravenous administration Sold in sealed ampoules with a total volume of 2 ml. Each ampoules contains the substance hexoprineline, the concentration of which is 10 mcg. There is no need to dilute the solution; it is completely ready for use. There are 5 ampoules in one cardboard package. What is in the ampoule besides the active ingredient:
- pure water for injection;
- sodium sulfate;
- disodium edetate.
The drug concentrate is used for droppers and looks like a colorless liquid. It contains a high content of hexoprineline - almost 25 mcg. The concentrate must be diluted in pure form it is not used. Pre-dilute in water for injection and add to the infusion solution. Additional components:
- sodium chloride;
- pure water;
- sulfuric acid.
The effect of Ginipral during pregnancy on the condition of the fetus
The drug is allowed during pregnancy, but it should not be abused - it is not safe. But if uterine hypertonicity occurs, this is the only option for treating and preventing premature birth or miscarriage.
The prescription of Ginipral must be justified by the risk of fetal loss
The main danger of using Ginepral is the penetration of the drug through the placenta barrier into the baby’s blood - with prolonged uncontrolled use, this can affect the baby’s cardiovascular system. What could be the consequences:
- heart pathology – too frequent heartbeat;
- heart disease (heart muscle);
- glucose levels decrease;
- spasms occur in the bronchi;
- acidosis;
- on the first day after birth, the child may develop anaphylactic shock;
- difficult and intermittent breathing after childbirth.
Ginipral during pregnancy: why is the drug prescribed?
If the patient does not have any contraindications (gynecological or general medical), tocolytic therapy can be performed. It is allowed to take the medicine during pregnancy from 22 to 36 weeks, taking into account the range of indications for use.
It is prohibited to use Ginipral during pregnancy of less than 20 weeks.
The dosage form in the form of tablets should be taken after treatment. intravenous injections, as a continuation of the course. Indications: threat of early delivery.
You can take tablets as prescribed by your doctor to maintain the effect (after the myometrium has stabilized). If hypertonicity is moderate, you can manage only by taking pills, without supplementing with infusion therapy.
In what cases are there indications for the use of liquids with the active substance (concentrate and solutions for intravenous injection):
- short-term preliminary treatment of preterm labor, without worsening general condition and complications;
- if the fetus is in a transverse presentation, when it is turned over;
- if a woman in labor needs to be transported, as an urgent measure for uterine tone.
In a pregnant woman, the solution is used intravenously if there are such indications for tocolysis:
- if the fetus has severe hypoxia and at the same time acute tocolysis (frequent and severe contractions). To prevent the death of the unborn child, the solution is urgently injected into a vein, and active substance dilates the vessels in the uterus (due to contractions when they become smaller);
- massive tocolysis - injected into a vein to stop serious and frequent contractions when the uterus is fully dilated;
- prolonged spasms (tocolysis) when stopping early gestation, if the pregnancy period is from 20 to 34 weeks;
- Another indication: if there are stitches on the cervix. It is used to preserve pregnancy and continue safe pregnancy.
Ginipral is prescribed in cases where there are stitches on the uterus, for example, after a caesarean section
It is worth remembering that Ginpral is not taken in the first trimester: it can harm the fetus without having the desired effect on the problem or reducing uterine hypertonicity.
This phenomenon can be explained by the fact that the receptors affected by the drug begin to form by the 20th week of pregnancy.
If hypertonicity occurs in the first three months, the doctor is obliged to choose another effective and safe solution.
Ginipral: instructions for use during pregnancy
If a pregnant woman has been prescribed to take this medicinal substance, then reducing, increasing the dosage or replacing it with analogues is strictly prohibited. This is a very serious drug that can cause complications or side effects if the course of treatment is not calculated correctly.
Dosage of Ginipral during pregnancy: dropper and tablets
Accepted norm intravenous solution– 10 mg. The concentrate is diluted in sodium chloride and carefully and slowly injected into a vein using a syringe. Permitted dose per day: 2 ampoules. To bring the condition back to normal and stabilize it after a jet injection of the solution inside, a concentrate is used for infusion. The rate of administration is 0.06 mcg/min.
