nifedipine

Determining the most effective treatment for women at risk of preterm labor is crucial in reducing potential complications and neonatal mortality. This study aimed to compare the effects of two oral medications, Dydrogesterone and nifedipine, on managing preterm labor in pregnant women admitted with threatened preterm labor.

The trial aimed to compare the efficacy of Dydrogesterone versus nifedipine in preventing preterm labor.

In this randomized controlled clinical trial, 54 pregnant women aged 18 to 45 years, with a gestational age of 26 to 34 weeks and at risk of preterm labor, were randomly assigned to receive either 40 mg oral Dydrogesterone or a standard dose of nifedipine (10 mg for the first dose) as a tocolytic. Key maternal and neonatal outcomes, including the interval between intervention and delivery, delivery type, neonatal intensive care unit (NICU) admission, NICU stay duration, and Bishop scores, were evaluated and compared between the two study groups.

The mean age of participants was 27.78 ± 2.53 years in the nifedipine group and 27.67 ± 2.53 years in the Dydrogesterone group. There were no significant differences (P > 0.05) between the two groups in baseline characteristics. The mean NICU stay in the Dydrogesterone group (2.3 ± 0.5 days) was significantly shorter than in the nifedipine group (4.6 ± 0.5 days) (P = 0.001). Although the frequency of gestational age at delivery, NICU admission, the interval between intervention and delivery, and repeated preterm labor were lower in the Dydrogesterone group, the differences between the groups were not statistically significant (P > 0.05).

The findings suggest that Dydrogesterone is effective in treating preterm labor. Both drugs prevented preterm labor; however, nifedipine, despite being a standard treatment, has potential side effects and may not be suitable for all patients. These results indicate that Dydrogesterone, with fewer side effects, could be an alternative for patients who cannot use nifedipine. Further studies with larger sample sizes are needed to confirm or refute this finding.

Preterm labor is one of the main causes of neonatal mortality and its treatment is still challenging.

The study aimed to compare the effectiveness of nifedipine (Nif) with and without sildenafil citrate (SC) for the treatment of preterm labor in pregnant women.

In this clinical trial study, 126 pregnant women referred to the Fatemieh hospital, Hamadan, Iran with a complaint of preterm labor were evaluated. Participants were randomly divided into 2 groups of Nif 20 mg orally (single dose), then 10 mg every 6-hr, and at the same time vaginal SC 25 mg every 8 hr (Nif + SC) or Nif alone. Treatment was continued for 48-72 hr if uterine contractions did not resolve in both groups. Delivery rates at the time of hospitalization and neonatal outcome were compared between the 2 groups.

No statistically significant difference was observed between the 2 study groups in terms of mean age, gestational age, body mass index, and parity. 76.2% of Nif + SC participants in the first 72 hr of hospitalization and 57.2% of Nif participants remained without delivery (p = 0.02). The neonatal hospitalization rate of the Nif + SC group in the neonatal intensive care unit was 25.4% and in the Nif group was 42.9% (p = 0.03).

Nif with SC is superior to Nif alone in women at risk of preterm labor due to increasing gestational age and better neonatal outcomes.

In Raynaud's phenomenon of the nipple there is a change in color, accompanied by pain or discomfort during breastfeeding.

Case report:

 A 29-years old female patient, breastfeeding, develops a severe bilateral nipple pain during and after breastfeeding and biphasic change in nipple color, with difficulties in the breastfeeding technique. She was medicated with nifedipine and recommended application of warm compresses to the nipples and use of electric breast pump, showing complete resolution after four weeks of treatment.

Raynaud's phenomenon of the nipple should be considered in breastfeeding women who report nipple pain or discomfort. In clinical practice, nipple pain is a very frequent complaint, and responsible for many cases of early abandonment of breastfeeding. It is therefore essential to make an early diagnosis and implement a correct and immediate treatment.

