Adult: For the induction of abortion during 2nd trimester of pregnancy due to intrauterine fetal death: As 1 mg pessary: Insert 1 pessary 3 hourly. Max: 5 administrations.
Vaginal Softening and dilatation of cervix prior to surgical termination of pregnancy
Adult: For cases during the 1st trimester: As 1 mg pessary: Insert 1 pessary 3 hours prior to surgery.
Vaginal Pregnancy termination in the 2nd trimester
Adult: As 1 mg pessary: Insert 1 pessary 3 hourly up to Max of 5 administrations. If termination is not established after 5 pessaries, a 2nd course of treatment may be given 24 hours following the initiation of the 1st course. If termination does not occur after 2 courses of treatment (10 pessaries), alternative methods must be employed to complete the uterine emptying.
Contraindications
Placenta praevia, uterine fragility associated with uterine scarring; labour induction or cervical softening at term. Renal impairment.
Special Precautions
Patient with CV disease, obstructive airway disease, vaginitis or cervicitis, elevated IOP; risk factors for uterine rupture (e.g. multiparity, twin pregnancy, cervical stenosis, vaginal bleeding due to unknown origin, uterine scarring).
Adverse Reactions
Significant: Uterine rupture, vaginal bleeding, mild uterine pain. Cardiac disorders: Chest pain, palpitations. Gastrointestinal disorders: Nausea, vomiting, diarrhoea. General disorders and administration site conditions: Mild pyrexia, chills. Musculoskeletal and connective tissue disorders: Muscle weakness, back pain. Nervous system disorders: Headache, dizziness. Reproductive system and breast disorders: Dyspnoea. Vascular disorders: Flushing. Potentially Fatal: Serious cardiac effects, including MI, coronary artery spasms, and severe hypotension.
Monitoring Parameters
Monitor vital signs, body temperature, blood pressure, heart rate, and respiratory rate. Assess for vaginal bleeding and uterine pain. Termination of pregnancy: Monitor for cervical dilatation and uterine contractions, particularly during 2nd trimester or the 2nd course of treatment in at-risk patients. Confirm pregnancy termination to ensure the process has been completed. Cervical softening and dilatation: Monitor for possible spontaneous abortion if the procedure is postponed for >3 hours following gemeprost administration. Intrauterine fetal death: Monitor for coagulopathy and manage based on current clinical practice standards.
Overdosage
Symptoms: Sedation, tremor, convulsion, abdominal pain, diarrhoea (which may be bloody), dyspnoea, palpitations and bradycardia. Management: Symptomatic treatment.
Drug Interactions
Action of gemeprost may be potentiated by oxytocin and other labour inducers or accelerators.
Action
Description: Mechanism of Action: Gemeprost, an alprostadil (prostaglandin E1) synthetic analogue, causes uterine contraction and softens and dilates cervical tissue. Following uterine contraction, placental and uterine blood flow is reduced. Additionally, it acts like endogenous prostaglandins to stimulate and mimic the cervical ripening process. Onset: Cervical softening: Within 3 hours. Pharmacokinetics: Absorption: Bioavailability: 12-28%. Metabolism: Metabolised in the liver via esterification into de-esterified gemeprost (main metabolite). Excretion: Via urine (50% of absorbed dose).
Chemical Structure
Gemeprost Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5282237, Gemeprost. https://pubchem.ncbi.nlm.nih.gov/compound/Gemeprost. Accessed Nov. 25, 2024.
G02AD03 - gemeprost ; Belongs to the class of prostaglandins. Used to induce abortion or augment labour and to minimize blood loss from the placental site.
References
Brayfield A, Cadart C (eds). Gemeprost. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/11/2024.Cervagem 1 mg Pessary (Aventis Pharma Limited, Trading as Sanofi). MHRA. https://products.mhra.gov.uk. Accessed 04/11/2024.Cervagem Pessary 1 mg (Sanofi-Aventis [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 04/11/2024.Gemeprost. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 04/11/2024.Joint Formulary Committee. Gemeprost. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/11/2024.
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