Нифедипин - самый безопасный препарат для купирования преждевременных родов

[Dr. Nika]

Согласно руководству ВОЗ "Essential Medicines for Reproductive Health: Guiding Principles for Their Inclusion on National Medicines Lists" 2006 года нифедипин назван самым безопасным препратом для купирования преждевременных родов. [Ссылки доступны только зарегистрированным пользователям ]

Nifedipine: a tocolytic medicine
Background
Preterm birth occurs in 5% to 22% of pregnancies and is a major cause of neonatal mortality worldwide. Preterm birth burdens health care systems and communities and is distressing to families. Preterm babies are at higher risk of dying or suffering complications and sequelae. Care of preterm premature babies usually demands a great amount of resources, including highly skilled personnel, technologically advanced equipment, and expensive treatments.1 Management of preterm labour consists of tocolysis or allowing labour to progress.

Tocolytic medicines, such as nifedipine, postpone premature labour and are used to treat women with threatened preterm birth under the premise that stopping uterine activity will reduce preterm birth and will give more time for treatments aimed at maturing the baby’s lungs.

1Most tocolytics delay delivery. However, not all of them have been shown to reduce prematurity and its complications. Furthermore, beta2 agonist tocolytics frequently cause adverse effects such as headache, hypotension, and tachycardia, affecting the mother or the baby sometimes seriously.

Evidence summary
Nifedipine is a dihydropyridine calcium channel blocker that is frequently used to treat high blood pressure and is also a tocolytic medicine. A systematic review of the scientific evidence has found that when women with threatened preterm labour before 34 weeks of gestation take nifedipine, their babies have fewer complications of prematurity. Furthermore, nifedipine has been found to have a lower risk of causing important adverse effects than other tocolytics.

2 There is strong evidence to support the use of nifedipine to inhibit preterm labour. Nifedipine was studied in 10 out of 12 randomised controlled trials in a systematic review.1,3 The results indicated that, compared with any other tocolytic agent (mainly betamimetics), nifedipine reduced the frequency of neonatal respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage, and neonatal jaundice. Nifedipine has been used throughout the world for many years.

Indications and dosage
• Nifedipine, immediate-release capsule, 10 mg


Acute tocolysis for women in uncomplicated premature labour between 20–33 weeks of gestation.
Acute tocolysis for women in premature labour, adult, initially sublingually, 10 mg repeated every 20 minutes to a maximum dose of 40 mg in the first hour. Once contractions cease, 20 mg every 4 hours for 48 hours, then maintenance, orally, 10 mg every 8 hours until 34 weeks of gestation.4
Nifedipine is effective and safe for this indication, and the sublingual route is pharmacologically equivalent to the conventional oral route because the medicine is absorbed low in the gastrointestinal tract.

Remarks
If less than 34 weeks of gestation, tocolysis should be accompanied by use of corticosteroids to improve fetal lung maturity.5
Nifedipine, as tocolytic, was added to the 14th WHO Model List of Essential Medicines (2005).
The use of nifedipine does not require special medical facilities or specialist medical care.