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Tocolytics (also called anti-contraction medications or labor suppressants) are medications used to suppress premature labor (from the Greek tokos, childbirth, and lytic, capable of dissolving). They are given when delivery would result in premature birth. The therapy also buys time for the administration of betamethasone, a glucocorticoid drug which greatly accelerates fetal lung maturity, but takes one to two days to work.

The suppression of contractions is often only partial and tocolytics can only be relied on to delay birth for several days. Depending on the tocolytic used the mother or fetus may require monitoring (e.g., blood pressure monitoring when nifedipine is used as it reduces blood pressure; cardiotocography to assess fetal well-being). In any case, the risk of preterm labor alone justifies hospitalization.It has been postulated that the use of a PGF receptor antagonist might be the best therapeutic approach for new tocolytic drugs.[1]

Types of agents[edit]

There is no clear first-line tocolytic agent.[2][3]

Various types of agents are used, with varying success rates and side effects. Some medications are not specifically approved by the U.S. Food and Drug Administration (FDA) for use in stopping uterine contractions in preterm labor, instead being used off-label.

Drug Mechanism of action Description Possible
Maternal side effects Fetal and neonatal side effects
Terbutaline (Brethine) β2 agonist Is often the drug given first, especially if there is only low risk of preterm birth.[4] Cardiac arrhythmias,[citation needed] diabetes Cardiac or cardiopulmonary arrhythmias, pulmonary edema, myocardial ischemia, hypertension, tachycardia, death[citation needed] Fetal tachycardia, hyperinsulinemia, hypoglycemia, myocardial and septal hypertrophy, myocardial ischemia[citation needed]
Ritodrine (Yutopar) β2 agonist No longer FDA approved[5] Poorly controlled thyroid disease and diabetes[citation needed] Metabolic hyperglycemia, hyperinsulinemia, hypokalemia, antidiuresis, altered thyroid function, physiologic tremor, palpitations, nervousness, nausea or vomiting, fever, hallucinations[citation needed] Neonatal tachycardia, hypoglycemia, hypocalcemia, hyperbilirubinemia, hypotension, intraventricular hemorrhage[citation needed]
Fenoterol β2 agonist Diabetes
Salbutamol (INN) or albuterol (USAN) β2 agonist Diabetes
Hexoprenaline (Gynipral) β2 agonist Not FDA approved Hyperthyroidism, cardiovascular diseases, glaucoma, placental abruption, vaginal bleeding, inflammatory diseases of internal genitalia, 1st trimester of pregnancy, breastfeeding[6][7] Vertigo, anxiety, tremor, hyperhidrosis, tachycardia, hypotension, hyperglycemia, edema Hypoglycemia, bronchospasm, anaphylactic shock[7]
Nifedipine (Procardia, Adalat) Ca2+ channel blocker Is one of the most commonly used tocolytic agents.[8] Cardiac disease.[citation needed] It should not be used concomitantly with magnesium sulfate[citation needed] Flushing, headache, dizziness, nausea, transient hypotension. Administration of calcium channel blockers should be used with care in patients with renal disease and hypotension. Concomitant use of calcium channel blockers and magnesium sulfate may result in cardiovascular collapse[citation needed] None noted as yet[citation needed]
Atosiban Oxytocin receptor antagonist Fewer side effects than β2 agonists[citation needed]
Indomethacin NSAID Late pregnancy (ductus arteriosus), significant renal or hepatic impairment[citation needed] Nausea, heartburn[citation needed] Constriction of ductus arteriosus, pulmonary hypertension, reversible decrease in renal function with oligohydramnios, intraventricular hemorrhage, hyperbilirubinemia, necrotizing enterocolitis[citation needed]
Sulindac NSAID Coagulation disorders or thrombocytopenia, NSAID-sensitive asthma, other sensitivity to NSAIDs[citation needed]
Magnesium sulfate[9] Myosin light chain inhibitor Shown to be ineffective for delaying birth or stopping early birth.[9] Meta-analyses have failed to support it as a tocolytic agent[9][10][11] Absolute contraindication: myasthenia gravis[citation needed]. Use as a tocolytic agent may result in death of the fetus or infant.[9] Flushing, lethargy, headache, muscle weakness, diplopia, dry mouth, pulmonary edema, cardiac arrest[citation needed] Lethargy, hypotonia, respiratory depression, demineralization with prolonged use[citation needed]
Ethanol GABAA receptor PAM Shown to be ineffective. Was a frequently used tocolytic in the mid-20th century, but later double-blind studies[12] found it was not effective.

