oxytocin

a hypothalamic hormone stored in and released from the posterior pituitary, or prepared
synthetically. Produced also by the corpus luteum of sheep, and perhaps other animals. Involved
in the release of PGF2 which induces luteolysis. It acts as a powerful stimulant to the pregnant
uterus, especially toward the end of gestation. The hormone also causes mil to be e!pressed
from the alveoli into the lactiferous ducts during sucling.
Generic Name: oxytocin
"rand #ame$ Pitocin, Syntocinon
Pharmacologic class: Posterior pituitary hormone
Therapeutic class: %terine&active agent
Pregnancy risk category NR
FDA Boxed Warning
' (rug isn)t indicated for elective induction of labor *defined as initiation of labor in pregnant
woman with no medical indications for induction+. ,vailable data aren)t ade-uate to evaluate
benefits versus ris.
Action
%nnown. Thought to directly stimulate smooth muscle contractions in uterus and cervi!.
Availability
Injection: ./ units0ml ampule or vial
Indications and dosages
To induce or stimulate labor
Adults: Initially, .&ml ampule *./ units+ in compatible I.1. solution infused at . to 2
milliunits0minute */.//. to /.//2 units0minute+. Increase rate in increments of . to 2
milliunits0minute - .2 to 3/ minutes until acceptable contraction pattern is established.
To control postpartum bleeding
Adults: ./ to 4/ units in compatible I.1. solution infused at rate ade-uate to control bleeding5 or
./ units I.6. after placenta delivery
Incomplete abortion
Adults: ./ units in compatible I.1. solution infused at ./ to 2/ milliunits0minute */./. to /./2
units0minute+
Off-label uses
' ,ntepartal fetal heart rate testing
' "reast enlargement
ontraindications
' 7ypersensitivity to drug
' 8ephalopelvic disproportion
' Fetal distress when delivery is not imminent
' Prolonged use in uterine inertia or severe to!emia
' 7ypertonic or hyperactive uterine pattern
' %nfavorable fetal position or presentation that)s undeliverable without conversion
' 9abor induction or augmentation when vaginal delivery is contraindicated *as in invasive cervical
cancer, active genital herpes, or total placenta previa+
!recautions
%se cautiously in$
' previous cervical or uterine surgery, history of uterine sepsis
' breastfeeding patients.
Administration
' :econstitute by adding . ml *./ units+ to .,/// ml of normal saline solution, lactated :inger)s
solution, or de!trose 2; in water.
&(on)t give by I.1. bolus in<ection.
' Infuse I.1. using controlled&infusion device.
' "e aware that drug isn)t routinely given I.6.
' =now that drug should be given only to inpatients at critical care facilities when prescriber is
immediately available.
:oute >nset Pea (uration
I.1. Immediate 4/ min . hr
I.6. 3&2 min 4/ min 2&3 hr
Adverse reactions
N": sei#ures$ coma$ neonatal brain damage$ subarac%noid %emorr%age
&: premature ventricular contractions, arr%yt%mias$ neonatal bradycardia
GI: nausea, vomiting
G': (ost(artal %emorr%age) (elvic %ematoma) uterine %y(ertonicity$ s(asm$ or tetanic
contraction) abru(tio (lacentae) uterine ru(ture *with e!cessive doses+
*ematologic: afibrinogenemia
*e(atic: neonatal +aundice
Ot%er: hypersensitivity reactions including ana(%ylaxis$ lo, --minute A(gar score .neonate/
Interactions
Drug-drug0 Sympathomimetics: postpartal hypertension
Thiopental anesthetics: delayed anesthesia induction
Vasoconstrictors: severe hypertension *when given within 3 to 4 hours of o!ytocin+
Drug-%erbs0 Ephedra (ma huang): increased hypertension
!atient monitoring
&8ontinuously monitor contractions, fetal and maternal heart rate, and maternal blood pressure
and ?8G. (iscontinue infusion if uterine hyperactivity occurs.
& 6onitor patient e!tremely closely during first and second stages of labor because of ris of
cervical laceration, uterine rupture, and maternal and fetal death.
' @hen giving drug to control postpartal bleeding, monitor and record vaginal bleeding.
' ,ssess fluid intae and output. @atch for signs and symptoms of water into!ication.
!atient teac%ing
' Inform patient about riss and benefits of o!ytocin&induced labor.
Teach patient to recogniAe and immediately report adverse drug effects.