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Adverse drug reactions to tocolytic treatment for preterm labour: prospective cohort study

BMJ 2009; 338 doi: (Published 06 March 2009) Cite this as: BMJ 2009;338:b744

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Adverse drug reaction of Tocolytics in India

We read the article by de Heus1 with interest. They have studied
prospectively, 1920 women in 28 hospitals and have come up with
interesting conclusions. We feel that in India ritodrine, terbutaline and
isoxsuprine remains to be the major tocolytics. Hundreds of thousands of
women in preterm labour are given these drugs on daily basis. Though,
obstetricians using these drugs say that "theoretically, there are many
side effects; but practically we do not see many side effects". The side
effects which many obstetricians feel are palpitations, restlessness but
are not of ‘serious’ nature etc. Routine monitoring of potassium levels is
not done. Hypotension, arrhythmias and worsening of ischemic heart disease
are rarely seen. Indeed, few studies have reported no significant adverse
effects of ritodrine, a beta-2 agonist used for premature labour2. This
makes a fit case to initiate the intensive monitoring of side effects of
tocolytics in India. We feel that we need to look at the side effect
profile of tocolytics in india more closely.


1. de Heus R, Mol BW, Erwich JJ, van Geijn HP, Gyselaers WJ, Hanssens
M, Härmark L, van Holsbeke CD, Duvekot JJ, Schobben FF, Wolf H, Visser GH.
2. Sharma A, Suri V, Gupta I. Tocolytic therapy in conservative management
of symptomatic placenta previa. Int J Gynaecol Obstet. 2004;84(2):109-13.

Competing interests:
None declared

Competing interests: No competing interests

11 March 2009
Vikas Dhikav
Senior Research Officer
Richa Gupta, Gynecologist, Gaziabad (UP)
All India Institute of Medical Sciences, New Delhi-110029, INDIA