Generic Name : Ritodrine Therapeutic Classification : Uterine Relaxants

Read more: Ritodrine (Yutopar) Drug Information - Indications, Dosage, Side Effects and Precautions | Medindia http://www.medindia.net/doctors/drug_information/ritodrine.htm#ixzz2oHgTm3ML Why it is prescribed (Indications) : This medication is a tocolytic agent, prescribed for uncomplicated premature labour. When it is not to be taken (Contraindications): Contraindicated in patients with high blood pressure during pregnancy, bleeding during pregnancy, intrauterine fetal death, heart disease, miscarriage and cord compression. Pregnancy Category : A B C D X Category B : Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester. Dosage & When it is to be taken : Adult: PO- 10 mg 30-60 mins before termination of IV infusion, repeat 2 hourly for 24 hour, then 10-20 mg 4-6 hourly. Max: 120 mg/day. IV- Initial: Infuse at 0.05 mg/min. Increase gradually till patient responds. Usual: 0.15-0.35 mg/min. IM 10- mg 3-8 hourly. Maintain for 12-48 hour after contractions have stopped. How it should be taken : It comes as a solution for injection to be administered by a health care provider. Warnings and Precautions : * Caution should be exercised in patients with history of heart disease, concurrent steroids, over active thyroid, heart attack, high blood pressure, sugar, asthma and breastfeeding. * Monitor plasma glucose and potassium level. * Monitor maternal pulse count throughout infusion; adjust rate to avoid maternal heartbeat exceeding 140 beats/min. Side Effects : Fast heart rate, palpitation, headache, nervousness, anxiety, nausea and vomiting. Potentially Fatal- Lung swelling and severe allergic reactions. Other Precautions : * Monitor patient's hydration status to reduce risk of lung swelling. Discontinue treatment if there are signs of lung swelling. Storage Conditions : Normally handled and stored by health care providers.

Ritodrine hydrochloride
Ritodrine hydrochloride (Yutopar) Ritodrine Hydrochloride ( RYE-toe-dreen)

Pregnancy Category: B Ritodrine HCl in 5% Dextrose Yutopar (Rx) Classification: Uterine relaxant Action/Kinetics: Stimulates beta-2 receptors of smooth muscle of the uterus, which results in inhibition of uterine
contractility. May also directly inhibit the actin-myosin interaction. Beta-adrenergic blocking agents inhibit the drug. Increased blood levels of insulin, glucose, and free fatty acids and decreased levels of potassium have been observed during IV infusion. Onset, IV: 5 min. Peak plasma concentration, IV: After a 9-mg infusion over 60 min, 32-50 ng/mL; PO: after a dose of 10 mg, 5-15 ng/mL. Time to peak serum levels: 20-60 min. t 1/2, after IV: 15-17 hr. Ninety percent of drug excreted within 24 hr through the urine.

Uses: Management of preterm labor in selected clients after week 20 of gestation. When indicated, initiate therapy as early
as possible after diagnosis. However, decision to use ritodrine should include determination of fetal maturity.

Contraindications: Before week 20 of pregnancy and when continuation of pregnancy is hazardous to mother (e.g.,
eclampsia, severe preeclampsia, intrauterine fetal death, antepartum hemorrhage, pulmonary hypertension, chorioamnionitis, and maternal hyperthyroidism, cardiac disease or uncontrolled diabetes mellitus). Also, medical conditions (e.g., uncontrolled hypertension, pheochromocytoma, bronchial asthma, hypovolemia, cardiac arrhythmias due to tachycardia or digitalis toxicity) that would be aggravated by beta-adrenergic agonists. Use in diabetics.

Special Concerns: Maternal pulmonary edema has been noted in women treated with ritodrine. The use in advanced
labor (i.e., greater than 4 cm cervical dilation or effacement greater than 80%) has not been established.

Side Effects: All effects are related to the stimulation of beta receptors by the drug. IV. CV: Increase in maternal and fetal
HR, increase in maternal systolic and marked decrease in diastolic BP (widening of pulse pressure), persistent tachycardia (may indicate pulmonary edema), palpitations, arrhythmias including VT chest pain or tightness, angina, heart murmur, myocardial ischemia. Sinus bradycardia following drug withdrawal. GI: N&V, bloating, ileus, epigastric distress, diarrhea or constipation. CNS: Headache, migraine headache, tremors, malaise, nervousness, jitteriness, restlessness, anxiety, emotional changes, drowsiness, weakness. Metabolic: Transient increases in insulin and blood glucose, increases in cyclic AMP and free fatty acids, decrease in potassium, glycosuria, lactic acidosis. Respiratory: Dyspnea, maternal pulmonary edema hyperventilation. Hematologic: Leukopenia or agranulocytosis after 2-3 weeks of IV therapy (leukocyte count returned to normal after cessation of drug). Other:Erythema, anaphylactic shock rash, intrauterine growth retardation, hemolytic icterus, sweating, chills, impaired liver function. NOTE: Neonatal effects are infrequent but may include hypoglycemia and ileus; also, hypocalcemia and hypotension in neonates whose mothers were treated with other betamimetic drugs.

Laboratory Test Alterations: Plasma glucose and insulin; plasma potassium. Overdose Management: Symptoms: Excessive beta-adrenergic stimulation, including tachycardia (in both the mother
and fetus), palpitations, cardiac arrhythmias hypotension, dyspnea, tremor, dyspnea, nervousness, N&V.Treatment: Supportive measures. A beta-adrenergic blocking agent can be used as an antidote. The drug is dialyzable.

