DINOPROSTONE (PGE2, PROSTAGLANDIN E2) 

(dye-noe-prost'one)
Cervidil, Prostin E2 , Prepidil
Classifications: HORMONES AND SYNTHETIC SUBSTITUTES; PROSTAGLANDIN; OXYTOCIC
Pregnancy Category: C

Availability
20 mg suppository; Prepidil 0.5 mg gel; Cervidil 10 mg vaginal insert

Actions
Synthetically prepared member of the prostaglandin E2 series that appears to act directly on myometrium
and on gastrointestinal, bronchial, and vascular smooth muscle. Stimulation of gravid uterus in early weeks
of gestation is more potent than that of oxytocin.

Therapeutic Effects
Contractions are qualitatively similar to those that occur during term labor. Has high success rate when
used as abortifacient before twentieth week and for stimulation of labor in cases of intrauterine fetal death.

Uses
To terminate pregnancy from twelfth week through second trimester as calculated from first day of last
regular menstrual period; to evacuate uterine contents in management of missed abortion or intrauterine
fetal death up to 28 wk gestational age; to manage benign hydatidiform mole; cervical ripening prior to
labor induction.

Contraindications
Acute pelvic inflammatory disease, history of pelvic surgery, uterine fibroids, cervical stenosis, active
cardiac, pulmonary, renal, or hepatic disease, pregnancy (category C).

Cautious Use
History of hypertension, hypotension, asthma, epilepsy, anemia, diabetes mellitus; jaundice, history of
hepatic, renal, or cardiovascular disease; cervicitis, acute vaginitis, infected endocervical lesion.

Route & Dosage

Induction of Labor
Adult: Endocervical Place Prepidil 0.5 mg endocervically, may repeat q6h (max: of 1.5 mg);
Place Cervidil insert 10-mg transversely in the posterior fornix of the vagina, remove on
onset of active labor or 12 h after insertion

Evacuation of Uterus
Adult: Intravaginal Insert suppository high in vagina, repeat q2–5h until abortion occurs or
membranes rupture (max: total dose 240 mg)
Administration
Endocervical & Intravaginal

 Antiemetic and antidiarrheal medication may be prescribed to be given before dinoprostone to

minimize GI side effects.
 Place vaginal insert in the vagina immediately after removal from the foil package. DO NOT use
without retrieval system.
 Keep patient in supine position for 10 min after administration of suppository to prevent expulsion
and enhance absorption.
 Store suppositories in freezer at temperature not exceeding –20° C (–4° F) unless otherwise
specified.

Adverse Effects ( 1%)

CNS: Headache, tremor, tension. CV: Transient hypotension, flushing, cardiac arrhythmias. GI: Nausea,
vomiting, diarrhea. Urogenital: Vaginal pain, endometritis, uterine rupture. Respiratory: Dyspnea,
cough, hiccups. Body as a Whole: Chills, fever, dehydration, diaphoresis, rash.

Interactions
Drug: OXYTOCICS used with extreme caution.

Pharmacokinetics
Absorption: Slowly absorbed from vagina; Cervidil insert releases approximately 0.3 mg/h. Onset: 10
min. Duration: 2–3 h. Distribution: Widely distributed in body. Metabolism: Rapidly metabolized
in lungs, kidneys, spleen, and other tissues. Elimination: Excreted mainly in urine; some excreted in
feces.

Nursing Implications
Assessment & Drug Effects

 Observe patient carefully, after insertion of the drug. Rupture of the membranes is not a
contraindication to drug, but be aware that profuse bleeding may result in expulsion of the
suppository. Report wheezing, chest pain, dyspnea, and significant changes in BP and pulse to the
physician.
 Monitor uterine contractions and observe for and report excessive vaginal bleeding and cramping
pain. Keep pad count. Save all clots and tissues for physician inspection and laboratory analysis.
 Abortion usually occurs within 30 h. When used in conjunction with oxytocin, time may be
shortened to 12–14 h.
 Monitor vital signs. Fever is a physiologic response of the hypothalamus to use of dinoprostone
and occurs within 15–45 min after insertion of suppository. Temperature returns to normal within
2–6 h after discontinuation of medication.

Patient & Family Education

 Continue taking your temperature (late afternoon) for a few days after discharge. Contact
physician with onset of fever, bleeding, abdominal cramps, abnormal or foul-smelling vaginal
discharge.
 Avoid douches, tampons, intercourse, and tub baths for at least 2 wk. Clarify with physician.
 Note: Dinoprostone may exacerbate joint pain and limitation due to its effect on the inflammatory
process.