Intravaginal administration of isosorbide mononitrate for cervical ripening in prolonged pregnancy: a randomised clinical trial

Use of Misoprostol versus Combined Misoprostol and Isosorbide Mononitrate for Cervical Ripening before Surgical Evacuation of Early Missed Abortion

“…However, this lowering in blood pressure had n't affected the hemodynamic of cases to degree of occurrence of dizziness or other symptoms of hypotension. Mirteimouri et al (10) stated that after receiving ISMN for cervical ripening at term, maternal blood pressure was shown to drop significantly. Abu-Zaid et al (11) stated that isosorbide dinitrate (ISDN) was proven to reduce both systolic and diastolic blood pressure more effectively than PG equivalents.…”

Progress in the Application of Nitric Oxide Donors to Promote Cervical Ripening

“…Experiments have found that the concentration of vaginal ISMN and the concentration of serum ISMN after administration also have dose-dependent effects, that is, 40 mg of ISMN taking 40 mg of ISMN in full-term pregnancy has a more obvious inhibitory effect on maternal blood pressure than 20 mg [10]. Experimental data [22] suggest that plasma ISMN levels gradually increase as the dose of intravaginal ISMN increases to 40 mg. And when the dose of intravaginal ISMN is increased to more than 40 mg, plasma ISMN levels hardly increase again. Further studies involving pharmacokinetic changes associated with larger doses of ISMN are needed to further explore this hypothesis.…”

“…However, the combination of ISMN with prostaglandins has been shown to lead to a cumulative level of systemic drug absorption with a clinically significant risk of side effects [22]. Therefore, the optimal combination dosage and frequency of administration scheme need to be further studied.…”