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l Zidovudine (ZDV) short course 6 страница
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Precautions and Contraindications: are the same as in Betamethasone.
Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)
Description: Corticosteroid, antiinflammatory.
Indications: Swelling, arthritis, skin diseases (psoriasis, hives), asthma, chronic obstructive pulmonary disease, pain.
Dosage: Epidural 20–80 mg.
Side Effects: Dizziness, nausea, indigestion, increased appetite, weight gain, weakness, or sleep disturbances.
Precautions: Extreme hypertension or hypotension, liver or heart disease, Reye's syndrome, alcohol or drug dependencies, neurologic disease.
Prednisolone
Description: Corticosteroid, antiinflammatory.
Indications: Suppression of inflammatory and allergic disorders including asthma, chronic obstructive pulmonary disease, rheumatic disease, pain due to inflammation.
Dosage: Usual starting dose is 10–30 mg PO per day.
Side Effects: Dizziness, nausea, indigestion, increased appetite, weight gain, weakness, or sleep disturbances.
Precautions: Extreme hypertension or hypotension, liver or heart disease, Reye's syndrome, alcohol or drug dependencies, neurologic disease.
Triamcinolone (Aristocort, Kenalog)
Description: Corticosteroid, antiinflammatory.
Indications: Inflammation, swelling, and pain.
Dosage: For epidural or nerve root injection, 10–80 mg as a single dose.
Side Effects: Increased or decreased appetite, insomnia, indigestion, nervousness.
Precautions: Extreme hypertension or hypotension, liver or heart disease, Reye's syndrome, alcohol or drug dependencies, neurologic disease.
Hydrocortisone
Description: Hydrocortisone is a glucocorticoid secreted by the adrenal cortex.
Analogues: Hydrocortisone Acetate, Hydrocortisone Cypionate, Hydrocortisone Sodium Phosphate, Hydrocortisone Sodium Succinate.
Indications: Hydrocortisone is usually the corticosteroid of choice for replacement therapy in patients with adrenocortical insufficiency, because these drugs have both glucocorticoid and mineralocorticoid properties.
Dosage and Administration: The route of administration and dosage of hydrocortisone and its derivatives depend on the condition being treated and the response of the patient. Hydrocortisone for intra-articular introduction is used in a dose of 0. 2-0. 3 ml; in acute adrenal insufficiency 25-30 mg are used IV.
Cortisone Acetate
Description: Cortisone is a glucocorticoid secreted by the adrenal cortex.
Indications: Cortisone (as the acetate) or hydrocortisone is usually the corticosteroid of choice for replacement therapy in patients with adrenocortical insufficiency, because these drugs have both glucocorticoid and mineralocorticoid properties.
Dosage and Administration: The initial adult oral dosage of cortisone acetate may range from 25-300 mg daily depending on the disease being treated. The initial adult IM dosage of cortisone acetate generally ranges from 20-300 mg daily depending on the disease being treated.
Side effects, precautions and contraindications are the same as in other corticosteroid agents.
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Insulin
Description: Insulin (regular) is a rapid-acting, sterile solution of the antidiabetic principle of the pancreas.
Indications: Insulin (regular) is used as replacement therapy for the management of diabetes mellitus, including in the emergency treatment of diabetic ketoacidosis or hyperosmolar hyperglycemic states when rapid control is required and, in combination with intermediate-acting or long-acting insulin preparations, to give better control of blood glucose concentrations in diabetic patients.
Dosage and Administration: Insulin (regular) injection is usually administered subcutaneously. To initiate therapy in patients with severe diabetes, unstable diabetes, or diabetes with complications, adults are generally given doses of 5-10 units subcutaneously 15-30 minutes before meals and at bedtime. The dose and frequency of administration must be carefully individualized.
Side Effects: Hypoglycemia is the most common adverse effect of insulins, and monitoring of blood glucose concentrations is recommended for all patients with diabetes.
Progesterone
Description: Progesterone is a naturally occurring progestin secreted by the corpus luteum and is the prototype of the progestins.
Indications: Progesterone is used for treatment of threatened abortion, amenorrhea, abnormal uterine bleeding caused by hormonal imbalance.
Dosage and Administration: Progesterone is administered by IM injection. Common packaged dosage form: 1 ml of 1 % solution in 1-ml ampules (10 mg). Usual individual dose: 1 ml of 1% solution intramuscularly or subcutaneously.
