Home Drug Guide Dinoprostone

Drug Guide

Generic Name

Dinoprostone

Brand Names Prostin E2, Prepidil, Cervidil

Classification

Therapeutic: Induction of labor, Cervical Ripening

Pharmacological: Prostaglandin E2 (PGE2) analog

FDA Approved Indications

Induction of labor in pregnant women at or near term with an unfavorable cervix
Cervical ripening before labor induction

Mechanism of Action

Dinoprostone stimulates local prostaglandin receptors, leading to cervical softening, dilation, and uterine contractions.

Dosage and Administration

Adult: Varies by product: Cervidil (vaginal insert): 10 mg, applied for up to 12 hours; Prepidil (gel): 0.5 mg, administered intracervically; Prostin E2 (injectable): doses tailored by clinician.

Pediatric: Not typically used for induction in pediatric patients.

Geriatric: Use with caution; dose adjustments based on response and tolerability.

Renal Impairment: Use caution; no specific adjustments established.

Hepatic Impairment: Use caution; no specific adjustments established.

Pharmacokinetics

Absorption: Rapid absorption through mucous membranes and cervical tissue.

Distribution: Widely distributed; crosses placental barrier.

Metabolism: Metabolized locally at site of action; some hepatic metabolism.

Excretion: Metabolites excreted in urine.

Half Life: Approximately 10-20 minutes when administered parenterally.

Contraindications

History of hypersensitivity to prostaglandins.
Previous Cesarean delivery or uterine surgery (due to risk of uterine rupture).
Fetal distress or abnormal fetal presentation in some cases.

Precautions

Monitor fetal heart rate and uterine activity closely.
Use with caution in women with asthma, glaucoma, or bleeding disorders.

Adverse Reactions - Common

Uterine tachysystole (excessive contractions) (Common)
Fetal distress (Common)
Nausea, vomiting (Common)

Adverse Reactions - Serious

Uterine rupture (especially in women with previous uterine surgery) (Rare)
Severe postpartum bleeding (Rare)
Fetal death (Rare)

Drug-Drug Interactions

Oxytocin (may increase uterine hyperstimulation risk)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor fetal heart rate, uterine activity, maternal vital signs before, during, and after administration.

Diagnoses:

Risk for uterine hyperstimulation
Risk for fetal compromise

Implementation: Administer according to protocol, with continuous fetal monitoring.

Evaluation: Assess effectiveness by cervical ripening and progression of labor; monitor for adverse reactions.

Patient/Family Teaching

Report any severe contraction patterns or fetal distress signs.
Inform about possible side effects such as nausea or uterine discomfort.
Explain the purpose and procedure of cervical ripening or labor induction.

Special Considerations

Black Box Warnings:

Uterine hyperstimulation and fetal distress leading to fetal death are serious risks, especially if misused or administered improperly.

Genetic Factors: No specific genetic factors identified.

Lab Test Interference: May affect fetal monitoring readings.

Overdose Management

Signs/Symptoms: Excessive uterine contractions, uterine rupture, fetal distress.

Treatment: Discontinue drug immediately, provide supportive care, manage uterine hyperstimulation with tocolytics if necessary, provide fetal and maternal monitoring.

Storage and Handling

Storage: Store at controlled room temperature (20-25°C), away from light and moisture.

Stability: Stable under recommended storage conditions; check expiration date regularly.