Calcium channel blockers
Calcium has a well-recognized role in muscle contractions; reducing calcium influx into cells reduces muscle contractility. Nifedipine is the most widely used drug in this group although it is not currently licensed for this use.
The recommended protocol consists of 20 mg orally stat, followed by slow-release 20 mg orally per 6 hours for the following 48 hours. Contraindications include allergy to nifedipine, hypotension, and hepatic dysfunction, and caution should be taken if the woman is using other antihypertensive medications or magnesium. Hypotension is a side effect; however, it is minimal in normotensive patients. Other commonly reported side effects are tachycardia, palpitations, flushing, headaches, dizziness, and nausea. A recent network meta-analysis directly and indirectly comparing all tocolytics using their performance against a common comparator showed that calcium channel blockers were found to be the most clinical and cost-effective treatment overall and have been recommended for use in the most recent National Institute for Health and Care Excellence PTB guideline (82).
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