In preterm delivery, uterine contractions begin prematurely and lead to the opening of the cervix. Nifedipine and Indomethacin drugs can help reduce contractions and delay childbirth.  However, there are contradictions regarding their effect on preterm birth and inflammatory factors. This study aimed to compare the effect of nifedipine and indomethacin on uterine contractions, CRP, and white blood cells in pregnant women with idiopathic preterm labor.

This single-blind clinical trial was conducted on 68 eligible pregnant women hospitalized with premature labor pains in Imam Sajjad Yasuj Hospital in 2022 and randomly assigned to two groups. With tocography, the fixation contractions must have at least four contractions higher than 15mmHg. Before and 48h after interventions, the number and time of contractions, cervical dilatation, WBC, DIFF, and CRP tests were measured. Data were analyzed using SPSS 25 software.

Both interventions improved the number and time of contractions, CRP, and neutrophil. However, there were no significant differences in these variables between Nifedipine and Indomethacin groups. The study showed a statistically significant difference between groups in the number of eosinophils and monocytes after the intervention (p<0.05).

Nifedipine and Indomethacin improve the number and duration of contractions, CRP, monocytes, and neutrophils. Nifedipine causes more decrease in eosinophil levels than indomethacin.

The anal fissure is one of the most common anorectal diseases that is associated with reduced quality of life and productivity loss. We aimed to compare the efficacy of topical nifedipine and diltiazem for the treatment of acute anal fissure (AAF).

This single-blind randomized clinical trial was conducted at Ziaeian hospital, Tehran. Patients with an acute fissure diagnosis were allocated to two groups. Group A applied 3 grams of 0.3% nifedipine cream on the peri-anal area, three times a day, for 8 weeks. Group B also applied the same amount of 2% diltiazem-ointment on the peri-anal area for the same period. The primary outcome was fissure remission in the 8th week of the treatments. The duration of pain relief, the side effect of treatment, and the recurrence rate were also compared between the groups.

After 8 weeks of treatment, a remission rate of 77.4% was shown in the nifedipine group which was significantly higher than the diltiazem group with a remission rate of 54% (P = 0.01). Applying nifedipine ointment is associated with earlier pain relief compared with diltiazem (P < 0.001). After 6 months of follow-up, the relapse rate was not statistically different between the nifedipine and diltiazem groups (16.3% versus 21.4%, respectively).

The application of topical nifedipine is associated with shorter pain relief and more remission rate for AAF compared with topical diltiazem. However, both methods were not different in terms of related side effects and AAF recurrence rate.

Nifedipine (NF) is a calcium channel blocker that accelerates wound healing and subsequently relieves pain and discomfort. The aim of the present study was to investigate the local effect of this drug on the wound-healing process of the palate.

In this triple-blind clinical trial study, 31 patients who were referred to the Periodontology Department of Babol Dental School (14 in the experimental group and 17 in the control group) were examined. They were candidates for gingival surgery and needed a palate transplant. Mucotom was used to create identical wounds in the palate (transplant donor). After a free gingival grafting, the active ingredient of 0.3% NF was applied as a mucosal adhesive (made of chitosan) in the area of the graft (palate). Patients were examined and recorded on days 2, 4, 7, 14, and 30 after surgery for wound closure and healing criteria (Landry & Manchester scar scale) and pain (VAS). Sutures were removed on day 7 of the study. Data were analyzed with SPSS 20 and chi-square, Kruskal-Wallis and Mann-Whitney tests. The significance level was set at 0.05.

Based on Landry and Manchester criteria, the wound healing process in the two groups was not significant (p=0.125). There was no significant difference between mean wound size reduction and VAS in both treatment and control groups (p=0.253).

Topical NF has no effect on the natural process of healing oral mucosal ulcers and reducing pain.

Endometrial receptivity is crucial for embryo implantation, and excessive uterine contraction reduces success. Nifedipine which is a calcium channel blocker, could decrease uterine contraction and improve pregnancy outcomes.

This study aimed to assess the effect of Nifedipine before embryo transfer on the pregnancy outcome in women undergoing in vitro fertilization (IVF) in a tertiary center in Iran.

