Hexoprenaline Uses, Dosage, Side Effects & Warnings | DrugsAtlas
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DRUG NAME: Hexoprenaline
Therapeutic Class: Bronchodilator / Tocolytic
Subclass: Selective β2-adrenergic receptor agonist
Speciality: Obstetrics & Gynaecology
Schedule (India): Schedule H
Route(s): Oral, Intravenous (IV), Subcutaneous (SC)
Formulations Available in India:
- Tablet: 0.5 mg
- Syrup: 0.1 mg/5 mL (60 mL, 100 mL bottles)
- Injection: 5 mcg/mL (2 mL ampoule containing 10 mcg)
- Injection: 25 mcg/5 mL vial (for IV infusion preparation)
INDICATIONS + DOSING — FOR CLINICIAN USE ONLY
Primary Indications (Approved / Standard in India)
▶ 1. Preterm Labour (Tocolysis) — Obstetric Use Only
A. Acute Tocolysis — Intravenous Infusion:
| Parameter | Recommendation |
|
Starting dose
|
0.075 mcg/min (approximately 5 mcg diluted in 500 mL and infused slowly) |
|
Titration
|
Increase by 0.075 mcg/min every 20–30 minutes based on uterine activity and maternal tolerance |
|
Usual maintenance dose
|
0.15–0.3 mcg/min |
|
Maximum dose
|
0.3 mcg/min (higher doses only under intensive monitoring) |
Clinical Notes:
- Specialist-only setting with continuous maternal and fetal monitoring
- Duration: Continue until contractions cease, then maintain for 12–48 hours before tapering
- Maximum total IV therapy duration: 48 hours
- Transition to oral maintenance before discontinuation if needed
B. Maintenance Tocolysis — Oral:
| Parameter | Recommendation |
|
Starting dose
|
0.5 mg every 6–8 hours |
|
Titration
|
Not usually required |
|
Usual maintenance dose
|
0.5 mg three to four times daily |
|
Maximum dose
|
2 mg/day |
Clinical Notes:
- Begin oral therapy 1–2 hours before stopping IV infusion
- Continue only as long as clinically indicated
- Not for prolonged maintenance beyond 7–10 days without reassessment
▶ 2. Acute and Chronic Bronchial Asthma / Bronchospasm
A. Oral Therapy — Adults:
| Parameter | Recommendation |
|
Starting dose
|
0.5 mg twice daily |
|
Titration
|
Increase cautiously based on response and tolerance |
|
Usual maintenance dose
|
0.5–1 mg twice to three times daily |
|
Maximum dose
|
2 mg/day in divided doses |
Clinical Notes:
- Reserve for patients not controlled with inhaled β2-agonists or with contraindications to inhalation therapy
- Inhaled salbutamol remains first-line for acute bronchospasm
- Not for acute severe asthma — use nebulised or parenteral bronchodilators
Secondary Indications — Adults Only (Off-label)
None established in Indian clinical practice.
PAEDIATRIC DOSING (Specialist Only)
Primary Indications (Approved / Standard in India)
▶ Bronchial Asthma / Bronchospasm — Oral Therapy
Syrup Formulation (0.1 mg/5 mL):
| Age Group | Starting Dose | Usual Maintenance | Maximum Dose |
|
2–6 years
|
0.1 mg (5 mL) twice daily | 0.1–0.2 mg (5–10 mL) twice daily | 0.5 mg/day |
|
6–12 years
|
0.2 mg (10 mL) twice daily | 0.2–0.3 mg (10–15 mL) twice to three times daily | 1 mg/day |
|
>12 years (Adolescents)
|
0.5 mg (25 mL or half tablet) twice daily | 0.5 mg twice to three times daily | 1.5 mg/day |
Clinical Notes:
- Tablet form not preferred below 12 years unless under specialist supervision
- Syrup preferred for accurate dosing in younger children
- Inhaled bronchodilators remain first-line; oral hexoprenaline reserved for specific situations
Secondary Indications — Paediatrics (Off-label)
Not applicable.
