Gemeprost

(BAN, USAN, rINN)
Gemeprost Chemical formula
Synonyms: 16,16-DimethyltransΔ 2 -prostaglandin E 1 methyl ester; Géméprost; Gemeprosti; Gemeprostum; ONO-802; SC-37681. Methyl (2E,13E)-(8R,11R,12R,15R)-11,15-dihydroxy-16,16-dimethyl-9-oxoprosta-2,13dienoate; Methyl (E)-7-{(1R,2R,3R)-3-hydroxy-2-[(E)-(3R)-3-hydroxy-4,4-dimethyloct-1-enyl]-5-oxocyclopentyl}hept-2-enoate.
Cyrillic synonym: Гемепрост.

💊 Chemical information

Chemical formula: C23H38O5 = 394.5.
CAS — 64318-79-2.
ATC — G02AD03.
ATC Vet — QG02AD03.

💊 Adverse Effects and Precautions

As for Dinoprostone. Vaginal bleeding and mild uterine pain may occur. Pulse and blood pressure should be monitored in patients given gemeprost. The effects of gemeprost on the fetus are not known. Once a prostaglandin has been given to terminate pregnancy it is essential that termination take place; if the prostaglandin is unsuccessful other measures should be used.

Incidence of adverse effects.

The incidence of vomiting (19 or 35%) and diarrhoea (12 or 19%) in 2 studies of patients treated with gemeprost pessaries was similar to that seen with other prostaglandins, but gemeprost was reported to cause less uterine pain.1,2
1. Cameron IT, Baird DT. The use of 16,16-dimethyl-trans-Δ prostaglandin E methyl ester (gemeprost) vaginal pessaries for the termination of pregnancy in the early second trimester: a comparison with extra-amniotic prostaglandin E . Br J Obstet Gynaecol 1984; 91: 1136–40
2. Andersen LF, et al. Termination of second trimester pregnancy with gemeprost vaginal pessaries and intra-amniotic PGF : a comparative study. Eur J Obstet Gynecol Reprod Biol 1989; 31: 1–7.

Effects on the cardiovascular system.

Periods of ventricular standstill of up to 6 seconds were seen in a patient during treatment with gemeprost vaginal pessaries.1 The patient required temporary cardiac pacing, but no persistent cardiac rhythm disturbances were detected on follow-up. Severe cardiogenic shock due to vasospasm, and subsequent stroke, has been reported in a patient who had received gemeprost pessaries some hours earlier; myocardial infarction ensuing from coronary spasm was reported in a second patient.2
1. Kalra PA, et al. Cardiac standstill induced by prostaglandin pessaries. Lancet 1989; i: 1460–1
2. Schulte-Sasse U. Life threatening myocardial ischaemia associated with the use of prostaglandin E to induce abortion. Br J Obstet Gynaecol 2000; 107: 700–2.

Effects on the fetus.

Congenital abnormalities have been reported in pregnancies carried to term after failed termination using prostaglandins, including gemeprost.

Effects on the uterus.

For reference to hyperstimulation and uterine rupture after use of prostaglandins, including gemeprost, for termination of pregnancy or induction of labour, see under Dinoprostone.

💊 Interactions

As for Dinoprostone.

💊 Uses and Administration

Gemeprost is a synthetic analogue of alprostadil. It is used to soften and dilate the cervix and as a uterine stimulant in the termination of pregnancy. In the first trimester, a pessary containing gemeprost 1 mg is inserted into the vagina 3 hours before surgery to ripen the cervix. Gemeprost may also be used for termination of pregnancy in the second trimester when a 1-mg pessary is inserted every 3 hours to a maximum of 5 pessaries. If this is ineffective, one further course may be given starting 24 hours after the beginning of the first course. If termination is not well established after 10 pessaries, alternative treatment should be used to complete uterine evacuation. In the case of intra-uterine fetal death in the second trimester, only one course of up to 5 pessaries should be given. Vaginal gemeprost is also used after oral mifepristone in the termination of pregnancy.

💊 Preparations

Proprietary Preparations

Austral.: Cervagem; Denm.: Cervagem; Fin.: Cervagem†; Fr.: Cervageme; Ger.: Cergem; Hong Kong: Cervagem†; Ital.: Cervidil; Jpn: Preglandin; Malaysia: Cervagem; Norw.: Cervagem†; NZ: Cervagem; Singapore: Cervagem; Swed.: Cervagem.
Published October 31, 2018.