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Author Topic: Anyone been prescribed progesterone injections or nifedipine in the UK?  (Read 3335 times)

Alice

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Hi All,

I would like to hear from anyone who has been prescribed progesterone injections (not suppositories) or nifedipine in the UK (or any other ongoing drug treatment to prevent preterm labour).  These drugs seem to be widely and successfully used in the US and Canada, but I'm not aware of their being used in the UK.  I am hoping to find a (private or NHS) doctor in London who would prescribe them for a future pregnancy.

After two preterm births I am not sure whether I can risk another pregnancy; we would love another child, having only one surviving son, but we would not want to risk the wellbeing of another baby being born early.  I'm in my late thirties and have had trouble conceiving previously, so we want to understand what options are open to us before considering surrogacy.

Many thanks,

Alice
Lost beloved twin boys at 2 days, and one month, after preterm delivery at 27+4 in September 2010 and appalling medical care.

Healthy baby boy arrived at 33 weeks in July 2011 and is doing really well.

myaandcadansmummy

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Re: Anyone been prescribed progesterone injections or nifedipine in the UK?
« Reply #1 on: November 01, 2011 at 03:38 PM »
Hiya

I'm not familiar with it but I have found this for you (I'm in uk too)

http://www.neonatalformulary.com/pdfs/uk_guidelines/NIFEDPINE-RCOG_guideline_on_tocolysis.pdf

Quote
Atosiban is licensed in the UK for treatment of threatened preterm labour. The recommended
dosage and administration schedule for atosiban is a three-step procedure.19 The initial bolus dose
is 6.75 mg over one minute, followed by an infusion of 18 mg/hour for three hours and then
6 mg/hour for up to 45 hours. Duration of treatment should not exceed 48 hours and the total dose
given during a full course should preferably not exceed 330 mg of atosiban.19 The purchase price of
atosiban is substantially higher than alternatives such as nifedipine or the beta-agonists. Drug costs
for a 19-hour treatment are £240 (June 2000 prices),19 compared with £40–80 for an equivalent
length of treatment with ritodrine and £17–25 for nifedipine.20 A full comparison of cost has not
been reported but this should also take into account the cost of administering each drug and any
benefits or adverse effects.
Nifedipine has the advantage of oral use and it is cheap. However, it is not licensed in the UK for
use as a tocolytic agent and so responsibility for its use lies with the prescribing doctor. There is no
consensus about the appropriate regimen for nifedipine: the optimal dose has not been defined and
the different release characteristics of the formulations available may affect the dosage required.
Dosage in the largest trial21 was 10 mg sublingually every 15 minutes for the first hour, until
contractions stopped, then 60–160 mg/day of slow release nifedipine depending on uterine activity.

Quote
If a tocolytic agent is used, ritodrine no longer seems the best choice. Alternatives such as atosiban
or nifedipine appear to have comparable effectiveness in terms of delaying delivery for up to seven
days and are associated with fewer maternal adverse effects. Atosiban is licensed for use as a
tocolytic but the purchase price is relatively expensive. Nifedipine is not licensed for use as a
tocolytic and the ideal dosage and formulation are unclear. For both these agents, further evidence
is required about their relative effects on substantive outcomes such as neonatal mortality and
morbidity, and on safety and long-term outcome for the child.


In essense Nifedipine is not licenced for use here yet (but any DR can still prescribe it off licence - its just finding a willing Dr).

Sorry I cant be more help xxx

Alice

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Re: Anyone been prescribed progesterone injections or nifedipine in the UK?
« Reply #2 on: November 01, 2011 at 03:49 PM »
Hi and many thanks for taking the time to respond.  I'm hoping to find a doctor who would prescribe it before I'm in fullblown preterm labour... I think you are right about trying to find a helpful doctor who would prescribe it off-label.  Not sure the 17P injections are even available off-label though.  Alternatively I will be going to Miami next March and could perhaps find a dodgy/sympathetic enough doctor to prescribe me a load to bring back.  Obviously it's not ideal, but nor is not having access to the most effective treatments...

Hope whatever brings you to this forum turns out well for you.

Best, Alice
Lost beloved twin boys at 2 days, and one month, after preterm delivery at 27+4 in September 2010 and appalling medical care.

Healthy baby boy arrived at 33 weeks in July 2011 and is doing really well.