Safety Monitoring (Paediatric):
- Heart rate monitoring before and during therapy
- Observe for tremor, restlessness, or behavioural changes
- Monitor serum potassium if prolonged high-dose therapy
- Assess blood glucose in diabetic patients
Age Restrictions:
- Not recommended below 2 years of age except under paediatric pulmonologist supervision with documented justification
RENAL ADJUSTMENT
| Renal Function | Recommendation |
| Mild–Moderate impairment (eGFR 30–89 mL/min) | No dose adjustment required |
| Severe impairment (eGFR <30 mL/min) | Use with caution; monitor for accumulation and cardiovascular effects |
| Haemodialysis | Limited data; use cautiously with close monitoring |
HEPATIC ADJUSTMENT
| Child-Pugh Class | Score | Recommendation |
|
Class A (Mild)
|
5–6 points | No dose adjustment required |
|
Class B (Moderate)
|
7–9 points | Use with caution; start at lower end of dose range; monitor closely |
|
Class C (Severe)
|
10–15 points | Avoid parenteral use; oral therapy only if essential and under specialist supervision |
CONTRAINDICATIONS
- Known hypersensitivity to hexoprenaline or formulation components
- Significant coronary artery disease or recent myocardial infarction
- Tachyarrhythmias (including atrial fibrillation with rapid ventricular response)
- Severe uncontrolled hypertension
- Uncontrolled hyperthyroidism
- Hypertrophic obstructive cardiomyopathy (HOCM)
Additional Contraindications for Obstetric (Tocolytic) Use:
- Intrauterine infection (chorioamnionitis)
- Severe pre-eclampsia or eclampsia
- Antepartum haemorrhage requiring immediate delivery
- Intrauterine fetal death
- Placenta praevia or abruptio placentae
- Cervical dilatation >4 cm
- Gestational age <20 weeks or >37 weeks
CAUTIONS
- Diabetes mellitus — may cause hyperglycaemia and hypokalaemia
- Mild–moderate hypertension
- History of cardiac disease or arrhythmias
- Hypokalaemia or conditions predisposing to electrolyte disturbances
- Concurrent use with other sympathomimetics
- Narrow-angle glaucoma
- Seizure disorders
- Multiple pregnancy (increased cardiovascular risk with tocolysis)
- Patients receiving corticosteroids (additive hypokalaemia)
PREGNANCY
| Aspect | Details |
|
Overall safety
|
Used in pregnancy specifically for tocolysis under specialist supervision |
|
When to use
|
Tocolysis for preterm labour between 24–34 weeks gestation; short-term use only (≤48 hours) |
|
For asthma in pregnancy
|
Inhaled salbutamol preferred; oral hexoprenaline only if inhalation not feasible |
|
Preferred alternatives
|
Nifedipine increasingly preferred as first-line tocolytic in many centres |
|
Monitoring required
|
Maternal: BP, heart rate, ECG, blood glucose, serum potassium, fluid balance. Fetal: continuous cardiotocography during IV infusion |
LACTATION
| Aspect | Details |
|
Compatibility
|
Compatible with breastfeeding |
|
Expected levels in milk
|
Low — minimal systemic absorption expected in infant |
|
Preferred alternatives
|
Inhaled salbutamol for bronchospasm if breastfeeding |
|
Infant monitoring
|
Observe for jitteriness, tachycardia, poor feeding (unlikely) |
ELDERLY
| Aspect | Recommendation |
|
Starting dose
|
0.25–0.5 mg/day (oral); start at lower end of range |
|
Titration
|
Slower titration; increase only if tolerated |
|
Extra risks
|
Increased sensitivity to cardiovascular effects (tachycardia, palpitations, arrhythmias); tremor more pronounced; hypokalaemia risk; underlying cardiac disease may be unmasked |
|
Monitoring
|
Heart rate, blood pressure, serum potassium; ECG if cardiac risk factors |
MAJOR DRUG INTERACTIONS
| Interacting Drug | Effect/Risk | Management |
|
Non-selective β-blockers (propranolol, carvedilol)
|
Antagonise bronchodilator effect; may precipitate bronchospasm | Avoid combination; use cardioselective β-blocker if essential |
|
MAO inhibitors (phenelzine, tranylcypromine, linezolid)
|
Potentiate sympathomimetic effects; risk of hypertensive crisis | Avoid combination; discontinue MAOI at least 2 weeks before hexoprenaline |
|
Tricyclic antidepressants (amitriptyline, imipramine)
|
Potentiate cardiovascular effects | Use with caution; monitor closely |
|
Halogenated anaesthetics (halothane, isoflurane, sevoflurane)
|
Increased risk of ventricular arrhythmias due to myocardial sensitisation | Discontinue hexoprenaline at least 24 hours before surgery if possible |
|
QT-prolonging drugs (amiodarone, haloperidol, ondansetron)
|
Additive arrhythmia risk, especially with hypokalaemia | Monitor ECG; correct electrolytes |
MODERATE DRUG INTERACTIONS
| Interacting Drug | Effect/Risk | Management |
|
Loop diuretics (furosemide)
|
Additive hypokalaemia risk | Monitor serum potassium; supplement as needed |
|
Thiazide diuretics
|
Additive hypokalaemia risk | Monitor potassium levels |