Calcium-channel blockers and an oxytocin antagonist can delay delivery by 2–7 days.[13] Otherwise, tocolysis is rarely successful beyond 24–48 hours because current medication do not alter the fundamentals of labor activation.[10] However, just gaining 48 hours is sufficient to allow the pregnant women to be transferred to a center specialized for management of preterm deliveries and give administered corticosteroids the possibility to reduce neonatal organ immaturity.

The efficacy of beta-agonists, atosiban and indomethacin is a decreased odds ratio (OR) of delivery within 24 hours of 0.54 (95 percent confidence interval (CI): 0.32-0.91) and 0.47 within 48 hours (OR 0.47, 95 percent CI 0.30-0.75).[2]

Antibiotics may delay the onset of labor in women with premature rupture of membranes, but this is not usually characterized as tocolysis.

Contraindications to tocolytics[edit]

In addition to drug-specific contraindications,[citation needed] several general factors may contraindicate delaying birth with the use of tocolytic medications.

See also[edit]


  1. ^ Mueller, Andreas; Maltaris, Theodoros; Siemer, Joern; Binder, Helge; Hoffmann, Inge; Beckmann, Matthias W.; Dittrich, Ralf (2006-04-25). "Uterine contractility in response to different prostaglandins: results from extracorporeally perfused non-pregnant swine uteri". Human Reproduction. 21 (8): 2000–2005. doi:10.1093/humrep/del118. ISSN 1460-2350. 
  2. ^ a b Tan TC, Devendra K, Tan LK, Tan HK (May 2006). "Tocolytic treatment for the management of preterm labour: a systematic review". Singapore Med J. 47 (5): 361–6. PMID 16645683. 
  3. ^ de Heus R, Mol BW, Erwich JJ, et al. (2009). "Adverse drug reactions to tocolytic treatment for preterm labour: prospective cohort study". BMJ. 338: b744. doi:10.1136/bmj.b744. PMC 2654772Freely accessible. PMID 19264820. 
  4. ^ Healthline > Treatment of Preterm Labor: Tocolytics Health Article Retrieved on 6 January 2009
  5. ^ [<Drugs@fda:fda approved drug products. (n.d.). Retrieved from HCL> "Drugs@FDA"] Check |url= value (help). 
  6. ^ "Gynipral (hexoprenaline) Full Prescribing Information". Russian State Register of Medicinal Products (in Russian). Nycomed Austria GmbH. St. Peter-Straße 25, A-4020, Linz, Austria. Retrieved 19 March 2016. 
  7. ^ a b "Gynipral (hexoprenaline) Tablets 0.5 mg, Solution for Intravenous Infusion 5 μg/mL (0.0005%)". "RLS" (РЛС): Russian Register of Medical Products (in Russian). Retrieved 19 March 2016. 
  8. ^ Welcome to the Women's - The Royal Women's Hospital Victoria Australia
  9. ^ a b c d Crowther, CA; Brown, J; McKinlay, CJ; Middleton, P (15 August 2014). "Magnesium sulphate for preventing preterm birth in threatened preterm labour". The Cochrane Database of Systematic Reviews (8): CD001060. doi:10.1002/14651858.CD001060.pub2. PMID 25126773. 
  10. ^ a b Simhan HN, Caritis SN (2007). "Prevention of Preterm Delivery". New England Journal of Medicine. 357 (5): 477–487. doi:10.1056/NEJMra050435. PMID 17671256. 
  11. ^ Nanda, K; Grimes, DA (2006). "Magnesium sulfate tocolysis: Time to quit". Obstetrics and Gynecology. 108 (4): 986–989. doi:10.1097/01.AOG.0000236445.18265.93. PMID 17012463. 
  12. ^ Castrén O, Gummerus M, Saarikoski S (1975). "Treatment of imminent premature labour". Acta Obstet Gynecol Scand. 54 (2): 95–100. PMID 1094787. 
  13. ^ Iams JD, Romero R, Culhane JF, Goldenberg RL (2008). "Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth". The Lancet. 371 (9607): 164–175. doi:10.1016/S0140-6736(08)60108-7. PMID 18191687. 
  14. ^ a b c d e f g h i j k Wong, Perry, and Hockenberry. Maternal Child Nursing Care. Mosby 2002