DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

rate then is reduced to 1-2 mL/minute until the mother is
ready for transfer to the postpartum unit. Carbetocin, a
longer-acting derivative of oxytocin, is under evaluation
in clinical trials to prevent or treat postpartum hemorrhage;
a dose of 100 μg is given intravenously (Leung
et al., 2006).
Ergot alkaloids markedly increase the motor activity of the
uterus. Although their capacity to induce sustained uterine tetany
precludes their use in the induction or facilitation of labor, they are
used to prevent or treat postpartum hemorrhage in normotensive
women. In this setting, the preferred ergot alkaloids are ergonovine
(ERGOTRATE) or its methyl analog methylergonovine (METHERGINE).
They are administered intramuscularly or intravenously, exhibit rapid
onsets of action (2-3 minutes intramuscularly, <1 minute intravenously),
and their effects persist for 45 minutes to 3 hours depending
on the route of administration. Adverse effects include nausea
and vomiting, elevated blood pressure, and decreased pain threshold
requiring analgesia.
Alternatively, the PGE 1
analog misoprostol (600 μg administered
orally or sublingually) may be used off label to stimulate uterine
contractions and prevent or treat postpartum hemorrhage.
Although meta-analyses suggest that it may be slightly less effective
than oxytocin, the low cost and lack of need for refrigeration or
sterile needles may make misoprostol the preferred agent for use in
developing nations. Other approaches under investigation include
recombinant factor VIIa and balloon tamponade.
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CHAPTER 66
CONTRACEPTION AND PHARMACOTHERAPY OF OBSTETRICAL