Reviews of PTL Drugs Find Few Benefits

Two reviews of all of the available preterm labor drugs in the U.S. conclude that most of these drugs are of limited or no value and that they pose significant risks to the health of women and their fetuses.

"Controversies in Tocolytic Therapy, " By Vern L. Katz and Richard M. Farmer (Clinical Obstetrics and Gynecology, 1999, Vol. 42, No. 4, pp. 802-819) concludes:

Preterm labor drugs only treat the symptoms of the condition rather than the cause.
Terbutaline and other drugs in its class (known as beta-adrenergics, beta-agonists or beta-mimetics) have cardiovascular and metabolic side effects and only temporarily halt preterm labor (for about 48 hours). They do not work in long-term use.
Because of the serious side effects of terbutaline and the other beta-adrenergics, magnesium sulfate should be used as the first choice in preterm labor drugs.
Indomethacin shows promise in short-term use, but has some serious fetal side effects when used over longer periods of time.
Nifedipine shows some promise and fewer side effects than other preterm labor drugs. However it has not been well studied.
Careful guidelines for the use of preterm labor drugs should be followed. These include: "The risk/benefit ratio for both mother and fetus must be re-evaluated on a continuing basis;" "Long-term use of tocolytics is difficult to justify at this time," and, "The safest tocolytic should be used for the shortest amount of time possible."

"A Risk-Benefit Assessment of Therapies for Premature Labour," by Kenneth Higby and Cheryl R. Suiter (Drug Safety 1999, July; 21 (1) pp. 35-56) concludes:

Indomethacin, and other prostaglandin inhibitors like it, appear to work for short periods of time for women at less than 32 weeks gestation.
Nifedipine (aka Procardia), and calcium antagonists like it, show promise but cannot be recommended because of insufficient studies.
Atosiban, and other oxytocin antagonists like it, show promise but cannot be recommended because of insufficient studies.
Magnesium sulfate is ineffective and the potential of adverse side effects is great. Its use as a preterm labor drug should be discontinued.
Terbutaline, and other beta-agonists like it, work for a period of 24 to 48 hours. Long-term use has not been proven beneficial to mother or fetus. These drugs "have not been shown to decrease perinatal morbidity or mortality. Furthermore, mother and fetus are placed at substantial risk because of the high incidence of serious, often life-threatening, adverse effects."
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