Pregnancy is a special condition of the female body that requires a careful and careful attitude to your health. Quite often, at various stages of gestation, various unfavorable conditions appear, one of which is an increased tone of the uterus, which can provoke a premature birth. To prevent undesirable consequences, a number of substances are prescribed to relax the myometrium. Many obstetricians prescribe Ginipral (tablets) as such an agent.
Its analogs are also used quite often, because drugs affect individual organisms individually - those who help well may not give the desired effect in others. In addition, this drug, despite its high effectiveness in the prevention of preterm labor, has a rather large number of contraindications and side effects, which causes some patients to fear and unwillingness to take it. In any case, stop choosing this medicine or decide how to replace Ginipral, it is recommended only by the attending physician.
Description of the drug
The drug “Ginipral” is produced in the form of white biconvex round tablets containing in each 500 μg of hexoprenaline sulfate, in the form of an intravenous solution with a dosage of 5 μg per 1 ml of liquid (10 μg of active substance per ampoule). A concentrate is also made for the preparation of an infusion solution (25 μg of hexoprenaline sulfate in one ampoule).
Mechanism of action
The drug “Ginipral”, whose action is due to the properties of hexoprenaline sulfate, which is classified as selective beta2-adrenergic agonist, refers to substances that reduce the tone and contractile activity of the uterine muscles (myometrium), that is, it helps to prevent premature labor.
When introduced, especially intravenously, it quickly causes a decrease in increased uterine tone, which helps to reduce the frequency and intensity of contraction of the uterus muscles, inhibition of spontaneous contractions or provoked by the appointment of oxytocin contractions. When used during labor, it helps to normalize too strong or irregular contractions. The termination of premature contractile activity of the uterus allows a woman to convey pregnancy to the optimal time for the appearance of the baby.
In addition to a specific effect, the drug has some effect on the state of cardiac activity and blood flow of both the mother and the fetus, which must be taken into account when prescribing.
Indications
Since this drug causes relaxation of the uterine muscles, a decrease in the frequency and intensity of their contractions, interfering with the opening of the cervix, the use of Ginipral is due to this particular action.
The drug in solution is prescribed in case of emergency to quickly suppress contractions:
- when acute intrauterine asphyxiation of the fetus occurs during childbirth;
- before carrying out a manual rotation of the child from a transverse position;
- when the umbilical cord falls out;
- with complicated labor;
- to relax the uterus before cesarean section;
- during preterm birth to inhibit contractions before sending the pregnant woman to the hospital.
Ginipral is also used intravenously:
- with the danger of premature labor pain;
- to relax the muscles of the uterus during the suturing procedures on her neck to prevent its untimely opening;
- for inhibition of contractions in case of insufficient gestation or with rapid and increased contractions against the background of an unprepared neck.
The use of Ginipral for such indications may require taking a whole course of the drug, which can last for several months.
Tablets are prescribed for the risk of premature birth, mainly as a continuation of infusion treatment.
Contraindications
The use of the medicine is associated with a number of serious side effects, therefore, it is used only as prescribed by the doctor, taking into account all the available contraindications, sometimes canceling the drug “Ginipral”, analogues of which may be more suitable in a particular situation.
You can not take the drug for a number of diseases:
- thyrotoxicosis;
- tachyarrhythmias;
- mitral valve defects , as well as aortic stenosis;
- myocarditis;
- Ischemic heart disease;
- arterial hypertension;
- severe diseases of the kidneys and liver;
- angle-closure glaucoma;
- uterine bleeding of various etiologies, premature placental abruption;
- the development of intrauterine infections;
- in the first trimester of pregnancy;
- lactation (breastfeeding);
- hypersensitivity to the components of the drug (especially with bronchial asthma or a history of sulfite sensitivity).
The presence of a whole list of contraindications makes it necessary in some cases to look for a replacement for Ginipral, an analogue of which can be difficult to choose, since it has a specific effect on the myometrium, and not on the entire smooth muscle as a whole.
