Indications for respiratory complications during the use of oral nifedipine as a tocolytic agent, especially in patients with multiple pregnancies

J E Lenglet, H P van Geijn, R J M Strack van Schijndel, A Vonk Noordegraaf, A C Bolte

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

In 7 women with premature labour pains, severe dyspnoea developed that was possibly related to the use of nifedipine as an 'off-label' tocolytic. 6 of these women had a twin pregnancy. Diuretics and oxygen therapy had little effect, but the patients recovered after the administration of nifedipine was stopped. The efficacy and safety of nifedipine as a tocolytic agent has been investigated in a number of well-designed randomised studies. However, these studies were performed in a selected group of pregnant women and women with multiple pregnancies or prematurely ruptured membranes were mostly excluded. It can be hypothesised that the respiratory complications in these cases are due to unequal ventilation/perfusion of the lungs in the presence of a physiologically elevated diaphragm due to the pregnancy. These changes are more pronounced in multiple pregnancies. After administration ofnifedipine, there is perfusion of atelectatic areas of the lung that are not or not well ventilated, resulting in ventilation-perfusion discrepancy and hence dyspnoea. Although case reports permit only limited extrapolation, these observations warrant caution with regard to the safety ofnifedipine as a tocolytic agent in patients with multiple pregnancies. The use of medication in groups of patients for which the agent has not been investigated, or which were explicitly excluded from the study, should be done with extreme caution. One should in any case be aware of the possible risks.

Translated title of the contributionIndications for respiratory complications during the use of oral nifedipine as a tocolytic agent, especially in patients with multiple pregnancies
Original languageDutch
Pages (from-to)198-205
Number of pages8
JournalNederlands Tijdschrift voor Geneeskunde
Volume151
Issue number3
Publication statusPublished - 20 Jan 2007

Cite this

@article{b663c8c032a84cfab0cea6f21c6c81be,
title = "Aanwijzingen voor respiratoire complicaties bij gebruik van oraal nifedipine als tocolyticum, met name bij pati{\"e}nten met een meerlingzwangerschap",
abstract = "In 7 women with premature labour pains, severe dyspnoea developed that was possibly related to the use of nifedipine as an 'off-label' tocolytic. 6 of these women had a twin pregnancy. Diuretics and oxygen therapy had little effect, but the patients recovered after the administration of nifedipine was stopped. The efficacy and safety of nifedipine as a tocolytic agent has been investigated in a number of well-designed randomised studies. However, these studies were performed in a selected group of pregnant women and women with multiple pregnancies or prematurely ruptured membranes were mostly excluded. It can be hypothesised that the respiratory complications in these cases are due to unequal ventilation/perfusion of the lungs in the presence of a physiologically elevated diaphragm due to the pregnancy. These changes are more pronounced in multiple pregnancies. After administration ofnifedipine, there is perfusion of atelectatic areas of the lung that are not or not well ventilated, resulting in ventilation-perfusion discrepancy and hence dyspnoea. Although case reports permit only limited extrapolation, these observations warrant caution with regard to the safety ofnifedipine as a tocolytic agent in patients with multiple pregnancies. The use of medication in groups of patients for which the agent has not been investigated, or which were explicitly excluded from the study, should be done with extreme caution. One should in any case be aware of the possible risks.",
keywords = "Adult, Dyspnea/chemically induced, Female, Humans, Nifedipine/adverse effects, Obstetric Labor, Premature/drug therapy, Pregnancy, Pregnancy Outcome, Pregnancy, Multiple, Risk Factors, Safety, Tocolysis/methods, Tocolytic Agents/adverse effects, Treatment Outcome",
author = "Lenglet, {J E} and {van Geijn}, {H P} and {van Schijndel}, {R J M Strack} and {Vonk Noordegraaf}, A and Bolte, {A C}",
year = "2007",
month = "1",
day = "20",
language = "Dutch",
volume = "151",
pages = "198--205",
journal = "Nederlands Tijdschrift voor Geneeskunde",
issn = "0028-2162",
publisher = "Bohn Stafleu van Loghum",
number = "3",

}

Aanwijzingen voor respiratoire complicaties bij gebruik van oraal nifedipine als tocolyticum, met name bij patiënten met een meerlingzwangerschap. / Lenglet, J E; van Geijn, H P; van Schijndel, R J M Strack; Vonk Noordegraaf, A; Bolte, A C.