|
Systemic corticosteroids
|
Enhanced hypokalaemia; may potentiate hyperglycaemia | Monitor electrolytes and blood glucose |
|
Digitalis glycosides (digoxin)
|
Hypokalaemia increases digoxin toxicity risk | Monitor potassium and digoxin levels |
|
Other sympathomimetics (salbutamol, terbutaline)
|
Additive cardiovascular effects; cumulative adverse effects | Avoid concurrent use if possible |
|
Antidiabetic agents (insulin, metformin, sulfonylureas)
|
May antagonise glucose-lowering effect | Monitor blood glucose more frequently |
|
Theophylline/aminophylline
|
Additive stimulant effects; increased tachycardia risk | Monitor closely |
COMMON ADVERSE EFFECTS
- Tremor (especially fine tremor of hands)
- Palpitations
- Tachycardia
- Headache
- Nausea
- Dizziness
- Nervousness or restlessness
- Flushing
- Muscle cramps
SERIOUS ADVERSE EFFECTS
| Adverse Effect | Notes |
| Severe hypokalaemia | May precipitate arrhythmias; monitor potassium especially with IV use |
| Cardiac arrhythmias (VT, SVT, AF) | Requires immediate discontinuation; may need hospitalisation |
| Myocardial ischaemia/infarction | Especially with high doses in patients with underlying CAD |
| Pulmonary oedema | Rare; associated with IV tocolytic use, especially with fluid overload |
| Paradoxical bronchospasm | Discontinue immediately; provide alternative bronchodilator |
| Lactic acidosis | Rare; associated with high-dose or prolonged IV infusion |
| Hyperglycaemia | May unmask or worsen diabetes; monitor glucose |
Immediate discontinuation required for: chest pain, significant arrhythmias, ECG changes, dyspnoea suggestive of pulmonary oedema.
MONITORING REQUIREMENTS
| Timing | Parameters |
|
Baseline
|
ECG (especially before IV use); serum electrolytes (K+, Mg2+); blood glucose (diabetics); BP; heart rate; respiratory status |
|
During IV infusion (obstetric)
|
Continuous fetal heart rate monitoring; maternal BP and HR every 15–30 minutes; urine output; fluid balance; serum potassium every 6–12 hours |
|
During oral therapy
|
Heart rate; symptoms of tremor or palpitations; blood glucose in diabetics |
|
Long-term
|
Periodic ECG; serum electrolytes; symptom control assessment; reassess need for continued therapy |
BRANDS AVAILABLE IN INDIA
- Gynipral® (injection — tocolytic formulation)
- Hexoprenaline tablets and syrup (various manufacturers)
- Tocol® (injection)
- Prelabour® (injection)
Note: Availability may vary regionally; primarily stocked in obstetric units and tertiary hospitals for tocolytic use.
PRICE RANGE (INR)
| Formulation | Price Range | Notes |
| Tablet 0.5 mg | ₹2–₹5 per tablet | Brand-dependent |
| Syrup 0.1 mg/5 mL (100 mL) | ₹35–₹60 per bottle | |
| Injection 10 mcg/2 mL | ₹45–₹90 per ampoule | Obstetric formulation |
| Injection 25 mcg/5 mL | ₹80–₹120 per vial | For IV infusion preparation |
- Not listed in NLEM India
- Price not NPPA-controlled
- Primarily available through hospital supply for obstetric use
CLINICAL PEARLS
- Tocolysis is the primary Indian use — Hexoprenaline is more commonly used as a tocolytic agent in Indian obstetric practice than as a bronchodilator; nifedipine is increasingly preferred as first-line tocolytic.
- Not first-line for asthma — For bronchospasm, inhaled salbutamol or terbutaline remain preferred; reserve oral hexoprenaline for patients unable to use inhalation therapy effectively.
- Strict fluid management in tocolysis — Pulmonary oedema risk increases with IV β2-agonists; limit IV fluids and monitor fluid balance closely during infusion.
- Potassium vigilance essential — Hypokalaemia is common with high-dose or prolonged therapy; monitor and supplement potassium, especially when combined with corticosteroids (often used for fetal lung maturity).
- 48-hour rule — IV tocolysis should not exceed 48 hours; this duration allows time for corticosteroid effect on fetal lung maturity without excessive maternal cardiovascular risk.
- Timely transition — Begin oral hexoprenaline 1–2 hours before stopping IV infusion to maintain uterine quiescence during transition.
TAGS
hexoprenaline; β2-agonist; tocolytic; preterm labour; bronchodilator; obstetric emergency; asthma; uterine relaxant; Schedule H; hypokalaemia risk
VERSION
RxIndia v0.9 — 28 Feb 2026
REFERENCES
- CDSCO approved product information
- Indian Pharmacopoeia / National Formulary of India
- API Textbook of Medicine
- ICMR Obstetric Medicine Guidelines
- AIIMS Pharmacology Department Prescribing Guide
- FOGSI Guidelines on Management of Preterm Labour
- IAP Guidelines (paediatric bronchospasm)
- Product inserts from Indian manufacturers
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This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.
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