Human Chorionic Gonadotropin
Description: Chorionic gonadotropin (CG) is a gonad-stimulating polypeptide hormone secreted by the placenta that is obtained from urine of pregnant women.
Indications: Human chorionic gonadotropin has a gonadotropic effect. It is used in cases of threatened spontaneous abortion in the ealiest stages of pregnancy.
Dosage: Common packaged dosage form: 500, 1000, 1500 and 2000 units in vials. Preparation of drug for administration: dilute as instructed in package insert. Usual individual dose: 500–3000 units intramuscularly per day or 1-2 times a week.
Side Effects: Adverse effects of CG include headache, irritability, restlessness, depression, fatigue or tiredness, edema, gynecomastia, aggressive behavior, and pain at the injection site.
Precautions and Contraindications: CG is contraindicated in patients with precocious puberty, androgen-dependent neoplasia. CG is also contraindicated in patients who have experienced an allergic reaction to the drug.
Folliculin
Description: Folliculin (estrone) is a natural estrogenic hormone.
Indications: High risk of abnormality of labor pains (hormonal energetic treatment), inducing of labor pains in patients with post-term pregnancy.
Dosage: Common packaged dosage form: ampules with 1 ml of 0. 05 or 0. 1% solution (5000 or 10. 000 units). Usual individual dose: 500-20. 000 units intramuscularly.
Ethinyl Estradiol
Description: Ethinyl estradiol is a synthetic analogue of estrone.
Indication for application: ovarian hypofunction, infantilism, and hormonal energetic treatment.
Dosage: Common packaged dosage form: 0. 05 mg tablets in vials. Usual individual dose: 0. 05-0. 1 mg 1-2 times a day.
Progesterone
Description: Progesterone is a synthetic progestational (corpus luteum) hormone.
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Indications for application: threatened abortion.
Dosage: Common packaged dosage form: 1 ml of 1 % solution in 1-ml ampules (10 mg). Usual individual dose: 1 ml of 1% solution intramuscularly or subcutaneously.
Pregnenoldione (Oxyprogesterone Kapronate)
Description: Pregnenoldione is a synthetic analogue of progesterone of durable action (7-14 days).
Indications for application: threatened abortion.
Dosage: Common packaged dosage form: 1 ml of 12. 5% solution (125 mg) in ampules, and 1 ml of 25% solution (250 mg) in ampules. Usual individual dose: 0. 5-2 ml of 12. 5% solution intramuscularly once a week.
Dufaston (didrogesteron)
Description: Dufaston is analogue of progestogen without anabolic and androgenous effect.
Indications for application: threatened abortion, luteal insufficiency.
Dosage: Common packaged dosage form: tablets containing 10 mg of active agent. Usual individual dose: 20–30 mg daily.
Utrogestan
Description: Utrogestan is natural progesterone.
Indications for application: threatened abortion, luteal insufficiency.
Dosage: Common packaged dosage form: 50 mg in capsules. Usual individual dose: 100 mg 2 times a day.
Progestogel
It is natural progesterone (utrogestan) in gel for intravaginal applications.
Hypotensive Agents
Methyldopa, Methyldopate Hydrochloride
Description: Methyldopa is a centrally acting hypotensive agent.
Indications: Hypertension. Methyldopa is used alone or in combination with other classes of antihypertensive agents in the management of hypertension. Methyldopa is most effective when used with a diuretic. The use of a diuretic may prevent tolerance to methyldopa and permit reduction of methyldopa dosage. Diuretics may also prevent sodium retention and increased plasma volume that may occur after prolonged methyldopa therapy. Methyldopa also has been used with other antihypertensive agents, permitting a reduction in the dosage of each drug and, in some patients, minimizing adverse effects while maintaining blood pressure control. Methyldopa has been used effectively for the management of hypertension in pregnant women without apparent substantial adverse effects on the fetus. Methyldopa is the most extensively used hypotensive agent to date in the management of hypertension in pregnant women.
Dosage and Administration: Methyldopa is administered orally; methyldopate hydrochloride is administered by IV infusion. IM or subcutaneous administration of methyldopate hydrochloride is not recommended because of unpredictable absorption. The usual initial adult oral dosage of methyldopa is 250 -500 mg 3-4 times a day, continually.
Side Effects: The most common adverse effect of methyldopa is drowsiness which occurs within the first 48-72 hours of therapy and may disappear with continued administration of the drug. Sedation commonly recurs when dosage is increased. A persistent decrease in mental acuity, including impaired ability to concentrate, lapses of memory, and difficulty in performing simple calculations, may occur and usually necessitates withdrawal of the drug. Other adverse nervous system effects which occur early in therapy include vertigo, headache, asthenia, and weakness.