The drug Ginipral can be prescribed in the form of droppers
Infusions cannot be used continuously. When the pregnant woman’s condition returns to normal and the hypertonicity disappears, the droppers are replaced with tablets. How to take infusion tablets correctly? 60 minutes before the end of the procedure, one tablet is taken orally every 2 to 3 hours. If the condition is normal, you can drink 2 pieces per day.
The tablet should not be chewed; it should be swallowed whole and washed down with plenty of water.
Side effects
Taking medication uncontrolled by a doctor can lead to undesirable consequences for the body of a pregnant woman:
- violations psychological health: severe dizziness and pain, sweating increases and a feeling of anxiety appears;
- allergic reactions: state of shock, difficulty breathing;
- heartache;
- vomiting, diarrhea, nausea;
- swelling, lack of microelements in the blood, high level glucose.
How will this affect the health of the unborn baby? The consequences can be very different: bronchospasm, acidosis or glycemia.
The main thing in the treatment process is to strictly follow all the doctors’ recommendations.
Restrictions
For the use of the drug there may be the most various diseases history, which the attending physician must know about. In order to exclude such problems in the future, it is important to take into account all risk factors and thoroughly study the pregnancy history. If any drug is taken at the same time, the doctor must know about it in order to exclude negative interaction with other components.
If you are taking Ginipral, you should exclude certain medications or substances, such as vitamin D
Interaction
There are some potent substances with which hexoprenaline should never be used: dopamine, calcium, vitamin D, antidepressants or adrenaline receptor blockers.
Ginipral during pregnancy: instructions for discontinuing the drug
Canceling a course of treatment must be done carefully: gradually reduce the amount of the drug, avoiding sudden jumps. Dose reduction is optimal when done slowly. Every few days the number of tablets is reduced by one. Later - half a tablet.
Example: a woman takes Ginipral during pregnancy in the amount of 6 tablets per day. To discontinue the drug, she should reduce the dose by 1 tablet every two days. When the amount reaches two tablets per day, the woman should reduce the dose by another half tablet. And so on every two days until Ginipral is completely discontinued.
According to the instructions, the duration of treatment is up to 33 weeks or longer.
Contraindications to the use of Ginipral
If a pregnant woman is intolerant to the main active ingredient, the drug is not prescribed. For what diseases is the drug contraindicated:
- threat of miscarriage during the 1st or 2nd trimester of gestation;
- when the cervix dilates more than 5 cm;
- in case of rupture of the membrane around the fetus;
- kidney or liver problems;
- bronchial asthma;
- serious and complex diseases that threaten the health of the mother and child and in which pregnancy cannot be continued. It could be infection reproductive system, ischemia or bleeding;
- glaucoma;
- problems with heart vascular system, tachycardia;
- serious illness suffered before the 20th week of pregnancy;
- ever suffered miscarriages or abortions, death of a child in utero or other problems with pregnancy.
If a woman has acute sulfate intolerance, Ginipral should not be used.
Features of the use of Ginipral
During treatment with Ginipral, the doctor must monitor and examine the patient
Before prescribing to a pregnant woman this medicine, the patient’s condition is assessed according to all criteria. There is an assessment between benefit and harm for the expectant mother and child. The course of treatment is carried out only in a hospital setting, under the constant supervision of the attending physician. It is necessary to regularly measure the heartbeat and general well-being of the fetus and the pregnant woman.
How health status is monitored:
- heart rate and blood pressure are monitored. The fact is that heart contractions increase significantly, up to 50 beats per minute, and the dosage must be appropriate. If the medicine is administered intravenously, then blood pressure must be constantly monitored;
- clinically measure lactose and glucose and their content in the blood. Such drugs can significantly increase blood glucose levels. If a pregnant woman has diabetes mellitus, the insulin dose must also be adjusted when treating hypertension;
- During multiple pregnancies, extensive pulmonary edema is often observed. To avoid this trouble, you need to control your water-electrolyte balance;
- prevention of potassium deficiency in blood serum. If the problem already exists, it is important to carry out appropriate therapy.
