Yes

Oxytocic Agent

Induces labor at term; controls postpartum bleeding; nasal preparation used to promote milk letdown in lactating females

X

Hypersensitivity to oxytocin or any component; significant cephalopelvic disproportion, unfavorable fetal positions, fetal distress, hypertonic or hyperactive uterus, contraindicated vaginal delivery, prolapse, total placenta previa, and vasa previa

To be used for medical rather than elective induction of labor; may produce antidiuretic effect (ie, water intoxication and excess uterine contractions); high doses or hypersensitivity to oxytocin may cause uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus; severe water intoxication with convulsions, coma, and death is associated with a slow oxytocin infusion over 24 hours

Fetal: <1%: Bradycardia, arrhythmias, intracranial hemorrhage, brain damage, neonatal jaundice, hypoxia, death

Maternal: <1%: Cardiac arrhythmias, premature ventricular contractions, hypotension, tachycardia, arrhythmias, seizures, coma, SIADH with hyponatremia, nausea, vomiting, pelvic hematoma, postpartum hemorrhage, increased uterine motility, fatal afibrinogenemia, increased blood loss, death, anaphylactic reactions

Symptoms of overdose include tetanic uterine contractions, impaired uterine blood flow, amniotic fluid embolism, uterine rupture, SIADH, seizures

Treat SIADH via fluid restriction, diuresis, saline administration, and anticonvulsants, if needed

Sympathomimetic pressor effects may be increased by oxytocin resulting in postpartum hypertension

Oxytocin should be stored at room temperature (15°C to 30°C) and protected from freezing; incompatible with norepinephrine, prochlorperazine

Produces the rhythmic uterine contractions characteristic to delivery and stimulates breast milk flow during nursing

Onset of uterine contractions: I.V.: Within 1 minute

Duration: <30 minutes

Metabolism: Rapid in the liver and plasma (by oxytocinase) and to a smaller degree the mammary gland

Half-life: 1-5 minutes

Elimination: Renal

I.V. administration requires the use of an infusion pump

Induction of labor: I.V.: 0.001-0.002 units/minute; increase by 0.001-0.002 units every 15-30 minutes until contraction pattern has been established; maximum dose should not exceed 20 milliunits/minute

Postpartum bleeding:

I.M.: Total dose of 10 units after delivery

I.V.: 10-40 units by I.V. infusion in 1000 mL of intravenous fluid at a rate sufficient to control uterine atony

Promotion of milk letdown: Intranasal: 1 spray or 3 drops in one or both nostrils 2-3 minutes before breast-feeding

Fluid intake and output during administration; fetal monitoring

None reported

None reported

No information available to require special precautions

No effects or complications reported

I.V., I.M.: Generally used in emergency situations. Drug teaching should be incorporated in other situational teaching.

Intranasal spray: While sitting up, hold bottle upright and squeeze into nostril.

Breast-feeding precautions: Do not breast-feed.

Injection: 10 units/mL (1 mL, 10 mL)

Solution, nasal: 40 units/mL (2 mL, 5 mL)

de Groot AN, van Dongen PW, Vree TB, et al, "Ergot Alkaloids. Current Status and Review of Clinical Pharmacology and Therapeutic Use Compared With Other Oxytocics in Obstetrics and Gynaecology," Drugs, 1998, 56(4):523-35.