Efficacy and side effects of magnesium sulfate and ritodrine as tocolytic agents

The article presents modern views on the pathogenesis of preterm labor, their relevance and classification. From the perspective of evidence-based medicine methods of prevention are considered. A comparison of the main tocolytic agents, their advantages and disadvantages is presented. Key words: premature birth, perinatal and infantile mortality, tocolysis, magnesium sulfate, gestational age.

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Maternal and fetal side effects of tocolysis using transdermal nitroglycerin or intravenous fenoterol combined with magnesium sulfate

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/s0301-2115(02)00197-5 ◽

2003 ◽

Vol 106 (1) ◽

pp. 14-19 ◽

Cited By ~ 17

Author(s):

Ekkehard Schleussner ◽

Arne Möller ◽

Walter Groß ◽

Christiane Kähler ◽

Udo Möller ◽

...

Keyword(s):

Side Effects ◽

Magnesium Sulfate

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Comparative study of efficacy of nifedipine, nitroglycerin dermal patches and isoxsuprine as tocolytic agents in suppression of preterm labour 1-year study at navodaya medical college hospital and research centre Raichur

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212672 ◽

2021 ◽

Vol 10 (7) ◽

pp. 2806

Author(s):

Rita D. ◽

V. Haripriya

Keyword(s):

Side Effects ◽

Preterm Labour ◽

Research Centre ◽

College Hospital ◽

Treatment Groups ◽

Medical College ◽

Uterine Contractions ◽

Significant Difference ◽

Tocolytic Agent ◽

Tocolytic Agents

Background: Tocolytic agents are used to reduce preterm deliveries. Very few studies documenting the comparison of tocolytic agents viz. nifedipine, nitroglycerin dermal patches and isoxsuprine. Other drugs are not used due to their adverse effects. Objective was to study and compare the safety efficacy of nifedipine, nitroglycerin dermal patches and isoxsuprine as tocolytic agents in suppression of preterm labour 1 year study.Methods: This was a prospective case control study was conducted for a period of 1 year. Total 90 cases selected to study were randomly distribute in to three treatment groups viz. A, B, and C nifedipine, nitroglycerin and isoxsuprine respectively. Subjects in all three groups were evaluated for maternal pulse rate, palpitation uterine contractions and fetal heart rate in order to assess efficacy of each drug under investigation.Results: There was no statistically significant difference in age of woman’s in three different groups. Among (100%) subjects, majority of the cases i.e. (27.8%) primi gravida followed by multi (72.2%). Side effects of nifedipine was less when compared to nitroglycerine dermal patch and isoxsuprine i/v/o of headache (8.9%), nausea (1.1%), vomiting (1.1%), tachycardia (3.3%), palpitation (3.3%), hypotension (1.1%). side effects were statistically significant different between the treatment groups. There was no statistically significant difference with respect to APGAR score at 1 minute and 5 minutes.Conclusions: Oral nifedipine was found to be superior and efficacious as tocolytic agent as compared to transdermal nitroglycerin and intravenous isoxsuprine.

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Magnesium Sulfate as Adjuvant in Prehospital Femoral Nerve Block for a Patient with Diaphysial Femoral Fracture: A Randomized Controlled Trial

Pain Research and Management ◽

10.1155/2018/2926404 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Chawki Jebali ◽

Mohamed Kahloul ◽

Nesrine Ibn Hassine ◽

Mohamed Aymen Jaouadi ◽

Fehmi Ferhi ◽

...

Keyword(s):

Side Effects ◽

Magnesium Sulfate ◽

Nerve Block ◽

Femoral Fracture ◽

Femoral Nerve Block ◽

Controlled Trial ◽

Femoral Nerve ◽

Sensory Block ◽

Group I ◽

Prehospital Management

Introduction. Prehospital management of traumatic pain is commonly based on morphine while locoregional analgesia techniques, especially the femoral nerve block (FNB), can be safely and efficiently used. Adjuvants uses can reduce local anesthetic doses and decrease their related risk. The aim of the study was to assess the analgesic effect of magnesium sulfate when used as an adjuvant in prehospital FNB. Methods. This is a randomized double-blinded trial conducted in a prehospital medical department of an academic hospital. Patients with isolated diaphysial femoral fracture and eligible to participate were randomized into 2 groups. Group C had a FNB with 15 ml of lidocaine with epinephrine (300 mg) and 3 ml of normal saline solution. Group I had a FNB with 15 ml of lidocaine with epinephrine (300 mg) and 3 ml of MgS 15% (450 mg). The FNB was performed according to the WINNIE technique. Primary endpoints were morphine consumption and pain intensity during the first 6 hours. Secondary endpoints were the duration of the sensory block, time to the first analgesic request, and side effects occurrence. Results. Twenty-four patients were enrolled in each group. Both groups were comparable according to demographic characteristics, initial pain scores, and vital constants. In group I, morphine requirements were significantly lower (2 ± 2 mg versus 5 ± 3 mg, p<10−3), analgesic onset was significantly faster, and the average time to the first analgesic request was longer (276 ± 139 min versus 160 ± 79 min, p<10−3). The average duration of sensory block was longer in group I (226 ± 64 min versus 116 ± 70 min p<10−3). No side effects were recorded. Conclusion. Magnesium sulfate should be considered as an efficient and safe adjuvant to lidocaine in prehospital FNB. This trial is registered with (NCT03597945).

