Pregnancy is a special condition of the female body that requires careful and attentive attitude to one's he alth. Quite often, at different gestation periods, various unfavorable conditions appear, one of which is an increased tone of the uterus, which can provoke premature birth. To prevent undesirable consequences, a number of substances are prescribed aimed at relaxing the myometrium. Many obstetricians prescribe the drug "Ginipral" (tablets) as such a remedy.
Analogues of it are also used quite often, because drugs affect different organisms individually - those that help one well may not give the desired effect on others. In addition, this drug, despite its high efficiency in the prevention of preterm labor, has a sufficiently large number of contraindications and side effects, which causes some patients to fear and unwillingness to take it. In any case, opting for this drug or deciding how to replace Ginipral is recommended exclusively by the attending physician.
Descriptiondrug
The drug "Ginipral" is produced in the form of white biconvex round tablets containing 500 μg of hexoprenaline sulfate each, in the form of a solution for intravenous administration with a dosage of 5 μg per 1 ml of liquid (10 μg of the active substance per 1 ampoule). They also produce a concentrate for the preparation of a solution for infusion (25 mcg of hexoprenaline sulfate in one ampoule).
Mechanism of action
The drug "Ginipral", the action of which is due to the properties of hexoprenaline sulfate, classified as a selective beta2-adrenergic agonist, refers to substances that reduce the tone and contractile activity of the muscles of the uterus (myometrium), that is, it helps prevent premature labor.
When administered, especially intravenously, it quickly causes a decrease in the increased tone of the uterus, which helps to reduce the frequency and intensity of uterine muscle contraction, inhibition of spontaneous or provoked by the appointment of oxytocin contractions. When used during labor, it helps to normalize too strong or irregular contractions. The cessation of premature contractile activity of the uterus allows a woman to carry the pregnancy to the optimal time for the appearance of the baby.
In addition to the 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 andthe intensity of their contractions, interfering with the opening of the cervix, then the use of "Ginipral" is due precisely to this action.
The drug in solution is prescribed in an emergency to quickly suppress contractions:
- when acute intrauterine asphyxia of the fetus occurs during childbirth;
- before the manual rotation of the child from the transverse position;
- when the umbilical cord prolapses;
- with complicated labor activity;
- to relax the uterus before caesarean section;
- in preterm labor to slow down contractions before sending the pregnant woman to the hospital.
Ginipral is also used intravenously:
- at risk of premature labor pains;
- to relax the muscles of the uterus during the manipulation of suturing her neck in order to prevent its untimely disclosure;
- for inhibition of contractions in case of insufficient gestational age or with rapid and intensified contractions against the background of an unprepared neck.
The use of "Ginipral" in such indications may require taking a whole course of the drug, which can last for several months.
Pills are prescribed at risk of preterm labor, mainly as a continuation of infusion treatment.
Contraindications
The use of the drug is associated with a number of serious side effects, therefore, it is used only as prescribed by the doctor, taking into account all the contraindications, sometimes canceling the drug "Ginipral", analogueswhich may be more appropriate in a particular situation.
Do not take the drug for a number of diseases:
- thyrotoxicosis;
- tachyarrhythmias;
- mitral valve defects, as well as aortic stenosis;
- myocarditis;
- IHD;
- hypertension;
- severe diseases of the kidneys and liver;
- angle-closure glaucoma;
- uterine bleeding of various etiologies, premature detachment of the placenta;
- 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 sensitivity to sulfites).
The presence of a whole list of contraindications forces in some cases to look for a replacement for the drug Ginipral, an analogue of which can be quite difficult to find, since it has a specific effect on the myometrium, and not on all smooth muscles as a whole.
Application diagram
As already mentioned, taking Ginipral requires strict indications and precise dosage compliance. Intravenous administration is preferably carried out in a hospital using automatic dosing infusion pumps or droppers, since drug treatment involves its slow flow over 5-10 minutes.
In case of an emergency, in order to quickly stop contractions, the solution is used at a dose of 10 mcg (one ampoule containing 2 ml of the agent), followed byinfusion of the drug "Ginipral". The dropper is prescribed with a very slow introduction 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 mcg / min).
If the effect of such treatment is positive, further therapy can be carried out using tablets at a dose of 500 mcg, which recommend drinking enough 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 taken one tablet at a time, first after 3 hours, then after 4-6 hours.
Special Instructions
The presence of a large number of side effects requires monitoring the he alth status 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 the constant supervision of the attending physician.
If there is a pronounced tachycardia or a decrease in blood pressure, the dose of the drug is reduced. The manifestation of signs such as shortness of breath, pain in the region of the heart, symptoms of cardiac ischemia, suggests the immediate abolition of this drug. To reduce side effects, Verapamil is prescribed in addition to the Ginipral drug, which is aimed at neutralizing the negative effect on the cardiovascular system.
With an increase in blood sugar caused byusing this remedy, you need to carefully monitor the indicators of carbohydrate metabolism in women with diabetes.
