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Nifedipine
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Nifedipine has been shown to be as effective as salbutamol in prolonging pregnancy in the setting of preterm labour, with significantly fewer maternal side effects.
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There is also evidence of improved neonatal outcomes with Nifedipine compared to salbutamol. Nifedipine is therefore the drug of choice for use as a tocolytic.
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Note: The combined cardiovascular effects of Nifedipine and intravenous Salbutamol are substantial.
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Indications
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- Suppression of threatened or established preterm labour, in the absence of contraindications to its use.
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Contraindications
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Suppression of labour is generally not indicated for:
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- Fetal malformation where palliative care only is planned
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- Suspected fetal compromise as determined by ultrasound or CTG warranting delivery
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Contraindications to the use of Nifedipine:
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- Significant maternal cardiac disease
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- Concurrent use of IV Salbutamol
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- Concurrent use of Magnesium Sulphate (MgSO4)
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- Concurrent use of transdermal nitrates (GTN) or antihypertensive medications
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Dosage
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followed by
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- 20mg orally after 30 minutes if contractions persist
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followed by
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- 20mg orally after 30 minutes if contractions persist
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followed by
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- 20mg orally tds for 48 - 72 hours if indicated.
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- Note: Maximum dose is 120mg per day
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After 72 hours if maintenance therapy is required, patients can be changed over to the long acting nifedipine (Adalat OROS®)30 - 60 mg orally per day.
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Note: Nifedipine tablets should be chewed then swallowed to enable faster absorption.
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Side effects
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Hypotension:
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- In normotensive patients the effects of Nifedipine on blood pressure are minimal
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- Care must be exercised in hypertensive patients, where blood pressure changes may be significant
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- If significant hypotension occurs, treatment should be discontinued. IV rehydration with Normal Saline or Hartmann's may be considered
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- Tachycardia, palpitations
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Observations
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- Continuous CTG while contracting
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- ½ hourly pulse and blood pressure for the first four hours, then
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- 2nd hourly pulse and blood pressure for the first 24 hours, then
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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