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Therapy with both magnesium sulfate and nifedipine does not increase the risk of serious magnesium-related maternal side effects in women with preeclampsia

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2004.11.059 ◽

2005 ◽

Vol 193 (1) ◽

pp. 153-163 ◽

Cited By ~ 110

Author(s):

Laura A. Magee ◽

Saman Miremadi ◽

Jing Li ◽

Carol Cheng ◽

Mary H.H. Ensom ◽

...

Keyword(s):

Side Effects ◽

Magnesium Sulfate ◽

Maternal Side

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Cardiopulmonary Adverse Effects of Oral and Subcutaneous Terbutaline for Tocolysis

Journal of Pharmacy Practice ◽

10.1177/089719009600900305 ◽

1996 ◽

Vol 9 (3) ◽

pp. 181-187

Author(s):

James O'Donnell ◽

Leslie Iffy

Keyword(s):

Adverse Effects ◽

Adverse Events ◽

Pulmonary Edema ◽

Magnesium Sulfate ◽

Drug Administration ◽

Clinical Case ◽

Adverse Reactions ◽

Package Insert ◽

Cardiovascular Risks ◽

Tocolytic Agents

Are there differences between the expected or reported adverse reactions associated with terbutaline when administered orally as opposed to the parenteral routes (such as subcutaneously or intravenously)? This is a report on a pulmonary edema and subsequent death of a laboring woman who was treated with a combination of tocolytic agents in an attempt to prolong the gestation. The agents included magnesium sulfate, and subcutaneous and oral terbutaline. The intention is to alert the reader to the cardiovascular risks associated with combining tocolytic agents, and to dispel a pervasive myth that serious adverse reactions do not occur with oral tocolysis (i.e., terbutaline).1 Until recently, the package insert sheets for both manufacturers of terbutaline restricted the attribution of serious cardiovascular risks to parenteral administration only. The clinical case will be presented, followed by a review of the published literature and the reports on file in the unpublished Food and Drug Administration MedWatch database. Finally, the comparative pharmacokinetics of the oral and parenteral terbutaline is presented to help the reader understand how these adverse events are to be expected with any route of administration of the tocolytic.

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Evaluating the Side Effects of Treatment for Preterm Labor in a Center that Uses “High-Dose” Magnesium Sulfate

American Journal of Perinatology ◽

10.1055/s-0033-1358770 ◽

2013 ◽

Vol 31 (08) ◽

pp. 711-716 ◽

Cited By ~ 3

Author(s):

Melissa Ingersoll ◽

Erin Meschter ◽

Ana Bodea-Braescu ◽

Rodney Edwards ◽

Matthew Wilson

Keyword(s):

Side Effects ◽

Magnesium Sulfate ◽

Preterm Labor ◽

High Dose

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A comparative study of intramuscular sulfate versus intravenous magnesium injection among eclampsia patients in Eastern, Uttar Pradesh, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202331 ◽

2020 ◽

Vol 9 (6) ◽

pp. 2470

Author(s):

Uzma Kauser ◽

Anjali Chaudhari

Keyword(s):

Side Effects ◽

Magnesium Sulfate ◽

Uttar Pradesh ◽

P Value ◽

Chi Square ◽

Mortality And Morbidity ◽

Medical College ◽

Effective Care ◽

Chi Square Test ◽

Eastern Uttar Pradesh

Background: Hypertensive in pregnancy is the second most common cause of maternal mortality in India. Among the hypertensive disorders that complicate pregnancy, pre-eclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity. The majority of deaths due to pre-eclampsia and eclampsia are avoidable through the provision of timely and effective care to the women presenting with these complications. Objectives of this study were to find out the effectiveness of intravascular and intramuscular magnesium sulfate in management of eclampsia. To compare the side effects and complications of intravascular and intramuscular magnesium sulfate in management of eclampsia.Methods: A total 100 patients presenting with eclamptic fits reporting to the center that has been included in the study. The study has been conducted in the labor room of Nehru Chikitsalaya of B. R. D. Medical College, Gorakhpur, Uttar Pradesh for 12 months duration period. Statistical analysis of observations has been done by Chi-square test with p-value <0.05 has been considered in the study.Results: Majority of eclampsia patients belonged to 20-25 years age group (63%) followed by above 30 years of age (22%). Nearly 16% patients in IM MgSO4 group and 12% patients in IV MgSO4 received recurrence of seizure after starting of treatment (p value >0.5). About 26% patients in IM MgSO4 group and 18% patients in IV MgSO4 group had mild side effects of MgSO4 but no patients in both the group had major side effects of MgSO4.Conclusions: The study concludes that intramuscular injection of MgSO4 is painful and the chances of abscess formation that's why compliance of intramuscular MgSO4 is not very good in compared to intravascular infusion of MgSO4. The chances of Mg toxicity are more MgSO4 regimen because of the dose required in IM MgSO4 regimen is more (44gm) that of IV MgSO4 (28 gm).

