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Rapid response to:


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

Rapid Response:

Direct comparison between nifedipine and atosiban

We read with great intrest the study by de Heus et al. (1) on
adverse drug reactions to tocolytic treatment for preterm labour. In their
conclusion the authors point to the need for a direct comparison between
oxytocin antagonists and calcium channel blockers in terms of tocolytic
efficiency and side effects. Actually 2 (small)randomized controlled
trials comparing atosiban and nifedipine have been published (2,3).
Pooling data from these trials for tocolysis before 35 weeks gestation
results in 71 women in the atosiban and 72 in the nifedipin group.
Delivery could be postponed in 57 (80.3%) with atosiban and 56 (77.7%),
the difference not being significant ( p in Chi square test = 0.713, odds
ratio 1.08; 95% confidence interval 0.71-1.65). Both studies also mention
side effects such as arterial hypotension, 1 (1.4%) versus 25 (34.7%)in
the atosiban and nifedipine group respectively ( p< 0.001, odds ratio
16.7, 95% confidence interval 2.43-115.9.

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.
Adverse drug reactions to tocolytic treatment for preterm labour:
prospective cohort study. BMJ. 2009: 338:b744.doi 10.1136/bmj.b744
2.Kashanian M, Aklbarian AR, Soltanzadeh M. Atosiban and nifedipine for
the treatment of preterm labor. Int J Gynaecol Obstet 2005; 91: 10-14

3. Al-Omari WR, Al-Shammaa HB, Al-Tikriti EM, Ahmed KW. Atosiban and
nifedipine in acute tocolysis: a comparative study. Eur J Obstet Gynecol
Reprod Biol 2006; 128: 129-134

Competing interests:
None declared

Competing interests: No competing interests

29 March 2009
Yves Jacquemyn
Head of ObGyn
Antwerp University Hospital Wilrijkstraat 10 2650 Edegem Belgium