150 women who were candidates for IVF were randomly assigned into 2 groups: group 1 received 20 mg Nifedipine 30 min before embryo transfer, and group 2 received no intervention. Blood pressure of the participants was monitored every 10 min for 1 hr under the supervision of an anesthesiologist. Finally, implantation rate and chemical and clinical pregnancy rates were compared between groups.

At the end of the study, 140 participants were included in the final analyses. No significant difference was observed in clinical pregnancy rates between groups (20% vs. 22%, p = 0.51)

Nifedipine administration before embryo transfer does not improve the implantation and clinical pregnancy rates in women undergoing IVF.

 In- vitro fertilization (IVF) is one of the approved treatment options for infertility. Despite many progresses in this field, its success rate is about 20 -25%. Utilization of drugs which suppress or decrease uterine smooth muscle contraction before embryo transfer, theoretically can improve fertility by increasing implantation rate. This study was designed to evaluate nifedipine administration on embryo transfer success.

 In this double blinded randomized clinical trial, ninety-eight infertile women from primary and secondary causes were included in two groups; one group received placebo and the other group a  single dose of 20 mg nifedipine, both thirty minutes before embryo transfer. Primary outcome was defined as clinical pregnancy, and secondary outcomes as live birth, ectopic pregnancy, multiple gestation and abortion.

 Clinical pregnancy occurred in eighteen patients in the placebo group and in seventeen patients in nifedipine group (OR = 0.91, 0.40-2.09 (95% CI)). Sixteen patients in placebo group and fourteen patients in nifedipine group had successful live births (OR = 0.82, 0.34-1.95 (95% CI)). Multiple gestation (OR = 1.71, 0.24- 11.78 (95% CI)) and abortion (OR = 0.46, 0.07-2.95 (95% CI)) were not different between the two groups. No side effect of drug occurred in any group.

 A single dose of 20 mg nifedipine tablet administered thirty minutes before IVF had no effect on improving clinical pregnancy and live birth rate. Using higher doses, or different regimens in specific patients’ subgroups may have more effect on embryo transfer success.

Recently, sildenafil as a drug effective in relaxing smooth muscles can be used as an adjunct to delay the onset of uterine contractions and therefore the occurrence of preterm labor. The aim of this study was to evaluate the effect of nifedipine combination with sildenafil on preterm delivery compared with nifedipine alone.

This randomized double-blinded clinical trial was performed on pregnant women with a gestational age of 26-34 weeks with singleton pregnancy and symptoms of preterm delivery. The mothers were randomly assigned into two groups receiving nifedipine plus sildenafil or those receiving nifedipine alone. The time of delivery, maternal and neonatal complications were compared between the two groups.

Mothers who received the combination therapy experienced significantly lower preterm delivery within 72 hours of intervention compared to nifedipine alone (4.5% versus 27.3%, p = 0.002). The rate of delivery during the first 7 days after discharge was 7.6% and 31.8% in nifedipine plus sildenafil and nifedipine alone, respectively (P = 0.001). The prevalence of neonatal respiratory distress syndrome (RDS) as well as mean birth weight was higher in the nifedipine group alone. Treatment protocol with nifedipine and sildenafil compared with nifedipine alone was associated with a significant increase in preterm delivery delay (beta =-5.819, p = 0.001).

The use of sildenafil in addition to nifedipine causes more delay in delivery in cases of preterm labor, followed by lower risk for RDS, reduces neonatal intensive care unit (NICU) admission, and preserves neonatal birth weight.

Preterm labor (PTL) is a serious emergency wherein robust management is imperative for achieving improved outcome.

To evaluate the efficacy and safety of nifedipine alone vs nifedipine with vaginal progesterone in managing threatened PTL.

