Names and pronunciation
(dye-noe-prost′one) Cervidil, Prepidil, Prostin E2
Source page 398
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Individual generic drug information
Extracted information for dinoprostone only.
(dye-noe-prost′one) Cervidil, Prepidil, Prostin E2
Source page 398
Func. class.: Oxytocic, abortifacient Func. class.: Antihistamine (first generation, nonselective)
Source pages 398, 399
Chem. class.: Prostaglandin E2 Chem. class.: Ethanolamine deriva- tive, H1-receptor antagonist
Source pages 398, 399
USES: Cervical ripening USES: Allergy symptoms, rhinitis, motion sickness, antiparkinsonism, nighttime sedation, infant colic, nonpro- ductive cough, insomnia in children
Source pages 398, 399
Do not confuse: diphenhydrAMINE/dicyclomine/dimen- hyDRINATE
Source page 399
ACTION: Acts on blood vessels, GI, respiratory system by competing with hista- mine for H1-receptor site; decreases aller- gic response by blocking histamine
Source page 399
Extracted information for dinoprostone only.
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
Source pages 398, 399
Black Box Warning: Requires a special- ized setting and an experienced clinician
Source page 398
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
Source page 400
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
Source page 400
TREATMENT OF OVERDOSE: Administer diazePAM, vasopressors, phe- nytoin IV
Source page 401
Extracted information for dinoprostone only.
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
Source pages 398, 399
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
Source pages 398, 399
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
Source pages 399, 400
Extracted information for dinoprostone only.
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
Source page 400
Evaluate: • Therapeutic response: absence of running or congested nose or rashes, improved sleep
Source page 400
CLINICAL CONSIDERATIONS
Source page 400
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
Source page 401
Extracted information for dinoprostone only.
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
Source page 400
Filter the extracted dose blocks for this individual drug.
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
Candidate age grouping · source pages 398, 399
Cervical ripening
• Adult/child >12 yr: PO 25-50 mg q4-6hr, max 300 mg/day; IM/IV 10-50 mg, max 300 mg/day
Candidate age grouping · source pages 398, 399
Cervical ripening
• Child 6-12 yr: PO/IM/IV 12.5-25 mg/dose
Candidate age grouping · source pages 398, 399
Cervical ripening
• Child 2-6 yr: PO 6.25 mg/dose Nighttime sleep aid
Candidate age grouping · source pages 398, 399
Cervical ripening
• Adult and child ≥12 yr: PO 25-50 mg at bedtime Antitussive (syrup only)
Candidate age grouping · source pages 398, 399
Cervical ripening
• Adult and child >12 yr: PO 25 mg q4hr, max 150 mg/24 hr
Candidate age grouping · source pages 398, 399
Cervical ripening
• Child 6-12 yr: PO 12.5 mg q4hr, max 75 mg/24 hr Motion sickness
Candidate age grouping · source pages 398, 399
Cervical ripening
• 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
Candidate age grouping · source pages 398, 399