Drug Interactions: Anesthetics, general / Additive hypotension or cardiac arrhythmias Atropine /

hypertension Beta-adrenergic blocking agents / Inhibition of the effect of ritodrine Corticosteroids /

Systemic Risk of pulmonary

edema Diazoxide / Additive hypotension or cardiac arrhythmias Magnesium sulfate / Additive hypotension or cardiac arrhythmias Meperidine / Additive hypotension or cardiac arrhythmias Sympathomimetics / Additive or potentiated effects of sympathomimetics

How Supplied: Injection: 10 mg/mL, 15 mg/mL Dosage

?IV Preterm labor. Initial: 0.05 mg/min (10 gtt/min using microdrip chamber); then, depending on response, increase by 0.05 mg/min (10 microdrops/min) q 10 min until desired response occurs. Effective dose range: 0.15-0.35 mg/min (30-70 gtt/min). Continue infusion antepartum for a minimum of 12 hr after contractions cease.

ritodrine hydrochloride
(ri' toe dreen) Yutopar Pregnancy Category B Drug classes

Sympathomimetic 2- selective adrenergic agonist Tocolytic drug (uterine relaxant)

Therapeutic actions A -receptor agonist that acts relatively selectively to inhibit contractility of uterine smooth muscle. Indications

Management of preterm labor in selected patients 20 wk gestation

Contraindications/cautions

Contraindications: hypersensitivity to ritodrine or components of preparation (injection contains sodium metabisulfite; some patients are allergic to sulfites); pregnancies of shorter duration than 20 wk; antepartum hemorrhage; eclampsia and severe preeclampsia; intrauterine fetal death; chorioamnionitis; maternal cardiac disease; pulmonary hypertension; maternal hyperthyroidism; uncontrolled maternal diabetes mellitus; preexisting maternal medical conditions that would be seriously affected by a -adrenergic agonist, such as hypovolemia, cardiac arrhythmias associated with tachycardia or digitalis toxicity, uncontrolled hypertension, pheochromocytoma, bronchial asthma already treated by betamimetics or steroids.

Dosage Available Forms: Injection--10, 15 mg/mL; injection in 5% Dextrose--0.3 mg/mL Individualize dosage by balancing uterine response and unwanted effects. The following is a guide to safe and effective dosage. IV:

0.05 mg/min IV initially (0.33 mL/min or 20 drops/min using a microdrip chamber at the recommended dilution; see below). Gradually increase by 0.05 mg/min (10 drops/min) every 10 min until desired result is attained. Usual effective dosage is between 0.15 and 0.35 mg/min (30---70 drops/min) continued for at least 12 h after uterine contractions cease. Pharmacokinetics
Route Onset Peak Oral Varies 30---60 min IV Rapid

Metabolism: Hepatic, T1/2: 1.7---2.6 h Distribution: Crosses placenta; enters breast milk Excretion: Urine IV facts

Preparation: Empty the contents of three ampuls (50 mg/ampul; total of 150 mg) into 500 mL of compatible IV diluent to make a solution of 0.3 mg/mL concentration. Compatible diluents are 0.9% Sodium Chloride Solution, 5% Dextrose Solution; 10% Dextran 40 in 0.9% Sodium Chloride Solution, 10% Invert Sugar Solution, Ringer's Solution, Hartmann's Solution. Store at room temperature; protect from excessive heat. Do not use after 48 h. Do not use IV solution that is discolored or contains precipitate or particulate matter. Infusion: Use a controlled infusion device to administer IV infusions; an IV mi-crodrip chamber (60 drops/mL) can provide a convenient range of infusion rates.

Adverse effects Maternal Effects

CNS: Headache, weakness, tremor, nervousness, restlessness, emotional upset, anxiety, malaise GI: Nausea, vomiting, ileus, constipation, diarrhea

CV: Increase in heart rate, increase in systolic BP, decrease in diastolic BP, palpitations, chest pain, supraventricular tachycardia, sinus bradycardia with withdrawal of drug Respiratory: Dyspnea, hyperventilation, postpartum pulmonary edema (sometimes fatal) Hypersensitivity: Anaphylactic shock, rash Other: Erythema, transient elevation blood glucose, hypokalemia

Fetal Effects

GI: Ileus CV: Fetal heart rate increase, hypotension in neonates whose mothers were given other -adrenergic agonists Hematologic: Hypoglycemia, hypocalcemia in neonates whose mothers were given other -adrenergic agonists

Clinically important interactions

Drug-drug o Increased sympathomimetic effects with other sympathomimetic drugs o Decreased therapeutic effects with -adrenergic blockers o Potentially fatal pulmonary edema with corticosteroids

Nursing Considerations

Assessment History: Hypersensitivity to ritodrine or components of preparation, pregnancy, antepartum hemorrhage, eclampsia and severe preeclampsia, intrauterine fetal death, chorioamnionitis, maternal cardiac disease, pulmonary hypertension, maternal hyperthyroidism, uncontrolled maternal diabetes mellitus, hypovolemia, cardiac arrhythmias, uncontrolled hypertension, pheochromocytoma, bronchial asthma already treated by betamimetics or steroids

Physical: Maternal and fetal heart rate, maternal BP and R, plasma glucose and electrolytes (potassium) Implementation

Monitor maternal P, R closely; persistent maternal P > 140 beats/min or persistent tachypnea (R > 20/min) may be signs of impending pulmonary edema. Avoid fluid overload; serial hemograms may indicate state of hydration. Maintain patient in left lateral position during the infusion to minimize hypotension.

Drug-specific teaching points

Report chest pain, dizziness, insomnia, weakness, tremor or irregular heart beat.

Adverse effects in Italic are most common; those in Bold are life-threatening.