Oxytocin

Indications
 Nasal
Facilitate lactation
Adult: 1 spray (4 units) into 1 nostril 5 minutes before suckling.
Intravenous
Adjunct in abortion
Adult: 10-20 milliunits/minute. Max total dose: 30 units in a 12-hr period.
Intravenous
Postpartum haemorrhage
Adult: 10-40 units by infusion in 1000 mL of IV fluid at a rate sufficient to control uterine atony.
Intravenous
Labour induction
Adult: 1-2 milliunits/minute, may increase at intervals of at least 30 minutes until a max of 3-4 contractions occur every 10 minutes. Not to exceed 32 milliunits/minute and no more than a total of 5 units should be given in 1 day. Not to be given within 6 hr after admin of vaginal prostaglandins. Monitor uterine contractions and foetal heart rate continuously. Withdraw gradually once labour is progressing.
Intravenous
Oxytocin challenge test for evaluating of foetal distress
Adult: Dilute 5-10 units in 1 L of 5% dextrose inj. Initially, administer the drug in the mother via IV infusion at a rate of 0.5 milliunits/minute. May gradually increase infusion rate at intervals of 15-30 minutes. Max: 20 milliunits/minute. Monitor foetal heart rate and uterine contractions immediately before and during infusion. Discontinue infusion when 3 moderate uterine contractions occur within one 10-minute interval. Compare baseline and oxytocin-induced foetal heart rates. If no change occurs, repeat the test in 1 wk. Termination of pregnancy may be required if a late deceleration in foetal heart rate occurs.

Reconstitution: Postpartum uterine bleeding: oxytocin 10-40 units to running IV infusion, max 40 units/1000 ml.
Incompatibility: When admixed: fibrinolysin (human), norepinephrine, prochlorperazine edisylate, warfarin; variable compatibility with phytonadione.
Contraindications
 Cephalopelvic disproportion; abnormal presentation of the foetus; hydraminios; multiparae; previous caesarian section or other uterine surgery; hyperactive or hypertonic uterus, uterine rupture; contraindicated vaginal delivery (invasive cervical cancer, active genital herpes, prolapse of the cord, cord presentation, total placenta previa or vasa previa); foetal distress where delivery is not imminent; severe pre-eclamptic toxaemia.
Warnings / Precautions
 CV disorders; >35 yr; lactation. Monitor foetal and maternal heart rate, maternal BP and uterine motility. Monitor fluid intake and output during treatment. Discontinute immediately if the uterus is hypertonic or hyperactive or if there is foetal distress. Use of nasal spray may produce maternal dependence on its effects. IM admin not regularly used due to unpredictable effects of oxytocin. Not to be used for prolonged periods in resistant uterine inertia, severe pre-eclampsia, or severe CV disorders. Risk of water intoxication when used at high doses for prolonged periods.
Adverse Reactions
 Foetus or neonate: Jaundice; arrhythmias, bradycardia; brain, CNS damage; seizure; retinal haemorrhage; low Apgar score. Mother: transient hypotension, reflex tachycardia; nasal irritation, rhinorrhoea, lachrymation (following nasal admin); uterine bleeding, violent contractions, hypertonicity; spasm; nausea, vomiting.
Potentially Fatal: Maternal water intoxication (especially with slow infusion over 24 hr); prolonged uterine contractions causing foetal hypoxia and death; rupture of gravid uterus; afibrinogenaemia; subarachnoid haemorrhage
Overdose Reactions
 Tetanic uterine contractions, impaired uterine blood flow, amniotic fluid embolism, uterine rupture, syndrome of inappropriate antidiuretic hormone secretion and seizures. Treatment: Supportive and symptom specific.
Drug Interactions
 Possible severe hypertension if given within 3-4 hr of vasoconstrictor in association with a caudal block anaesthesia. Cyclopropane anaesthesia may increase risk of hypotension and maternal sinus bradycardia with abnormal AV rhythms. Dinoprostone and misoprostol may increase uterotonic effect of oxytocin, thus oxytocin should not be used within 6 hr after admin of vaginal prostaglandins. Concurrent use may increase the vasopressor effect of sympathomimetics.
Potentially Fatal: Concomitant use with prostaglandins increases risk of uterine rupture and cervical lacerations.
See Below for More oxytocin Drug Interactions
Mechanism of Actions
 Oxytocin induces rhythmic uterine contraction which increases throughout the pregnancy, reaching the max at term by proliferating oxytocin receptors. It increases the tone and amplitude of the uterine contractions at small doses.
Onset: Uterine contractions: IM: 3-5 minutes; IV: approx 1 minute.
Duration: IM: 2-3 hr; IV: 1 hr.
Absorption: Steady state is reached normally 40 minutes after parenteral admin.
Distribution: Distribution throughout extracellular fluid, small amounts reach foetus.
Metabolism: Rapidly via the liver and plasma (by oxytocinase); some metabolism via mammary gland.
Excretion: Elimination half-life: 1-5 minutes; excreted via urine.
Storage Conditions
 Intravenous: Store at 2-8 °C. Nasal: Store at 2-8 °C.
ATC Classification
 H01BB02 - oxytocin ; Belongs to the class of oxytocin and analogues. Used in posterior pituitary lobe hormone preparations.
Storage
 Intravenous: Store at 2-8 °C. Nasal: Store at 2-8 °C.
Available As
  • Oxytocin 10 iu
  • Oxytocin 10 mg
  • Oxytocin 2 iu
  • Oxytocin 5 iu
  • Oxytocin 8.33 mcg

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