"Ginipral" and "Verapamil"
For some patients, to eliminate the problem increased tone smooth muscles of the uterus, two drugs are prescribed in combination: Ginipral and Verapamil. Why might these two drugs be prescribed at the same time?
One of the side effects of Ginipral is increased heart rate.
The reason lies in the following: the first mentioned substance can often be heard as a complaint of rapid heartbeat. It can be eliminated by the second drug listed above - Verapamil. Another property of it: it is also able to reduce uterine contractions.
How to take Verapamil correctly: 20 minutes before taking Ginipral, with plenty of water.
Possible side effects after taking Ginipral
Why might side effects occur while taking tocolytics? This is due to the pharmacological characteristics of the drug. In order to avoid these unpleasant moments, you should regularly measure your blood pressure and follow a clearly standardized dosage. When the course of treatment ends, all unpleasant side effects disappear without a trace.
What may occur while taking it? medicinal product:
- fat metabolism is disrupted;
- there is an acute lack of potassium;
- the lungs may swell;
- legs and arms swell;
- spasms appear in the bronchi;
- rashes on the skin, the dermis may peel and itch;
- attacks of arrhythmia;
- diarrhea and nausea, possible vomiting;
- disruptions in the gastrointestinal tract.
The drug is used with extreme caution in patients with diabetes mellitus - hyperkalemia may develop. Patients may complain of increased heart rate, severe pain V temporal region, constipation and dizziness.
Patients with diabetes mellitus may need to change their insulin dose when taking Ginipral.
If a woman suffers from asthma attacks, she may experience wheezing and state of shock.
If the drug was taken several hours before birth, it is important to examine the newborn baby and conduct tests to detect ketone bodies.
What can replace Ginipral during pregnancy?
There are several pharmaceuticals, similar in composition: “Ipradol” and “Hexoprenaline”. There are also recognized medicines that have a similar active ingredient and similar therapeutic effect: "Partusitsen" and "Magnesia".
Ginipral during pregnancy - reviews
There are much more positive comments about the use of Ginipral than negative ones. Patients highlight the immediate effect, which helped many to maintain a normal pregnancy, carry and give birth to a healthy child.
Prevention of premature birth is a very important advantage of the drug. If you take pills or give an injection in the required dosage, the drug instantly relieves even the strongest contractions of the uterus.
Of course, like any medicine, Ginipral also has a number of negative aspects, which should also be taken into account before taking it. Many pregnant women experience severe discomfort for some time immediately after taking the pills internally, the first 40 to 45 minutes.
After this period of time discomfort passed without a trace. However, these disadvantages seem insignificant against the background of the enormous advantages. It can be concluded that Ginipral during pregnancy is effective and fast acting medicine, allowing you to carry your baby to the due date.
How is childbirth after taking Ginipral?
Women taking the drug usually gave birth on the date specified by the specialist ultrasound examination period, waiting for natural contractions. But the process itself occurs individually for everyone. It is possible to give birth calmly and without problems to that category of women in labor who were treated with Ginepral with very strong uterine tone. Labor activity began on time - most often, 3 weeks after stopping the course of treatment.
The second half of pregnant women carry the child until 42 weeks and are admitted to the hospital, since natural contractions did not occur. To stimulate contractions, they are given a drug, most often oxytocin. If it is not suitable, other methods are selected.
If the cervix is fully dilated, but there are no contractions, the patient is prepared for surgery. In this case, a caesarean section is urgently required.
Often, this substance is the only way to carry and safely give birth to a child, so it is recommended to listen to the opinion of specialists.
Prevention of uterine hypertonicity
If the doctor has diagnosed increased tension in the smooth muscles and uterine walls, the pregnant woman is prescribed a calm environment, minimal stress, no worries or stress.
The main thing is to take the prescribed medicine on time and as prescribed. During the course of treatment it is strictly forbidden to have sexual intercourse. To reduce the voltage by abdominal walls, it is best to lie down a lot and keep a bolster or rolled blanket under your knees.
Shoes during short permitted walks should be as comfortable as possible - without a hint of heels or high platforms. If a woman has chronic diseases, then it is necessary to begin their treatment as quickly as possible.
