Adult Dosing
Cervical ripening
- Insert: Place in the posterior fornix of vagina; remove at the onset of labor or after 12 hrs after insertion
- Gel: Apply 0.5 mg to cervix; if desired response is not obtained repeat 0.5 mg q6 hrs to a Max 1.5 mg/24 hr
Note:
- After applying gel patient should be remain in supine position for 15-30 minutes to minimize leakage from the cervical canal
Second trimester abortions, evacuation of the uterus in cases of missed abortion, intrauterine fetal death, and benign hydatidiform mole
- Insert 20 mg SUPP high into vagina. May be repeated q2-5 hrs interval until abortion occurs
- MAX: 2 days
Note:- After using suppository patient should be remain in supine position for 10 minutes
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
- It should be administered only by trained obstetrical personnel in a hospital setting with appropriate obstetrical care facilities [US Black Box Warning]
- Increased risk of postpartum disseminated intravascular coagulation have been seen in pregnant patient with gestational age over 40 wks, caution should be exercised and measure fibrinolysis as soon as possible in the immediate post-partum period
- Use of drug may cause inadvertent disruption and subsequent embolization of antigenic tissue which may lead to development of anaphylactoid syndrome of pregnancy (amniotic fluid embolism), physician should remain alert during use
- Remove dinoprostone prior to amniotomy and oxytocin administration, and carefully monitor uterine activity for uterine hyperstimulation
- Contraindicated in patient with history of cesarean section or major uterine surgery
- Carefully monitor uterine activity, fetal status and the progression of cervical dilatation and effacement
- Remove vaginal insert during any evidence of uterine hyperstimulation, sustained uterine contractions, fetal distress, or other fetal or maternal adverse reactions
- Increase in temperature has occurred but return to normal on discontinuation of drug
Cautions: Use cautiously in
- Cervical ripening in patients with ruptured membranes
- History of previous uterine hypertony
- Glaucoma
- History of childhood asthma
- History of hypo-or hypertension
- Renal disease
- Hepatic disease
- Anemia
- Jaundice
- Diabetes
- History of epilepsy
- Presence of cervicitis
- Infected endocervical
- Lesions, or acute vaginitis
Pregnancy Category:C
Breastfeeding: Dinoprostone is a normal component of breastmilk in where it protect infant GI tract. Administration with intravaginal route may suppress lactation but it should not be used postpartum in mothers who wish to breastfeed. By one month postpartum, the drug appears not to suppress lactation. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 31 March 2011).