Precautions and Contraindications: When methyldopa is used as a fixed-combination preparation that includes hydrochlorothiazide, the cautions, precautions, and contraindications associated with thiazide diuretics must be considered in addition to those associated with methyldopa.
Labetalol Hydrochloride
Description: Labetalol hydrochloride is an ά - and ß -adrenergic blocking agent.
Indications: Hypertension. Labetalol hydrochloride is used alone or in combination with other classes of antihypertensive agents in the management of hypertension. ß -Adrenergic blocking agents (e. g., labetalol) are considered one of several preferred antihypertensive drugs for the initial management of hypertension in patients with heart failure, postmyocardial infarction, high coronary disease risk, and/or diabetes mellitus. Although ß -blockers can be used as monotherapy for the initial management of uncomplicated hypertension, thiazide diuretics are considered the preferred initial monotherapy for such condition.
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Dosage and Administration: Labetalol hydrochloride is usually administered orally, but may be administered by slow, direct IV injection or by slow, continuous IV infusion. For PO use 100-400 mg 2-3 times a day. IV use for immediate reduction of BP: 10-20 mg every 10 min or droppingly 1-2 mg/min. The highest daily dose is 2400 mg. To control acute severe hypertension in pregnant women with preeclampsia when delivery is imminent, IV labetalol hydrochloride may be given in an initial dose of 20 mg by slow, direct IV injection, followed by 40 mg IV 10 minutes later and then 80-mg doses at 10-minute intervals for 2 additional doses to a total cumulative dose of 220 mg maximum.
Side Effects: symptomatic orthostatic hypotension, drowsiness or tiredness, headache, fatigue, lethargy. Nausea, dyspepsia, vomiting, abdominal pains are also reported.
Precautions and Contraindications: Labetalol should be used with caution in patients with inadequate cardiac function, in patients with latent cardiac insufficiency. Since ß -adrenergic blocking agents may inhibit bronchodilation produced by endogenous catecholamines, the drugs generally should not be used in patients with bronchospastic disease. The drug should be used with caution in patients with impaired hepatic function, in patients with pheochromocytoma. Labetalol has been effective for the management of hypertension associated with pregnancy, and is considered a suitable alternative to methyldopa. Labetalol increasingly is being preferred because of better patient tolerance.
Atenolol
Description: Atenolol (Metoprolol) is a ß 1-selective adrenergic blocking agent.
Indications: Atenolol is used in the management of hypertension or chronic stable angina pectoris in patients with chronic obstructive pulmonary disease (COPD) or type I diabetes mellitus. Many clinicians prefer to use low dosages of a ß 1-selective adrenergic blocking agent (e. g., atenolol, ), rather than a nonselective agent (e. g., nadolol, pindolol, propranolol, timolol).
Dosage and Administration: Atenolol is administered orally or by slow IV injection. Dosage of atenolol must be individualized and adjusted according to the patient's response and tolerance. In pregnancy atenolol can be used PO, 25-100 mg once a day, not to exceed 100 mg/day. The highest daily dose is 100 mg.
Side Effects: Atenolol shares the toxic potentials of ß -adrenergic blocking agents. In therapeutic dosage, atenolol usually is well tolerated and has a low incidence of adverse effects. The incidence and severity of adverse reactions may occasionally be obviated by a reduction in dosage. Abrupt withdrawal of the drug should be avoided, especially in patients with coronary artery disease, since it may exacerbate angina or precipitate myocardial infarction.
Precautions and Contraindications: Atenolol should be used with caution in patients with inadequate cardiac function, since congestive heart failure may be precipitated by blockade of ß -adrenergic stimulation when atenolol therapy is administered. In addition, in patients with latent cardiac insufficiency, prolonged ß -adrenergic blockade may lead to cardiac failure.
Pindolol
Description: Pindolol is a nonselective ß -adrenergic blocking agent possessing intrinsic sympathomimetic activity.
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Indications: Hypertension. Pindolol is used alone or in combination with other classes of antihypertensive agents in the management of hypertension. Pindolol is considered one of several preferred antihypertensive drugs for the initial management of hypertension in patients with heart failure, postmyocardial infarction, high coronary disease risk, and/or diabetes mellitus.
Dosage and Administration: Pindolol is administered orally. For PO use 5-15 mg are every 12 hours. The highest daily dose is 60 mg.