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Antinociceptive effects of magnesium sulfate for monitored anesthesia care during hysteroscopy: a randomized controlled study

10.21203/rs.3.rs-26722/v5 ◽

2020 ◽

Author(s):

Peng-fei Gao ◽

Jing-yan Lin ◽

Shun Wang ◽

Yun-feng Zhang ◽

Guo-qiang Wang ◽

...

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Magnesium Sulfate ◽

Rating Scale ◽

Isotonic Saline ◽

Controlled Study ◽

Control Group ◽

Anesthesia Induction ◽

Anesthesia Care ◽

Monitored Anesthesia Care

Abstract Background: Opioids are the most effective antinociceptive agents, they have undesirable side effects such as respiratory depressant and postoperative nausea and vomiting. The purpose of the study was to evaluate the antinociceptive efficacy of adjuvant magnesium sulphate to reduce intraoperative and postoperative opioids requirements and their related side effects during hysteroscopy.Methods: 70 patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in the magnesium group (Group M) received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before anesthesia induction and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group (Group C) received an equal volume of isotonic saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative hemodynamic variables were recorded and postoperative pain scores were assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 hour, and 4 hours after recovery of consciousness. The primary outcome of our study was total amount of intraoperative and postoperative analgesics administered.Results: Postoperative serum magnesium concentrations in Group C were significantly decreased than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P=0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P=0.129). Bradycardia did not occur in either group and the incidence of hypotension was comparable between the two groups. Total dose of fentanyl given to patients in Group M was less than the one administered to Group C [100 (75-150) vs 145 (75-175) μg, median (range); P < 0.001]. In addition, patients receiving magnesium displayed lower VNRS scores at 15 min, 30 min, 1 hour, and 4 hours postoperatively.Conclusions: In hysteroscopy, adjuvant magnesium administration is beneficial to reduce intraoperative fentanyl requirement and postoperative pain without cardiovascular side effects. Our study indicates that if surgical patients have risk factors for hypomagnesemia, assessing and correcting magnesium level will be necessary.Trial registration: www.chictr.org.cn ChiCTR1900024596. date of registration: July 18th 2019.

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Modern tocolysis and adverse effects of tocolytics

GYNECOLOGY ◽

10.26442/2079-5696_2018.2.46-50 ◽

2018 ◽

Vol 20 (2) ◽

pp. 46-50

Author(s):

O R Baev ◽

O N Vasilchenko ◽

A O Karapetyan

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Pregnant Women ◽

Preterm Labor ◽

Primary Outcome ◽

Comparable Efficacy ◽

Premature Births ◽

Instrumental Methods ◽

Tocolytic Agents ◽

Methods Of Control

Relevance. Toсolytic therapy is the only method that is used in the treatment of pregnant women with preterm labor. However, the effectiveness and safety of this therapy is still a matter of debate. One of the least studied issues of this problem is the safety of therapy, which is primarily manifested by the frequency of side effects. The aim is to carry out a comparative study of the safety of the most common tocolytic agents - atosiban, nifedipine and hexoprenaline sulfate. Material and methods. The study included 173 pregnant women with threatening premature births in a period of 28 to 34 weeks. In 54 cases, tocolysis with nifedipinum, 57 with atosiban, 62 with hexoprenaline was performed. To assess the effectiveness of tocolysis, clinical and instrumental methods of control (ultrasound with cervicometry) were used. The primary outcome points were the frequency of prolongation of pregnancy at 48 h and the incidence of side effects, including those requiring the termination of tocolysis. Results. Prolongation of pregnancy at 48 h was achieved in groups of nifedipine, atosiban and hexoprenaline sulfate, respectively in 46 (85.19%), 55 (96.49%) and 53 (77.40%) pregnant. Atosiban showed significantly higher efficacy. In 8 cases of tocolysis with nifedipine and 3 - hexoprenaline, the tocolysis protocol was not performed due to intolerance of treatment. In these observations, the highest frequency of preterm labor occurred. After excluding these observations from the analysis of differences in the frequency of prolongation of pregnancy was not. The overall frequency of adverse events in the groups was 38.9, 12.3 and 82.3%, and was significantly lower in the atosiban group than nifedipine and hexoprenaline sulfate. Conclusions. The effectiveness of tocolysis is affected by the tolerability of the drugs. Atosiban showed the best of the three drug safety profile. With comparable efficacy, atosiban has proven to be a drug that, to a greater extent than nifedipine and hexoprenaline sulfate, meets the current requirements for tocolytic drugs.

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