Application chart
As already mentioned, taking "Ginipral" requires strict indications and accurate adherence to dosage. Intravenous administration is preferably carried out in a hospital using automatic dosing infusomats or droppers, since treatment with the drug involves its slow delivery for 5-10 minutes.
In case of emergency, in order to quickly stop the contractions, the solution is used in a dose of 10 μg (one ampoule containing 2 ml of the drug), followed by infusion of the Ginipral preparation. A dropper is prescribed with a very slow administration at a rate of 0.3 mcg / min. If a gradual decrease in uterine activity is expected, the solution is administered for a longer time (0.075 μg / min).
With the positive effect of such treatment, further therapy can be carried out with the help of tablets in a dose of 500 micrograms, which are recommended to be drunk with a sufficient amount of water, but not tea or coffee, which can enhance the negative effect of the substance. The daily dose of tablets is 4-8 pieces when taking them one tablet at first after 3 hours, then - after 4-6 hours.
special instructions
The presence of a large number of side effects requires monitoring the health of both the patient and the fetus, in particular, it is necessary to monitor the function of the cardiovascular system. It is advisable to take an ECG measurement before and during treatment.
If the patient has an increased sensitivity to such drugs, he is prescribed in small doses, selected strictly individually, with constant monitoring by the attending physician.
If severe tachycardia or a decrease in blood pressure is observed, the dose of the drug is reduced. The manifestation of signs such as shortness of breath, pain in the heart, symptoms of cardiac ischemia, suggests the immediate withdrawal of this drug. To reduce side effects, Verapamil is prescribed in addition to the Ginipral preparation, which is aimed at neutralizing the negative effect on the cardiovascular system.
With an increase in blood sugar caused by the use of this drug, you need to carefully monitor the carbohydrate metabolism in women with diabetes.
The drug "Ginipral" helps to reduce urine output, therefore, it is necessary to note all the changes that may be associated with the retention of fluid in the body. Sometimes co-administration with glucocorticosteroids can lead to pulmonary edema, therefore it is necessary to constantly monitor during the infusion period, as well as the volume of the injected solution.
Side effects
When using a drug that can affect the entire body in a complex manner, such as the Ginipral drug, side effects can occur from any body system:
- a negative effect on the central and peripheral nervous systems is characterized by headache, dizziness, anxiety, slight trembling in the fingers;
- the effect on the cardiovascular system can cause tachycardia, arterial hypotension (most often diastolic) in a pregnant woman, rhythm disturbance (ventricular extrasystole) or cardialgia, which quickly disappear after drug withdrawal, can occur much less often;
- rare disorders of the digestive tract can manifest as nausea, vomiting, inhibition of intestinal motility up to complete stagnation of the food coma;
- in the presence of sensitivity to the components of the drug, allergic reactions can occur in the form of shortness of breath, bronchospasm, impaired consciousness, which can go into a coma, in patients with bronchial asthma or hypersensitivity to sulfites - up to anaphylactic shock.
In addition, sweating may intensify, oliguria and edema may occur. In newborns, hypoglycemia and acidosis are often observed.
Overdose
In an emergency situation of premature birth or in the case of persistent uterine hypertonicity, it is necessary to prescribe this drug in significant quantities, which can cause an excess of the maximum allowed daily dose and the associated negative consequences.
Symptoms of overdose include: severe tachycardia in a pregnant woman (the fetus is extremely rare), arrhythmia, trembling fingers, headache of different localization, increased sweating, anxiety, cardialgia, decreased blood pressure and shortness of breath. The occurrence of such symptoms is the basis for the cancellation of the drug "Ginipral", an analogue of which may not give such a clinical picture.
When such symptoms appear, antagonist substances are prescribed, which are non-selective beta-blockers that can completely neutralize the effect of the drug.
Interaction with other medicinal substances
The presence of a disease in a pregnant woman may require the mandatory intake of medicines that are not always compatible with this muscle relaxant, so the question may arise: "How to replace Ginipral if withdrawal of the main drug is not possible?"