Side Effects: Bradycardia and hypotension, dizziness, fatigue, and insomnia, nausea and abdominal discomfort.
Precautions and Contraindications: Pindolol shares the toxic potentials of ß -adrenergic blocking agents, and the usual precautions of these agents should be observed. There are no adequate and controlled studies to date using pindolol in pregnant women, and the drug should be used during pregnancy only when the potential benefits justify the possible risks to the fetus.
Clonidine
Description: Clonidine hydrochloride, an imidazoline-derivative hypotensive agent, is a selective ά 2-adrenergic agonist.
Indications: Hypertension. Clonidine hydrochloride and transdermal clonidine are used alone or in combination with other classes of antihypertensive agents in the management of hypertension. Clonidine hydrochloride has been used in conjunction with thiazide diuretics, chlorthalidone, or furosemide, producing a greater reduction in blood pressure than is obtained with either drug alone. Use of a diuretic may aid in overcoming tolerance to clonidine and permit reduction of clonidine dosage.
Dosage and Administration: Clonidine is administered orally. To avoid the possibility of precipitating the withdrawal syndrome, clonidine therapy should not be discontinued abruptly. If oral clonidine therapy is to be discontinued, dosage of the drug should be slowly reduced over a period of 2-4 days to avoid the possibility of precipitating the withdrawal syndrome. For the management of hypertension, the usual initial adult oral dosage of clonidine hydrochloride is 0. 075-0. 2 mg 2-4 times a day. Dosage may be increased by 0. 1-0. 2 mg daily or every few days or longer until the desired response is achieved. When clonidine hydrochloride is used alone, the usual oral maintenance dosage ranges from 0. 05-0. 4 mg twice daily not to exceed 1. 2 mg daily. For IV/IM use 0. 5-1 ml of 0. 01% solution for immediate reduction of BP is needed.
Side Effects: Dry mouth, drowse, depression, withdrawal syndrome. Clonidin is not reported as contraindicated in pregnancy. However, use of clonidin in the III trimester of pregnancy may lead to withdrawal syndrome of a newborn (irritability, insomnia during the 1-5 day after birth).
Precautions and Contraindications: When clonidine hydrochloride is used as a fixed-combination preparation that includes chlorthalidone, the cautions, precautions, and contraindications associated with thiazide diuretics must be considered in addition to those associated with clonidine. Because of the risk of rebound hypertension, patients receiving clonidine preparations should be warned of the danger of missing doses or stopping the drug without consulting their physician.
Hydralazine Hydrochloride
Description: Hydralazine hydrochloride is a vasodilating agent.
Indications: Hydralazine is used in the management of moderate to severe hypertension. Hydralazine is generally used in conjunction with a diuretic and another hypotensive agent.
Dosage and Administration: Hydralazine hydrochloride is usually administered orally. The usual initial adult oral dosage of hydralazine hydrochloride is 10-50 mg 2-3 times a day.
Side Effects: The most frequently occurring adverse effects of hydralazine are headache, palpitation, and tachycardia. Hydralazine hydrochloride has an adverse effect on the fetus (thrombocytopenia), while has no teratogenic effect.
Precautions and Contraindications: Hydralazine should not be used during pregnancy unless the possible benefits outweigh the potential risks to the fetus.
Sodium Nitroprusside
Description: Sodium nitroprusside is a vasodilating agent.
Indications: Hypertensive crises. IV sodium nitroprusside is used in hypertensive crises for immediate reduction of blood pressure in patients in whom such reduction is considered an emergency (hypertensive emergencies). The drug is consistently effective in the management of hypertensive emergencies, irrespective of etiology, and may be useful even when other drugs have failed; however, sodium nitroprusside is contraindicated in compensatory hypertension (e. g., arteriovenous shunt or coarctation of the aorta) and should be used with caution in patients with high intracranial pressure or azotemia.
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Dosage: For IV use 0. 25-0. 5 µg/kg/min. The highest daily dose is 120 µg/kg.
Side Effects: The most clinically important adverse effects of sodium nitroprusside are profound hypotension and the accumulation of cyanogen (cyanide radical).
Precautions and Contraindications: Sodium nitroprusside should be used during pregnancy only when clearly needed.
Nifedipine
Description: Nifedipine is a 1, 4-dihydropyridine-derivative calcium-channel blocking agent.
