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Hexoprenaline Uses, Dosage, Side Effects & Warnings | DrugsAtlas

Authoritative Clinical Reference

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.

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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Hexoprenaline Uses, Dosage, Side Effects & Warnings | DrugsAtlas

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

Secondary Indications — Adults Only (Off-label)

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

Secondary Indications — Paediatrics (Off-label)

RENAL ADJUSTMENT

HEPATIC ADJUSTMENT

CONTRAINDICATIONS

CAUTIONS

PREGNANCY

LACTATION

ELDERLY

MAJOR DRUG INTERACTIONS

MODERATE DRUG INTERACTIONS

COMMON ADVERSE EFFECTS

SERIOUS ADVERSE EFFECTS

MONITORING REQUIREMENTS

BRANDS AVAILABLE IN INDIA

PRICE RANGE (INR)

CLINICAL PEARLS

TAGS

VERSION

REFERENCES

Clinical Responsibility

Is this information helpful?

RxIndia

Hexoprenaline Uses, Dosage, Side Effects & Warnings | DrugsAtlas

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

Secondary Indications — Adults Only (Off-label)

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

Secondary Indications — Paediatrics (Off-label)

RENAL ADJUSTMENT

HEPATIC ADJUSTMENT

CONTRAINDICATIONS

CAUTIONS

PREGNANCY

LACTATION

ELDERLY

MAJOR DRUG INTERACTIONS

MODERATE DRUG INTERACTIONS

COMMON ADVERSE EFFECTS

SERIOUS ADVERSE EFFECTS

MONITORING REQUIREMENTS

BRANDS AVAILABLE IN INDIA

PRICE RANGE (INR)

CLINICAL PEARLS

TAGS

VERSION

REFERENCES

Clinical Responsibility

Is this information helpful?