Peace of mind and correct lifestyle - best prevention for a pregnant woman
During the course of treatment, it is recommended to visit less crowded places. If we talk about food and menus at the time of treatment, then a pregnant woman needs to eat a lot of foods high in magnesium. You can take vitamins, a complex or one microelement. Magnesium will help reduce hypertension, reducing the excitability of the nervous system.
INSTRUCTIONS
on medical use of the drug
Ginipral
(GYNIPRAL)
Compound:
active ingredient: hexoprenaline;
1 tablet contains 0.5 mg of hexoprenaline sulfate;
Excipients: lactose, corn starch, previously latinized starch, copovidone, Trilon B (trilon B), talc, glycerol distearate, magnesium stearate.
Dosage form. Pills.
Pharmacotherapeutic group.
Products for use in gynecology. Sympathomimetics that suppress uterine contractility. ATC code G02С A 05.
Indications.
Threat of premature birth (primarily as a continuation of other fusion therapies).
Contraindications.
Hypersensitivity to the components of the drug, increased sensitivity to sulfites; thyrotoxicosis; cardiovascular diseases, ischemic disease heart, arterial hypertension, disorders heart rate, occurring with tachycardia, myocarditis, mitral valve disease and idiopathic hypertrophic subaortic stenosis; severe liver and kidney diseases; closed angle glaucoma; uterine bleeding, premature placental abruption; internal uterine infections.
Directions for use and doses
Use orally. The tablets are swallowed whole with water.
1-2 hours before stopping the Ginipral infusion, start taking tablets.
Take 1 tablet every 3 hours first, then every 4-6 hours
(From 4 to 8 Ginipral tablets per day).
Adverse reactions
Ginipral is usually well tolerated by patients.
While taking Ginipral, headache, anxiety, slight tremor of the fingers, sweating, palpitation, tachycardia, dizziness, and in rare cases, nausea and vomiting may develop.
Sometimes there may be redness of the skin.
There may be a slight increase in heart rate (HR), a decrease blood pressure, especially diastolic.
Isolated cases of heart rhythm disturbances (ventricular extrasystole) and complaints of chest pain were recorded. These symptoms disappear quickly after stopping the drug.
Blood sugar levels, especially in diabetes, increase due to the glycogen-lytic effect of the drug.
Diuresis decreases, especially at the beginning of treatment. Sometimes there was a temporary decrease in potassium levels (at the beginning of treatment) and an increase in the concentration of transaminases in the blood serum.
During treatment with Ginipral, the intensity of intestinal motility may decrease. In rare cases, intestinal atony was observed (control of stool regularity is necessary).
In newborns, hypoglycemia and acidosis, bronchospasm, and anaphylactic shock may occur.
Overdose.
Symptoms: severe tachycardia, tremor, headache, dizziness, increased sweating, arrhythmia, anxiety, cardialgia, decreased blood pressure, shortness of breath.
Treatments. Usually to eliminate side effects a reduction in the dosage of the drug is sufficient. For elimination severe symptoms It is recommended to use non-selective beta-blockers, which completely neutralize the effect of Ginipral.
Use during pregnancy or breastfeeding.
Ginipral is prescribed for use during pregnancy (see section "Indications").
The drug is not prescribed for use during breastfeeding.
Children. The drug is not used for children.
Features of application. During treatment, blood pressure, pulse, cardiac activity, and fetal heartbeat should be constantly monitored.
Patients with hypersensitivity to sympathomimetics should use Ginipral in small doses prescribed individually, under constant medical supervision.
If there is a significant increase in the mother's heart rate (more than 130 beats/min) and/or a significant decrease in blood pressure, the dose should be reduced; if there are complaints of difficulty breathing, pain in the heart and if signs of heart failure appear, the use of the drug should be discontinued.
When treating patients with diabetes, it is necessary to monitor carbohydrate metabolism, since the use of Ginipral, especially on initial stage treatment may cause an increase in blood sugar.
If birth occurs immediately after a course of treatment with Ginipral, it is necessary to consider the possibility of hypoglycemia and acidosis in the newborn due to penetration acidic foods metabolism (milk and ketone compounds).