This comparative study was carried out at the Pakistan Institute of Medical Sciences, Islamabad over a 2-year’ period, from September, 2013 to August, 2015. The study included 276 patients with threatened PTL. Half of them were allocated to nifedipine alone group whereas the remainder half to the additional progesterone group. In nifedipine alone group (group A), all the patients were given 20 mg of rapid release nifedipine orally. If uterine contraction continued, a 10 mg dose was repeated every 20 min with a maximum of 40 mg within the first hour. After completing the first hour, 20 mg was given every 4-6 hr for 72 hr. In the additional vaginal progesterone group (group B), following successful tocolysis with nifedipine, additional - maintenance tocolysis was ensured with vaginal progesterone 200 mg daily.

Successful acute tocolysis was achieved with nifedipine among 86.23% patients. Mean pregnancy prolongation was 11.13±5.08 days in group A while 29.73±3.10 days in group B. (p≤ 0.001)

Acute tocolytic therapy with nifedipine was successful in the majority of our patients. The additional daily use of vaginal progesterone suppositories resulted in significant prolongation of pregnancy as well as reduction in the rate of low birth weight and neonatal ICU admissions.

Many antimalarial agents and calcium channel blockers have been demonstrated to alter male reproductive activity. Increasing prevalence of hypertension, therefore, increases concern of male infertility, and concurrent administration of antihypertensive and antimalarial agents in malaria-prone areas.

The study evaluates the reproductive effect of co-administration of artesunate (Ats)-amodiaquine (Amod) and nifedipine (Nif) in male guinea pigs.

In this experimental study, 24 adult male pigs were divided into four groups (n=6/ each) as one control (given distilled water) and 3 intervention groups (given standard daily dose equivalents of Ats-Amod, Nif or combination of both drugs) for 14 days. Serum levels of testosterone, follicle-stimulating hormone and luteinizing hormone were measured using enzyme-linked immunosorbent assay. Testicular weight was measured and the relative weight (organ-to-body weight ratio) was obtained. Sperm count, motility, and morphology were equally analyzed.

Nif treatment produced no significant effect on the hormone levels (p=0.058) and sperm parameters (p=0.0568) that were measured, whereas Ats-Amod and Ats-Amod+Nif decreased testosterone level (p=0.0482), sperm count and motility (p<0.0001), but failed to cause an alteration in follicle-stimulating hormone, luteinizing hormone and sperm morphology. Percentage of motility reduction by Ats-Amod+Nif was greater (p=0.025) compared to Ats-Amod effect. Relative testicular weight was decreased (p=0.046) by Ats-Amod and Ats-Amod+Nif, but unaffected by Nif.

The result suggests that short-term administration of standard daily dose equivalent of Nif does not alter hormone levels and sperm indices, while Ats-Amod alone or in combination with Nif decreases testosterone, sperm count, and motility. The combination also results in synergistic inhibition of sperm motility

Preterm labor is a leading cause of fetal and neonatal morbidity and mortality. There are various kinds of drugs used to suppress the preterm labor, but they are not thoroughly effective. The aim of this study was to compare the effectiveness of oral nifedipine with intravenous magnesium sulfate in delaying the preterm labor.

A randomized, clinical trial was conducted in a hospital in Babol, Iran. One hundred twenty singleton pregnant women with preterm labor, 24-37 weeks of gestation, were randomly assigned to receive oral nifedipine or intravenous magnesium sulfate. The main outcome of the study was the inhibition of uterine and the secondary outcome was the side effect related to drugs and neonatal outcome. The data were analyzed with SPSS software, using chi-squared test and independent t test.

According to the results, in 35% of women in the nifedipine group and 23.3% of women in the magnesium sulfate group, the inhibited uterine contraction was less than 48 hours. Also, in 65.0% of women in the nifedipine group and 76.7% of women in the magnesium sulfate group, the inhibited uterine contraction was more than 48 hours. There was no significant difference between the nifedipine and the magnesium sulfate groups in the inhibition of uterine contraction in both less and more than 48 hours. The total side effects of medication were found to be lower in patients receiving oral nifedipine than those who received intravenous magnesium sulfate. (26.6 vs. 45.0) (p= 0.036). There was no significant difference in neonatal outcome between the two groups.

Oral nifedipine should be a suitable alternative to intravenous magnesium sulfate in suppression preterm labor with fewer side effects.