ALPHAPRODINE

Drugs in Pregnancy and Lactation.

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Name: ALPHAPRODINE
Class: Narcotic Agonist Analgesic
Risk Factor:    CM*

Fetal Risk Summary

No reports linking the use of alphaprodine with congenital defects have been located. Characteristic of all narcotics used in labor, alphaprodine may produce respiratory depression in the newborn (1,2,3,4,5,6,7 and 8). Tissue pO2 and pCO2 were determined in nine women in active labor at term given intravenous alphaprodine (0.4 mg/kg prepregnancy weight) (9). Peak decreases in trancutaneous pO2 (tcpO2) occurred at 5 minutes after injection with peak increases of tcpCo2 occurring at 20 minutes. Both changes were statistically significant variations from baseline values. The fetal heart rate fell from a mean predose rate of 139 beats/minute to 132 beats/minute at 20 minutes, a significant change, with a consistent loss of variability occurring at 25 minutes. No adverse effects were noted in the mother or the fetus.

In a group of 40 women treated with alphaprodine during labor, sinusoidal fetal heart rate patterns were observed in 17 fetuses (42.5%) (10). The pattern occurred about 19 minutes after administration of the narcotic and persisted for about 60 minutes. No apparent harm resulted from the abnormal patterns.

Suppression of collagen-induced platelet aggregation has been demonstrated, but specific data were not given (11). Abnormal bleeding after use of this drug has not been reported, even though the magnitude of platelet dysfunction was comparable to that found in hemorrhagic states.

[*Risk Factor D if used for prolonged periods or in high doses at term.]

Breast Feeding Summary

No data are available.

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References

  1. Smith EJ, Nagyfy SF. A report on comparative studies of new drugs used or obstetrical analgesia. Am J Obstet Gynecol 1949;58:695–702.
  2. Hapke FB, Barnes AC. The obstetric use and effect on fetal respiration of Nisentil. Am J Obstet Gynecol 1949;58:799–801.
  3. Kane WM. The results of Nisentil in 1,000 obstetrical cases. Am J Obstet Gynecol 1953;65:1020–6.
  4. Backner DD, Foldes FF, Gordon EH. The combined use of alphaprodine (Nisentil) hydrochloride and levallorphan (Lorfan) tartrate for analgesia in obstetrics. Am J Obstet Gynecol 1957;74:271–82.
  5. Gillan JS, Hunter GW, Darner CB, Thompson GR. Meperidine hydrochloride and alphaprodine hydrochloride as obstetric analgesic agents. A double-blind study. Am J Obstet Gynecol 1958; 75:1105–10.
  6. Roberts H, Kuck MAC. Use of alphaprodine and levallorphan during labour. Can Med Assoc J 1960;83:1088–93.
  7. Burnett RG, White CA. Alphaprodine for continuous intravenous obstetric analgesia. Obstet Gynecol 1966;27:472–7.
  8. Anthinarayanan PR, Mangurten HH. Unusually prolonged action of maternal alphaprodine causing fetal depression. Q Pediatr Bull (Winter) 1977;3:14–6.
  9. Miller FC, Mueller E, McCart D. Maternal and fetal response to alphaprodine during labor. A preliminary study. J Reprod Med 1982;27:439–42.
  10. Gray JH, Cudmore DW, Luther ER, Martin TR, Gardner AJ. Sinusoidal fetal heart rate pattern associated with alphaprodine administration. Obstet Gynecol 1978;52:678–81.
  11. Corby DG, Schulman I. The effects of antenatal drug administration on aggregation of platelets of newborn infants. J Pediatr 1971;79:307–13.

Index