When using the drug, diuresis decreases, so it is necessary to control vata for symptoms associated with fluid retention in the body.
In some cases, simultaneous use of corticosteroids during drug infusions can cause pulmonary edema. This is especially important during combined treatment with corticosteroids in patients with concomitant diseases that lead to fluid retention (kidney disease, early toxicosis of pregnancy).
Before starting tocolytic therapy, it is necessary to take potassium supplements, since with hypokalemia the effect of sympathomimetics on the myocardium is enhanced.
Simultaneous use of some narcotic drugs(eg, halothane) and sympathomimetics may cause cardiac arrhythmias; must be prevented joint reception with these drugs.
With prolonged tocolytic therapy, it is necessary to monitor the condition of the fetoplacental complex and ensure that there is no placental abruption. Clinical symptoms of premature placental abruption can be smoothed out with tocolytic therapy.
When the membranes rupture and when the cervix is dilated by more than 2-3 cm, the effectiveness of tocolytic therapy is low.
During tocolytic treatment with beta-agonists, the symptoms of concomitant dystrophic myotonia may increase. In such cases, the use of diphenylhydantoin (phenytoin) drugs is recommended.
Patients with rare hereditary galactose intolerance, lactase deficiency or glucose-galactose malabsorption should not use the drug.
During tocolytic treatment, it is necessary to control the release of the intestines.
Coffee and tea may increase the side effects of Ginipral.
The ability to influence the reaction speed when driving vehicles or other mechanisms.
Some adverse reactions from the central nervous system in individual cases may affect the ability to drive vehicles or operate machinery.
Interaction with others medicines and other types of interactions.
Non-selective beta-blockers weaken or neutralize the effect of Ginipral.
Methylxanthine (for example, theophylline) enhances the effect of Ginipral.
The intensity of glycogen accumulation in the liver caused by the use of GCS is reduced under the influence of Ginipral.
The effect of oral hypoglycemic agents during therapy with Ginipral is weakened.
Concomitant treatment with certain sympathomimetic drugs (cardiovascular and anti-asthmatic drugs) should not be carried out, since the effect of drugs on the cardiovascular system is enhanced and the risk of occurrence of adverse reactions due to overdose.
Ginipral should not be used in conjunction with drugs containing ergot alkaloids, as well as with drugs containing calcium, vitamin D, dihydrotachysterol and mineralcorticoids, as well as with MAO inhibitors, tricyclic antidepressants.
General anesthesia (fluorotane) and adrenergic stimulants increase side effects on the cardiovascular system.
Pharmacological properties.
Pharmacological
Ginipral is a selective beta-2 sympathomimetic that relaxes the uterine muscles. Under the influence of Ginipral, the frequency and intensity of uterine contractions decreases. The drug suppresses spontaneous and oxytocin-induced labor contractions. During childbirth, it normalizes very strong or irregular contractions. Under the influence of Ginipral, premature contractions stop in most cases, which makes it possible to prolong pregnancy until the normal due date. Suppression of labor contractions is observed immediately after intravenous administration of the drug and lasts approximately 20 minutes. The effect of the drug is prolonged after subsequent drip administration of the drug. Due to its beta-2 selectivity, Ginipral has a slight effect on cardiac activity and blood flow in the pregnant woman and fetus.
Pharmacokinetics
The drug consists of two catecholamine groups, which in the human body undergo a methylation process due to catecholamine-O-methyltransferase. While the action of isoprenaline is almost completely abolished by the introduction of one methyl group, hexoprenaline becomes biologically inactive only if both of its catecholamine groups are methylated. This property, as well as the high ability of Ginipral to adhesive to the surface, is considered the reason for its long long acting.
When using hexoprenaline during the first 4 hours 80% active substances excreted in the urine unchanged, that is, in the form of free hexoprenaline and monomethyl derivative. After this, the excretion of dimethyl derivative and related compounds (glucuronide and sulfate) increases. A small part is excreted in the bile in the form of complex metabolites.
Pharmaceutical characteristics.