Indications: Hypertension. Calcium-channel blockers (e. g., nifedipine) are considered one of several preferred antihypertensive drugs for the initial management of hypertension in patients with a high risk of developing coronary artery disease, including those with diabetes mellitus.
Dosage and Administration: Nifedipine is administered orally: 10-20 mg 3-4 times a day.
Side Effects: dizziness, lightheadedness, giddiness, flushing or heat sensation, and headache.
Precautions and Contraindications: Nifedipine shares the toxic potentials of the calcium-channel blocking agents, and the usual precautions of these agents should be observed.
New Hypotensive Drugs
Angiotensin-Converting Enzyme Inhibitors (Captopril, Enalapril Maleate), Angiotensin II Receptor Antagonists (Losartan Potassium, Valsartan) are avoided in pregnancy because during the last half of pregnancy they are associated with severe fetal renal toxicity that can lead to in utero anuria and oligohydramnios, structural defects of the cranium and kidneys, and hypotension and anuria in the newborn.
Laxative Agents
Senna (Senokot)
Description: Laxative.
Indication: Constipation.
Dosage: One to two tablets PO once or twice per day.
Side Effects: Diarrhea, nausea, vomiting, rectal irritation, stomach cramps, or bloating.
Precautions: Kidney disease, heart disease, high blood pressure, edema, or allergies, especially to tartrazine.
Bisacodyl (Dulcolax)
Description: Laxative.
Indication: Constipation.
Dosage and Administration: Bisacodyl is administered orally, 0. 005g 1-3 times a day.
Precautions and Contraindications: Laxatives should be used during pregnancy only when clearly needed because of possible uterotonic effect.
Oxytocics
Dinoprostone
Description: Dinoprostone, the naturally occurring prostaglandin E2, stimulates uterine smooth muscle and also produces cervical dilation and softening.
Indications: Dinoprostone suppositories are used intravaginally to induce abortion during the second trimester of pregnancy (beyond the 12th week of gestation). Continuous IV infusion of a dilute solution of oxytocin is usually used in conjunction with dinoprostone administration to shorten the induction-to-abortion time and reduce the number of dinoprostone doses required and the number of adverse effects.
Dosage and Administration: Dinoprostone may be administered in vaginal suppositories, cervical gel, and vaginal insert. The usual dosage of dinoprostone for second trimester abortions and for evacuation of the uterus in cases of missed abortion, intrauterine fetal death, and benign hydatidiform mole is 20 mg every 2-3 hours until abortion occurs or membranes rupture. In patients who fail to respond within 24-36 hours after the initial dinoprostone dose, dinoprostone administration can be continued. Continuation of dinoprostone for longer than 2 days is not recommended. The usual dosage of dinoprostone cervical gel is 0. 5 mg (2. 5 ml of Prepidil® gel). If the desired response is obtained with the use of the gel, the manufacturer recommends an interval of 6-12 hours before administration of IV oxytocin. If there is no cervical and/or uterine response to the initial dose of dinoprostone cervical gel, a second 0. 5-mg dose may be given after 6-12 hours. The maximum recommended cumulative dose of dinoprostone cervical gel during a 24-hour period is 1. 5 mg (7. 5 ml of Prepidil® gel). Cervidil is a vaginal insert containing 10 mg of dinoprostone. It provides a lower rate of release of medication (0. 3 mg/hour) than the gel but has the advantage that it can be removed should hyperstimulation occur. To improve cervical inducibility (cervical " ripening" ) near or at term in pregnant women with medical or obstetric need for labor induction, the usual dosage of dinoprostone vaginal inserts is 10 mg (1 insert; designed to deliver about 0. 3 mg of the drug per hour over 12 hours). Dinoprostone vaginal inserts should be removed upon onset of active labor or 12 hours after insertion.
Side Effects: Most of dinoprostone's adverse effects are related to the contractile effects of the drug on GI, vascular, bronchial, and uterine smooth muscle. Since dinoprostone is metabolized rapidly, discontinuing administration of the drug and supportive therapy are usually adequate treatments for serious adverse effects. Headache, chills, and shivering occur in about 10% of patients receiving dinoprostone. Other adverse reactions: backache, joint inflammation or pain (new or exacerbated), vaginal pain, vaginitis, vulvitis, weakness, muscle cramps or pain, nocturnal leg cramps, breast tenderness, blurred vision, rash, myalgia, stiff neck, dehydration, tremor, paresthesia, hearing impairment, urine retention, pharyngitis, laryngitis, diaphoresis, eye pain, skin discoloration, and tension.
