Yogol N S, Shakya R, Thapa P
Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre.
JNMA J Nepal Med Assoc. 2009 Oct-Dec;48(176):265-8.
Preterm delivery is an important cause of perinatal morbidity and mortality. To decrease the medical and economical impact of preterm delivery, tocolytic agents are available among which isoxsuprine and ritodrine are widely used in Nepal. The study on efficacy of ritodrine and isosuprine has not been done yet in Nepelese women. So to observe on efficacy and safety of Ritodrine and Isoxsuprine, this study was conducted.
A prospective observational study was conducted with an aim to assess the efficacy and safety of Isoxsuprine 10 mg orally eight hourly versus Ritodrine 10 mg initially infused intravenously along with 5% dextrose at the rate of 10 drops per minute with an increase of 5-10 drops every 30 minutes for 24 hours and then given oral at 5-10 mg eight hourly, in patient with preterm labor requiring uterine tocolysis.
This study found that Ritodrine is more effective and safer than Isoxsuprine in suppressing preterm labor. The failure rate of Isoxsuprine and Ritodrine were 22.22% and 6.5% respectively. The maternal side effects including cardiac side effects were significantly higher in Isoxsuprine. The cardiac side effects caused by Ritodrine can be controlled by adjusting the drip rate. Though Isoxsuprine seems more economical than Ritodrine, it is lesser cost effective to patients due to its higher failure rate, that results in added expenses in terms of increased morbidity and mortality.
Hence, Ritodrine is superior to Isoxsuprine as it is more efficacious in managing preterm labor and increasing fetal maturity. Also the adverse effects of Ritodrine are less than those of Isoxsuprine which result in better patient compliance and cost effectiveness.
早产是围产期发病和死亡的重要原因。为降低早产的医学和经济影响,有多种宫缩抑制剂可供使用,其中异舒普林和利托君在尼泊尔被广泛使用。尼泊尔女性中尚未开展关于利托君和异舒普林疗效的研究。因此,为观察利托君和异舒普林的疗效和安全性,开展了本研究。
进行了一项前瞻性观察性研究,目的是评估每8小时口服10毫克异舒普林与初始静脉输注10毫克利托君加5%葡萄糖(每分钟10滴,每30分钟增加5 - 10滴,持续24小时,然后每8小时口服5 - 10毫克)对需要子宫宫缩抑制的早产患者的疗效和安全性。
本研究发现,在抑制早产方面,利托君比异舒普林更有效且更安全。异舒普林和利托君的失败率分别为22.22%和6.5%。异舒普林的母体副作用(包括心脏副作用)明显更高。利托君引起的心脏副作用可通过调整滴速来控制。虽然异舒普林似乎比利托君更经济,但由于其较高的失败率,对患者来说成本效益较低,这导致发病率和死亡率增加方面的额外费用。
因此,利托君优于异舒普林,因为它在管理早产和提高胎儿成熟度方面更有效。而且利托君的不良反应比异舒普林少,这导致更好的患者依从性和成本效益。