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Pharmacokinetics of Tocolytic Agents

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Abstract

Tocolytic agents are drugs designed to inhibit contractions of myometrial smooth muscle cells. Such an effect has been demonstrated in vitro or in vivo for several pharmacological agents, including β-adrenergic agonists, calcium channel antagonists, oxytocin antagonists, NSAIDs and magnesium sulfate. However, the aim of tocolysis is not only to stop uterine contractions or to prevent preterm delivery, but to prevent perinatal morbidity and mortality associated with preterm birth. The achievement of this goal has not yet been clearly demonstrated for any of the drugs available, and the use of tocolytic agents may appear controversial. Therefore, it is important to avoid maternal and fetal toxicity when tocolytic agents are used.

During pregnancy, all steps of drug pharmacokinetics are altered. Absorption of drugs administered orally is limited because of delayed stomach emptying and reduced intestinal motility. The volume of distribution of drugs is increased. The metabolic activity of the liver is increased, accelerating the metabolism of lipophilic drugs. Renal filtration is increased, leading to enhanced renal elimination of water-soluble drugs. These modifications are generally responsible for reduced plasma concentration and reduced half-life of most drugs. These specific modifications have to be taken into account when using a drug in pregnant women.

The aim of this review is to provide the reader with pharmacological data about drugs currently used to treat preterm labour. Such data in pregnant women may affect the choice of optimal drug dosage and route of administration.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Maternité Port-Royal, Université René Descartes, Paris, France

    Vassilis Tsatsaris & Dominique Cabrol

  2. Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France

    Bruno Carbonne

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  1. Vassilis Tsatsaris
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Correspondence to Bruno Carbonne.

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Tsatsaris, V., Cabrol, D. & Carbonne, B. Pharmacokinetics of Tocolytic Agents. Clin Pharmacokinet 43, 833–844 (2004). https://doi.org/10.2165/00003088-200443130-00001

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