Names and pronunciation
(dye-noe-prost′one) Cervidil, Prepidil, Prostin E2
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Drug reference
(dye-noe-prost′one) Cervidil, Prepidil, Prostin E2
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Func. class.: Oxytocic, abortifacient Func. class.: Antihistamine (first generation, nonselective)
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Chem. class.: Prostaglandin E2 Chem. class.: Ethanolamine deriva- tive, H1-receptor antagonist
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USES: Cervical ripening USES: Allergy symptoms, rhinitis, motion sickness, antiparkinsonism, nighttime sedation, infant colic, nonpro- ductive cough, insomnia in children
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Do not confuse: diphenhydrAMINE/dicyclomine/dimen- hyDRINATE
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ACTION: Acts on blood vessels, GI, respiratory system by competing with hista- mine for H1-receptor site; decreases aller- gic response by blocking histamine
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CONTRAINDICATIONS: Hyper- sensitivity, C-section, surgery, fetal distress, multiparity, vaginal bleeding, cephalopel- vic disproportion Precautions: Pregnancy, cardiac dis- ease, asthma, anemia, jaundice, diabetes mellitus, seizure disorders, hypertension, glaucoma, uterine fibrosis, cervical ste- nosis, pelvic surgery, pelvic inflammatory disease, respiratory disease CONTRAINDICATIONS: Hyper- sensitivity to H1-receptor antagonist, neonates Precautions: Pregnancy, breastfeeding, children <6 yr, increased intraocular pressure, cardiac/renal disease, hyper- tension, bronchial asthma, seizure disor- der, stenosed peptic ulcers, hyperthy- roidism, prostatic hypertrophy, bladder neck obstruction
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Black Box Warning: Requires a special- ized setting and an experienced clinician
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SIDE EFFECTS CNS: Dizziness, drowsiness, confusion, headache, seizures CV: Hypotension, palpitations EENT: Blurred vision, tinnitus, nasal stuffiness GI: Nausea, anorexia, diarrhea GU: Retention, dysuria, frequency HEMA: Thrombocytopenia, agranulocyto- sis, hemolytic anemia INTEG: Photosensitivity, rash MISC: Anaphylaxis RESP: Increased thick secretions, wheezing, chest tightness
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INTERACTIONS Increase: CNS depression—barbiturates, opiates, hypnotics, tricyclics, alcohol Increase: diphenhydrAMINE effect— MAOIs Drug/Herb Increase: CNS depression—chamomile, kava, valerian Drug/Lab Test False negative: skin allergy tests
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TREATMENT OF OVERDOSE: Administer diazePAM, vasopressors, phe- nytoin IV
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DOSAGE AND ROUTES Cervical ripening • Adult: GEL 0.5 mg vaginal gel placed in cervical canal, may repeat after 6 hr, max 1.5 mg/24 hr; vaginal insert 10 mg high in vagina, remove at onset of active labor or within 12 hr DOSAGE AND ROUTES Antihistamine/antiemetic/antiverti- genia • Adult/child >12 yr: PO 25-50 mg q4-6hr, max 300 mg/day; IM/IV 10-50 mg, max 300 mg/day • Child 6-12 yr: PO/IM/IV 12.5-25 mg/dose • Child 2-6 yr: PO 6.25 mg/dose Nighttime sleep aid • Adult and child ≥12 yr: PO 25-50 mg at bedtime Antitussive (syrup only) • Adult and child >12 yr: PO 25 mg q4hr, max 150 mg/24 hr • Child 6-12 yr: PO 12.5 mg q4hr, max 75 mg/24 hr Motion sickness • Adult: IM/IV 10-50 mg, max 25 mg/ D min; doses up to 100 mg/dose may be used; PO 25-50 mg q4-6hr
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Available forms: Vaginal gel 0.5 mg/3 g; vaginal insert 10 mg (dye-fen-hye′dra-meen) Aler-Dryl, Allergy Childrens, Allergy Relief Childrens, Allergy Relief, Anti-Hist Allergy, Aurodryl Allergy Childrens, Banophen, Benadryl Allergy Childrens, Benadryl Allergy, Complete Allergy Relief, Di-Phen, Diphen, Diphenhist, Genahist, Geri- Dryl. GoodSense Allergy Relief, GoodSense Sleep Aid, M-Dryl, Naramin, Nighttime Sleep Aid, Nytol Maximum Strength, Nytol, Ormir, PediaCare Childrens Allergy, Pharbedry, Siladryl Allergy, Simply Sleep, Sleep Tabs, Tetra-Formula Nighttime Sleep, Total Allergy Medicine, Total Allergy, ZzzQuil Available forms: Capsules 25, 50 mg; tablets 25, 50 mg; chewable tablets 12.5 mg; elixir 12.5 mg/5 mL; syrup 12.5 mg/5 mL; injection 50 mg/mL