The drug "Ginipral" helps to reduce diuresis, so it is necessary to note all the changes that may be associated with fluid retention in the body. Sometimes co-administration with glucocorticosteroids can lead to pulmonary edema, so it is necessary to constantly monitor 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 way, such as Ginipral, side effects can occur from any body system:
- 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, much less often a rhythm disturbance (ventricular extrasystole) or cardialgia may occur, quickly disappearing after discontinuation of drugs;
- rare disorders of the digestive tract can be manifested by nausea, vomiting, inhibition of intestinal motility up to complete stagnation of the food coma;
- if there is sensitivity to the components of the drug, allergic reactions may occur in the form of shortness of breath, bronchospasm, impaired consciousness, which can turn into a coma, in patients with bronchial asthma orhypersensitivity to sulfites - up to anaphylactic shock.
In addition, sweating may increase, oliguria and edema may occur. Newborns often have hypoglycemia and acidosis.
Overdose
In an emergency situation of preterm labor or in case of persistent uterine hypertonicity, it is necessary to prescribe this drug in significant amounts, which can cause the maximum allowed daily dose to be exceeded and the associated negative consequences.
Symptoms of an overdose include: severe tachycardia in a pregnant woman (this phenomenon is extremely rare in a fetus), arrhythmia, trembling in the fingers, headache of various localization, increased sweating, anxiety, cardialgia, lowering blood pressure and shortness of breath. The occurrence of such symptoms is the basis for the abolition 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 the withdrawal of the main drug is not possible?"
To substances exhibiting atypical action whenjoint appointment of a solution or tablets "Ginipral", 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 accumulation of glycogen in the liver;
- oral hypoglycemic substances when used together with this drug are less effective in their therapeutic effect;
- Interactions of this drug with cardiovascular and bronchodilator drugs can lead to increased effects and signs of overdose;
- halothane and beta-adrenergic stimulants 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 Ginipral, the abolition of which in this case is an absolute necessity.
Since the active substance (hexoprenaline sulfate) is highly active, it can only be diluted with isotonic sodium chloride solution and 5% dextrose (glucose).
Drug "Ginipral": analogues and synonyms
Belonging to the group of beta-adrenergic agonists, this remedy has a number of drugs similar in action and indications:
- "Partusisten" - available as a sterile solution for intravenous administration and in the form of tablets, is prescribed to prevent preterm birth only in a hospital setting.
- "Ritodrine" - is used mainly for bronchial asthma and other obstructive conditions, but can also relax the uterine muscle.
- "Fenoterol" - has a similar effect, is used only under medical supervision in hospitals.
- "Salbupart" - is prescribed for the risk of preterm birth, is administered very slowly intravenously over 6-12 hours.
Magnesium has a similar effect on reducing uterine tone, which, by blocking calcium channels, quite effectively relaxes the myometrium, while showing much fewer side effects.
Another medication that can replace the drug "Ginipral" is an analogue of "Indomethacin", related to prostaglandin inhibitors. It is able to reduce the increased uterine tone well, but when used after a pregnancy of 32 weeks, it causes a significant number of serious undesirable effects: it helps to slow down the maturation of the fetal lung tissue, and can cause jaundice and enterocolitis.
Some obstetricians prescribe the drug "Nifedipine" to reduce the tone of the uterus. It is not a specific remedy used in gynecology, its scope mainly concerns the treatment of cardiovascular pathologies, but since this remedy helps to relax smooth muscles, it can also be used to relieve tension in the muscles of the uterus. Whereinit should be noted that the drug causes a decrease in blood pressure, which prevents its administration to patients with hypotension.
Reviews
Many pregnant women note that the appointment of this drug made it possible to remove the increased tone of the uterus, to prevent the occurrence of premature labor. Moms who received the drug "Ginipral" during the gestation period do not note any negative consequences from its long-term use in the newborn. For many, the appointment of this substance helped to bring the child to a safe time for his birth, allowing all his organs and systems to prepare for independent life. Some experienced a slight negative effect in the form of a tremor of the fingers, headaches and others, which led to the gradual withdrawal of the drug, since it cannot be abruptly abandoned. The transition to a new drug should take some time, during which the dosage of Ginipral tablets is carefully reduced, while introducing the preferred drug. Despite the extensive list of contraindications and side effects, the majority still speaks positively, noting the relaxing effect of the drug on the muscular wall of the uterus, which is especially important in case of an emergency due to untimely delivery.
Thus, the use of "Ginipral" is carried out exclusively by the attending physician or is used in a hospital in case of emergency situations associated with the occurrence of untimely labor. At the same time, it is necessary to strictly observeall prescriptions and recommended dosages so as not to cause side effects. When using this drug, you must be especially attentive to the slightest deterioration or change in your condition, in order to respond in a timely manner to the situation that has arisen, if necessary, up to the withdrawal of the Ginipral drug, an analogue of which may become more suitable in each case. Although it should be noted the high efficiency of this drug in uterine hypertonicity and the ability to quickly suppress myometrial contractions during preterm labor.