Substances exhibiting an atypical effect when co-administered with Ginipral solution or tablets include:
- beta-blockers that can weaken or completely neutralize the effect of the drug "Ginipral";
- methylxanthines (including the substance "Theophylline"), enhancing its effectiveness;
- glucocorticosteroids, the combined action of which can lead to a decrease in the intensity of glycogen accumulation by the liver;
- oral hypoglycemic substances when used together with this drug are less effective in showing their therapeutic effect;
- the interaction of this medication with cardiovascular and bronchodilators may lead to an increase in their influence and the appearance of signs of an overdose;
- fluorotan and beta-adrenostimulants increase the incidence of side effects in relation to the heart and other elements of the circulatory system;
- ergot alkaloids, MAO inhibitors, tricyclic antidepressants and agents containing calcium and vitamin D, as well as dihydrotachysterol and mineralocorticoids, are completely incompatible with the Ginipral drug, the cancellation of which in this case is absolutely necessary.
Since the active substance (hexoprenaline sulfate) has a high activity, it can be diluted exclusively with isotonic sodium chloride solution and 5% dextrose (glucose).
The drug "Ginipral": analogues and synonyms
Relating to the group of beta-adrenergic agonists, this remedy has a number of drugs similar in effect and indications:
- "Partusisten" - is available as a sterile solution for intravenous administration and in the form of tablets, is prescribed to prevent premature birth only in a hospital setting.
- "Ritodrin" - is used mainly for bronchial asthma and other obstructive conditions, but is also able to relax the uterine muscle.
- “Fenoterol” - has a similar effect, it is used only under medical supervision in hospitals.
- "Salbupart" - is prescribed in case of danger of premature birth, is administered very slowly intravenously for 6-12 hours.
A similar effect in reducing uterine tone is possessed by the substance magnesia, which, by blocking calcium channels, quite effectively relaxes the myometrium, while exhibiting much fewer side effects.
Another medicine that can replace the Ginipral preparation is the Indomethacin analogue, which refers to prostaglandin inhibitors. It can well reduce the increased uterine tone, but when used after a gestation period of 32 weeks, it causes a significant amount of serious undesirable effects: it helps to slow the maturation of the fetal lung tissue, and can cause jaundice and enterocolitis.
Some obstetricians prescribe the drug "Nifedipine" to reduce uterine tone. It is not a specific tool that is used in gynecology, its scope mainly concerns the treatment of cardiovascular pathologies, but since this tool helps to relax smooth muscles, it is possible to use it to relieve tension in the muscles of the uterus. It should be noted that the drug causes a decrease in blood pressure, which prevents the appointment of its patients with hypotension.
Reviews
Many pregnant women note that the appointment of this drug allowed to remove the increased tone of the uterus, to prevent the occurrence of premature labor. Moms who received the Ginipral preparation during the gestation period did not notice any negative consequences from prolonged use in the newborn. The purpose of this substance has helped many to bring the child to a safe time for his birth, allowing all his organs and systems to prepare for an independent life. Some experienced a slight negative effect in the form of tremor of the fingers, headaches and others, which led to the gradual withdrawal of the drug, since it can not be thrown sharply. The transition to a new drug should take some time, during which the dosage of Ginipral tablets is carefully reduced, while introducing the preferred medicine. Despite an extensive list of contraindications and side effects, most still speak positively, noting the relaxing effect of the medication on the muscle wall of the uterus, which is especially important in case of emergency in case of late delivery.
Thus, the use of Ginipral is made exclusively by the attending physician or is used in a hospital in case of emergency situations associated with the occurrence of untimely labor. In this case, all prescriptions and recommended dosages must be strictly observed so as not to cause side effects. When using this drug, it is necessary to be especially attentive to the slightest deterioration or change in one's condition, in order to respond to the situation in a timely manner, up to the cancellation of the Ginipral drug, the analogue of which may become more suitable in each particular case. Although it should be noted the high effectiveness of this drug for uterine hypertonicity and the ability to quickly suppress myometrial contractions in premature births.