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Administer: • Avoid use in children <6 yr; death has occurred; overdose has occurred with topical gel taken orally (adult/child) • With meals for GI symptoms; absorp- tion rate may slightly decrease • At bedtime only if using for sleep aid IM route • Deep IM in large muscle; rotate site Direct IV route • Undiluted; give 25 mg/min or less Intermittent IV INFUSION route • Dilute with 0.9% NaCl, 0.45% NaCl, D5W, 0.9% NaCl, D10W, LR, Ringer’s Y-site compatibilities: Acetaminophen, aldes- leukin, alfentanil hydrochloride, amifostine, amikacin sulfate, aminocaproic acid, ampho- tericin B lipid complex (Abelcet), ampho- tericin B liposome (AmBisome), amsa- crine, anidulafungin, argatroban, ascorbic acid injection, atenolol, atracurium besylate, atropine sulfate, azithromycin, benztropine mesylate, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefTAZidime, ceftizoxime, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clindamy- cin, codeine, cyanocobalamin, cyclophospha- mide, cycloSPORINE, cytarabine, DACTINo- mycin, DAPTOmycin, digoxin, diltiazem, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, enala- prilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythro- mycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, folic acid, gallium, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glyco- pyrrolate, granisetron, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipe- nem-cilastatin, irinotecan, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, manni- tol, mechlorethamine, melphalan, meperi- dine, meropenem, metaraminol, methadone, methicillin, methotrexate, methoxamine, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, miconazole, midazolam, minocycline, mitoXANtrone, morphine, multi- ple vitamins injection, mycophenolate, nalbu- phine, naloxone, nesiritide, netilmicin, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed, penicillin G potas- sium/sodium, pentamidine, pentazocine, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potas- sium chloride, procainamide, prochlorpera- zine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, quinupris- tin-dalfopristin, ranitidine, remifentanil, Ring- er’s, ritodrine, riTUXimab, rocuronium, sar- gramostim, sodium acetate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophyl- line, thiamine, thiotepa, ticarcillin, ticarcillin- clavulanate, tigecycline, tirofiban, TNA, tobra- mycin, tolazoline, TPN, trastuzumab, trimetaphan, urokinase, vancomycin, vaso- pressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex/C, voricon- azole, zoledronic acid
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Assess: • Urinary retention, frequency, dysuria; product should be discontinued • CBC during long-term therapy; blood dyscrasias may occur • Respiratory status: rate, rhythm, in- crease in bronchial secretions, wheezing, chest tightness • EPS: If using for dystonic reactions, assess type of involuntary movement and evaluate response to medication • Cough: Characteristics (type, fre- quency, thickness of secretions); evaluate response to this medication, increase fluids to 2L/day unless contraindicated • Anaphylaxis: used for this rash, throat tightness, have emergency equipment nearby • Store in tight container at room tem- perature • Pregnancy/breastfeeding: no well- controlled studies; use only if benefit outweighs fetal risk; avoid breastfeeding, excreted in breast milk
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Evaluate: • Therapeutic response: absence of running or congested nose or rashes, improved sleep
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About all aspects of product use; to notify prescriber of confusion, sedation, hypotension • To avoid driving, other hazardous ac- tivity if drowsiness occurs • That photosensitivity may occur, use sunscreen, protective clothing • To avoid concurrent use of alcohol, other CNS depressants • To use hard candy, gum, frequent rins- ing of mouth for dryness • Product should be discontinued 4 days before skin allergy tests • Not to use for sedation in child <4 yr, deaths have occurred • Pregnancy/breastfeeding: To re- port if pregnancy is planned or suspected or if breastfeeding, avoid if breastfeeding
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PHARMACOKINETICS Metabolized in liver, excreted by kidneys, crosses placenta, excreted in breast milk, half-life 2-4 hr PO: Peak 2-4 hr, duration 4-8 hr IM: Onset ½ hr, peak 2-4 hr, duration 4-8 hr IV: Onset immediate, duration 4-8 hr
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• Adult: GEL 0.5 mg vaginal gel placed in cervical canal, may repeat after 6 hr, max 1.5 mg/24 hr; vaginal insert 10 mg high in vagina, remove at onset of active labor or within 12 hr DOSAGE AND ROUTES Antihistamine/antiemetic/antiverti- genia
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• Adult/child >12 yr: PO 25-50 mg q4-6hr, max 300 mg/day; IM/IV 10-50 mg, max 300 mg/day
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• Adult and child ≥12 yr: PO 25-50 mg at bedtime Antitussive (syrup only)
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• Adult and child >12 yr: PO 25 mg q4hr, max 150 mg/24 hr
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• Adult: IM/IV 10-50 mg, max 25 mg/ D min; doses up to 100 mg/dose may be used; PO 25-50 mg q4-6hr
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