Basic physical and chemical properties: white, round, biconvex.
Best before date. 5 years.
Storage conditions. Store at a temperature not exceeding 25 º C in a place protected from light and out of reach of children.
Package. 10 tablets in a blister. 2 blisters in a cardboard box.
Photo of the drug
Latin name: Gynipral
ATX code: G02CA05
Active substance: Hexoprenaline
Manufacturer: MbH GLOBOPHARM Pharmazeutische Produktions- und Handelsgesellschaft (Austria), Takeda (Germany), GmbH Nycomed Austria (Austria)
Description is valid on: 05.12.17
Ginipral is a selective beta2-blocker used in obstetric practice.
Active substance
Hexoprenaline.
Release form and composition
Available in two dosage forms.
- Tablets are white, round, biconvex. Packed in blisters of 10 jokes.
- The solution for intravenous administration is a clear, colorless liquid. Packaged in ampoules of 2 ml.
Indications for use
Threat of premature birth (continuation of infusion therapy).
The solution for intravenous administration is used in the following situations:
- acute tocolysis (inhibition of labor contractions during complicated childbirth, immobilization of the uterus before cesarean section, acute intrauterine asphyxia, umbilical cord prolapse, before turning the child from a transverse position);
- an emergency measure before delivering a woman to the maternity hospital in case of premature birth;
- massive tocolysis (inhibition of premature contractions when the uterus is dilated or the cervix is smooth);
- long-term tocolysis (immobilization of the uterus before, during, and after cervical cerclage);
- prevention of premature birth with frequent or intensified contractions without opening the throat or smoothing the cervix.
Contraindications
- myocarditis;
- tachyarrhythmias;
- cardiac ischemia;
- arterial hypertension;
- aortic stenosis and mitral valve disease;
- thyrotoxicosis;
- angle-closure glaucoma;
- uterine bleeding;
- premature placental abruption;
- intrauterine infections;
- severe liver and kidney diseases;
- hypersensitivity to the components of the drug.
Contraindicated in the first trimester of pregnancy and lactation.
Instructions for use Ginipral (method and dosage)
The tablets are taken orally with a small amount of water.
If there is a threat of premature birth: 500 mcg (1 tablet) 1 – 2 hours before the end of the infusion.
The drug should be taken 1 tablet first. every 3 hours, and then every 4 - 6 hours.
Daily dose: 2 – 4 mg (4 – 8 tablets).
The solution is administered intravenously, slowly over 5 to 10 minutes using automatically dosing infusion pumps or using conventional infusion systems. The contents of the ampoule are diluted with isotonic sodium chloride solution to 10 ml. The dose of the drug is selected individually.
- For acute tocolysis: 10 mcg (1 amp. 2 ml). If necessary, treatment can be continued with infusions.
- For massive tocolysis: 10 mcg (1 amp. 2 ml) followed by infusion at a rate of 0.3 mcg per minute.
- Alternative option: only infusion of the drug at a rate of 0.3 mcg per minute without prior bolus administration.
- For long-term tocolysis: long-term drip infusion at a rate of 0.075 mcg per minute.
If there are no contractions within 48 hours, 500 mcg tablets should be added.
Side effects
The use of Ginipral may cause the following side effects:
- Cardiovascular system: arterial hypotension in the mother, tachycardia, cardialgia, cardiac arrhythmia (ventricular extrasystole).
- Central and peripheral nervous system: dizziness, headache, slight tremor of fingers, anxiety.
- Gastrointestinal tract: inhibition of intestinal motility, nausea, vomiting, intestinal obstruction, temporary increase in transaminase concentrations.
- Laboratory indicators: hypocalcemia (at the beginning of treatment), hypokalemia, increased blood glucose concentration.
- Allergic reactions: bronchospasm, difficulty breathing, anaphylactic shock, impaired consciousness (sometimes up to coma).
- Other: edema, oliguria, increased sweating.
Side effects in newborns include acidosis and hypoglycemia.
Overdose
An overdose of Ginipral is accompanied by the following symptoms:
- maternal arrhythmia;
- severe tachycardia;
- decreased blood pressure;
- cardialgia;
- headache;
- anxiety;
- increased sweating.