In: Nederlands Tijdschrift voor Geneeskunde, Vol. 151, No. 3, 20.01.2007, p. 198-205.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Aanwijzingen voor respiratoire complicaties bij gebruik van oraal nifedipine als tocolyticum, met name bij patiënten met een meerlingzwangerschap

AU - Lenglet, J E

AU - van Geijn, H P

AU - van Schijndel, R J M Strack

AU - Vonk Noordegraaf, A

AU - Bolte, A C

PY - 2007/1/20

Y1 - 2007/1/20

N2 - In 7 women with premature labour pains, severe dyspnoea developed that was possibly related to the use of nifedipine as an 'off-label' tocolytic. 6 of these women had a twin pregnancy. Diuretics and oxygen therapy had little effect, but the patients recovered after the administration of nifedipine was stopped. The efficacy and safety of nifedipine as a tocolytic agent has been investigated in a number of well-designed randomised studies. However, these studies were performed in a selected group of pregnant women and women with multiple pregnancies or prematurely ruptured membranes were mostly excluded. It can be hypothesised that the respiratory complications in these cases are due to unequal ventilation/perfusion of the lungs in the presence of a physiologically elevated diaphragm due to the pregnancy. These changes are more pronounced in multiple pregnancies. After administration ofnifedipine, there is perfusion of atelectatic areas of the lung that are not or not well ventilated, resulting in ventilation-perfusion discrepancy and hence dyspnoea. Although case reports permit only limited extrapolation, these observations warrant caution with regard to the safety ofnifedipine as a tocolytic agent in patients with multiple pregnancies. The use of medication in groups of patients for which the agent has not been investigated, or which were explicitly excluded from the study, should be done with extreme caution. One should in any case be aware of the possible risks.

AB - In 7 women with premature labour pains, severe dyspnoea developed that was possibly related to the use of nifedipine as an 'off-label' tocolytic. 6 of these women had a twin pregnancy. Diuretics and oxygen therapy had little effect, but the patients recovered after the administration of nifedipine was stopped. The efficacy and safety of nifedipine as a tocolytic agent has been investigated in a number of well-designed randomised studies. However, these studies were performed in a selected group of pregnant women and women with multiple pregnancies or prematurely ruptured membranes were mostly excluded. It can be hypothesised that the respiratory complications in these cases are due to unequal ventilation/perfusion of the lungs in the presence of a physiologically elevated diaphragm due to the pregnancy. These changes are more pronounced in multiple pregnancies. After administration ofnifedipine, there is perfusion of atelectatic areas of the lung that are not or not well ventilated, resulting in ventilation-perfusion discrepancy and hence dyspnoea. Although case reports permit only limited extrapolation, these observations warrant caution with regard to the safety ofnifedipine as a tocolytic agent in patients with multiple pregnancies. The use of medication in groups of patients for which the agent has not been investigated, or which were explicitly excluded from the study, should be done with extreme caution. One should in any case be aware of the possible risks.

KW - Adult

KW - Dyspnea/chemically induced

KW - Female

KW - Humans

KW - Nifedipine/adverse effects

KW - Obstetric Labor, Premature/drug therapy

KW - Pregnancy

KW - Pregnancy Outcome

KW - Pregnancy, Multiple

KW - Risk Factors

KW - Safety

KW - Tocolysis/methods

KW - Tocolytic Agents/adverse effects

KW - Treatment Outcome

M3 - Article

VL - 151

SP - 198

EP - 205

JO - Nederlands Tijdschrift voor Geneeskunde

JF - Nederlands Tijdschrift voor Geneeskunde

SN - 0028-2162

IS - 3

ER -