dinoprostone (dye-noe-prost-one) Cervidil Vaginal Insert, Prepidil Endocervical Gel, Prostin E Vaginal Suppository

 Indications

Endocervical Gel, Vaginal Insert: Used to “ripen” the

cervix in pregnancy at or near term when induction of

labor is indicated. Vaginal Suppository: Induction of

midtrimester abortion, Management of missed abortion

up to 28 wk, Management of nonmetastatic gestational

trophoblastic disease (benign hydatidiform mole).

Action

Produces contractions similar to those occurring during

labor at term by stimulating the myometrium (oxytocic

effect). Initiates softening, effacement, and dilation

of the cervix (“ripening”). Also stimulates GI

smooth muscle. Therapeutic Effects: Initiation of

labor. Expulsion of fetus.

Pharmacokinetics

Absorption: Rapidly absorbed.

Distribution: Unknown. Action is mostly local.

Metabolism and Excretion: Metabolized by enzymes

in lung, kidneys, spleen, and liver tissue.

Half-life: Unknown.

TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION

Cervical ripening

(gel)

rapid 30–45 min unknown

Cervical ripening

(insert)

rapid unknown 12 hr

Abortion time

(suppository)

10 min 12–24 hr 2–3 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to prostaglandins

or additives in the gel or suppository; The gel/insert

should be avoided in situations in which prolonged

uterine contractions should be avoided, including: Previous

cesarean section or uterine surgery; Cephalopelvic

disproportion; Traumatic delivery or difficult labor;

Multiparity (6 term pregnancies); Hyperactive or hypertonic

uterus; Fetal distress (if delivery is not imminent);

Unexplained vaginal bleeding; Placenta previa;

Vasa previa; Active herpes genitalis; Obstetric emergency

requiring surgical intervention; Situations in

which vaginal delivery is contraindicated; Presence of

acute pelvic inflammatory disease or ruptured membranes;

Concurrent oxytocic therapy (wait for 30 min

after removing insert before using oxytocin).

Use Cautiously in: Uterine scarring; Asthma; Hypotension;

Cardiac disease; Adrenal disorders; Anemia;

Jaundice; Diabetes mellitus; Epilepsy; Glaucoma; Pulmonary,

renal, or hepatic disease; Multiparity (up to 5

previous term pregnancies); Women 30 yr, those with

complications during pregnancy, and those with a gestational

age 40 wk (qrisk of disseminated intravascular

coagulation).

Adverse Reactions/Side Effects

Endocervical Gel, Vaginal Insert.

GU: uterine contractile abnormalities, warm feeling in

vagina. MS: back pain. Misc: AMNIOTIC FLUID EMBOLISM,

fever.

Suppository

CNS: headache, drowsiness, syncope. Resp: coughing,

dyspnea, wheezing. CV: hypotension, hypertension.

GI: diarrhea, nausea, vomiting. GU: UTERINE

RUPTURE, urinary tract infection, uterine hyperstimulation,

vaginal/uterine pain. Misc: allergic reactions including

ANAPHYLAXIS, chills, fever.

Interactions

Drug-Drug: Augments the effects of other oxytocics.

Route/Dosage

Cervical Ripening

Vag (Adults , Cervical): Endocervical gel—0.5 mg;

if response is unfavorable, may repeat in 6 hr (not to

exceed 1.5 mg/24 hr). Vaginal insert—one 10-mg insert.

Abortifacient

Vag (Adults): One 20-mg suppository, repeat q 3–5

hr (not to exceed 240 mg total or longer than 48 hr).

Availability

Endocervical gel (Prepidil): 0.5 mg dinoprostone in

3 g of gel vehicle in a prefilled syringe with catheters.

Vaginal insert (Cervidil): 10 mg. Vaginal suppository

(Prostin E Vaginal): 20 mg.