Treatment of overdose involves the use of drug antagonists, which include non-selective beta-blockers, which completely neutralize the effect of the drug.
Analogues
Analogs by ATX code: Ipradol.
Do not decide to change the drug on your own; consult your doctor.
pharmachologic effect
- Ginipral is a selective beta 2-adrenergic agonist that reduces the tone and contractile activity of the myometrium. The active ingredient, hexoprenaline, reduces the frequency and intensity of uterine contractions, inhibits spontaneous and oxytocin-induced labor contractions. During childbirth, it normalizes excessively strong or irregular contractions.
- The action of the drug is aimed at stopping premature contractions, which allows you to prolong pregnancy until the normal due date.
- Able to have a slight effect on cardiac activity and blood flow of a pregnant woman and fetus. This phenomenon is associated with the beta 2 selectivity of the active substance.
- It is excreted mainly in the urine unchanged and in the form of metabolites. A small part is excreted in the bile in the form of complex metabolites.
special instructions
- For patients with hypersensitivity to sympathomimetics, the drug should be prescribed in minimal doses, selected individually. In this situation, hexoprenaline is used under constant medical supervision.
- During the treatment period, careful monitoring of the functions of the cardiovascular system (blood pressure, heart rate) of both mother and child should be carried out. It is recommended to record an electrocardiogram before and during therapy. If there is a marked decrease in blood pressure or a significant increase in heart rate, the dose should be reduced.
- If cardialgia, difficulty breathing or symptoms of heart failure occur, treatment with Ginipral should be stopped immediately.
- The use of the drug helps reduce diuresis, so the patient should carefully monitor signs indicating fluid retention in the body.
- During therapy, regular monitoring of intestinal activity is necessary.
- The use of hexoprenaline can lead to an increase in blood glucose concentrations, so mothers with diabetes require control of carbohydrate metabolism. Combining the drug with glucocorticosteroids can lead to pulmonary edema (especially in patients suffering from kidney disease).
- During treatment, strict restriction of fluid intake is necessary. Also, you should limit your salt intake.
- Before starting tocolytic treatment, potassium supplements should be taken, since the effect of sympathomimetics on the heart muscle is enhanced by hypokalemia. With long-term tocolytic treatment, it is necessary to monitor the state of the fetoplacental complex, and also make sure that there is no placental abruption.
- The simultaneous use of sympathomimetics and anesthesia drugs can provoke cardiac arrhythmias.
- Before using halothane, drug use should be discontinued.
- Tocolytic therapy in combination with beta-agonists causes an increase in the symptoms of concomitant dystrophic myotonia. In this situation, it is recommended to resort to diphenylhydantoin drugs.
- The use of tablets with coffee or tea leads to increased side effects of the drug.
During pregnancy and breastfeeding
Contraindicated in the first trimester of pregnancy and breastfeeding.
In the second and third trimesters of pregnancy, it is used according to indications.
In childhood
Information is absent.
In old age
Information is absent.
For impaired renal function
Contraindicated in serious illnesses kidney
For liver dysfunction
Contraindicated in severe liver diseases.
Drug interactions
- Joint use with beta-blockers weakens or neutralizes the effect of the drug.
- Combined use with methylxanthines (including theophylline) enhances the effectiveness of the drug.
- Simultaneous use with GCS reduces the intensity of glycogen accumulation in the liver.
- Simultaneous use with oral hypoglycemic drugs weakens the effect of the latter.
- Concomitant use with other drugs with sympathomimetic activity (cardiovascular and bronchodilator drugs) may enhance the effect on the cardiovascular system and cause overdose symptoms.
- Combined use with ftorotan and beta-agonists increases side effects from the cardiovascular system.
- Incompatible with ergot alkaloids, MAO inhibitors, tricyclic antidepressants, as well as with drugs containing calcium and vitamin D, dihydrotachysterol and mineralocorticoids.
- During therapy with the drug, you should refrain from mixing with solutions other than isotonic sodium chloride solution and 5% dextrose (glucose) solution.