Precautions and Contraindications: Dinoprostone should be used only by medically trained personnel in a hospital where intensive care and surgical facilities are immediately available. Patients should be informed of the benefits and risks of dinoprostone-induced abortions. A complete medical history and physical examination should be performed prior to administration of the drug. Caution should be exercised when administering dinoprostone to patients with cervicitis, infected endocervical lesions, acute vaginitis, compromised (scarred) uterus, asthma or a history of asthma, hypertension or hypotension, seizure disorders, diabetes mellitus, glaucoma, increased intraocular pressure, anemia, jaundice, or cardiovascular, renal, or hepatic disease.
Cytotec
Description: Cytotec (misoprostol) is a synthetic analog of prostaglandin E1.
Indications: Misoprostol is used as an adjunct to mifepristone for the medical termination of intrauterine pregnancy (i. e., medical abortion). The drug has been used for induction of labor and for treatment of serious postpartum hemorrhage in the presence of uterine atony.
Dosage: Cytotec is available in 100 µg tablets, which are divided into the desired dose. Dosing regimens range from 25 to 50 µg every 3–4 hours. The use of misoprostol for cervical ripening is an off-label use.
Mifepristone
Description: Mifepristone, a synthetic derivative of the progestin norethindrone, is a progesterone-receptor antagonist that is used for the medical termination of intrauterine pregnancy (i. e., medical abortion).
Indications: Mifepristone is used for the medical termination of intrauterine pregnancy (i. e., medical abortion) through 49 days as dated from the first day of the last menstrual period or as determined by clinical or ultrasonographic scan. Unless a complete abortion has occurred and is confirmed, the woman must receive misoprostol 2 days after receiving mifepristone. Misoprostol, a prostaglandin E1 analog, induces uterine contraction and expulsion of the products of conception. Mifepristone has also been used for termination of pregnancy during the second or third trimester, induction of labor, postcoital contraception, endometriosis, leiomyoma, and meningioma. Mifepristone has also been used with vaginal administration of misoprostol (using tablets formulated for oral administration) for termination of pregnancy.
Dosage and Administration: Mifepristone is administered orally as a single dose without regard to meals. The recommended adult dosage of mifepristone is 600 mg. Two days after mifepristone administration (i. e., on the 3rd day), a clinical examination or ultrasonographic scan must be performed to confirm that termination of pregnancy has occurred. If termination of pregnancy is not confirmed, the patient should receive 400 µg of misoprostol orally. Patients must return for a follow-up clinical examination 14 days after the administration of mifepristone to confirm the complete termination of pregnancy and to assess severity of any continued bleeding. Persistence of moderate to severe vaginal bleeding at this follow-up visit could indicate an incomplete abortion. A risk of fetal malformation exists if pregnancy continues, and surgical termination may be recommended to manage medical abortion failures.
Contraindications: Confirmed or suspected ectopic pregnancy, undiagnosed adnexal mass, or IUD currently in place.
Ergonovine Maleate, Methylergonovine Maleate
Description: Ergonovine maleate (Ergometrine maleate) and methylergonovine maleate (Methilergometrini maleate), which are amine ergot alkaloids, directly stimulate contractions of uterine smooth muscle.
Indications: Ergometrine maleate and Methilergometrini maleate are used for the prevention and treatment of postpartum and postabortion hemorrhage caused by uterine atony or subinvolution.
Dosage and Administration: Ergonovine maleate or methylergonovine maleate may be administered orally or by IM or IV injection. Dosage of ergonovine maleate and methylergonovine maleate is the same. To produce intense uterine contractions and to reduce bleeding after delivery of the placenta, the usual IM dose is 0. 2 mg, repeated as necessary, but not more than every 2-4 hours or for more than a total of 5 doses.
Side Effects: When administered in correct doses, there is little risk of serious adverse systemic effects in patients receiving ergonovine or methylergonovine. However, the most common adverse effects of the drugs include nausea and vomiting; vomiting may be minimized by prior administration of prochlorperazine or other phenothiazine antiemetics. Hypertension may occur following administration of ergonovine or methylergonovine, especially when administered IV undiluted or too rapidly or when used in conjunction with regional anesthesia or vasoconstrictors.
Precautions and Contraindications: If ergonovine or methylergonovine is administered during the second or third stage of labor prior to delivery of the placenta, complications such as retention of the placenta may occur. IV use of the drugs should be limited to patients with severe uterine bleeding or other life-threatening emergency situations.
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