Dinoprostone (Prostaglandin E2)(dye noe prost’ ohn)
Cervidil, Prepidil, Prostin E2
PREGNANCY CATEGORY C
Drug Classes
Abortifacient
Prostaglandin
Therapeutic Actions
Stimulates the myometrium of the pregnant uterus to contract, similar to the contractions of the uterus during labor, thus evacuating the contents of the uterus.
Indications
Termination of pregnancy 12–20 wk from the first day of the last menstrual period
Evacuation of the uterus in the management of missed abortion or intrauterine fetal death up to 28 wk gestational age
Management of nonmetastatic gestational trophoblastic disease (benign hydatidiform mole)
Initiation of cervical ripening before induction of labor
Contraindications and Cautions
Contraindicated with allergy to prostaglandin preparations; acute PID; active cardiac, hepatic, pulmonary, renal disease; women in whom prolonged uterine contractions are inappropriate (eg, caesarean delivery, uterine surgery, fetal distress, obstetric emergency).
Use cautiously with history of asthma; hypotension; hypertension; CV, adrenal, renal, or hepatic disease; anemia; jaundice; diabetes; epilepsy; scarred uterus; cervicitis, infected endocervical lesions, acute vaginitis.
Available Forms
Vaginal suppository—20 mg; vaginal gel—0.5 mg; vaginal insert—10 mg
Dosages
Adults
Termination of pregnancy: Insert one suppository (20 mg) high into the vagina; keep supine for 10 min after insertion. Additional suppositories may be given at 3- to 5-hr intervals based on uterine response and tolerance. Do not give longer than 2 days.
Cervical ripening: Give 0.5 mg gel via provided cervical catheter with patient in the dorsal position and cervix visualized using a speculum. Repeat dose may be given if no response in 6 hr. Wait 6–12 hr before beginning oxytocin IV to initiate labor. Insert: Place one insert transversely in the posterior fornix of the vagina. Keep patient supine for 2 hr; one insert delivers 0.3 mg/hr over 12 hr. Remove, using retrieval system, at onset of active labor or 12 hr after insertion. After insert is removed, may start oxytocin after 30 min, if needed.
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