Formulary
Oxytocin: Indications, Dosing, Side Effects and Interactions
Oxytocin clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Oxytocin: Indications, Dosing, Side Effects and Interactions
Oxytocin clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Induction of labour**
- **Adult** (By Intravenous Infusion): for medical reasons, Stimulation of labour in hypotonic uterine inertia Initially 0.001-0.004 unit/minute, not to be started for at least 6 hours after administration of vaginal prostaglandin, dose increased at intervals of at least 30 minutes until a maximum of 3-4 contractions occur every 10 minutes (0.01 units/minute is often adequate) up to max. 0.02 units/minute, if regular contractions not established after a total 5 units, stop induction attempt (may be repeated next day starting again at 0.001-0.004 units/minute).
**Caesarean section**
- **Adult** (By Slow Intravenous Injection): 5 units immediately after delivery.
**Active management of the third stage of labour**
- **Adult** (By Slow Intravenous Injection): 5 units for 1 dose, to be administered immediately after delivery and before the cord is clamped and cut. Dose to be given only if oxytocin was used for induction of labour.
- **Adult** (By Intramuscular Injection): 10 units for 1 dose, to be administered immediately after delivery and before the cord is clamped and cut.
**Treatment of postpartum haemorrhage**
- **Adult** (By Slow Intravenous Injection): 5 units, repeated if necessary.
**Treatment of severe cases of postpartum haemorrhage (following intravenous injection)**
- **Adult** (By Intravenous Infusion): 40 units, given in 500 mL infusion fluid given at a rate sufficient to control uterine atony.
Cautions
General cautions: Avoid large infusion volumes and restrict fluid intake by mouth (risk of hyponatraemia and water-intoxication); cardiovascular disease Specific cautions: When used for Induction of labour for medical reasons History of lower-uterine segment caesarean section; mild pregnancy-induced cardiac disease; mild pregnancy-induced hypertension; moderate pregnancy-induced cardiac disease; moderate pregnancy-induced hypertension; presence of borderline cephalopelvic disproportion (avoid if significant); risk factors for disseminated intravascular coagulation; secondary uterine inertia; women over 35 years When used for Stimulation of labour in hypotonic uterine inertia History of lower-uterine segment caesarean section; mild pregnancy-induced cardiac disease; mild pregnancy-induced hypertension; moderate pregnancy-induced cardiac disease; moderate pregnancy-induced hypertension; presence of borderline cephalopelvic disproportion (avoid if significant); risk factors for disseminated intravascular coagulation; secondary uterine inertia; women over 35 years
Contraindications
Any condition where spontaneous labour and/or vaginal delivery inadvisable (e.g. presence of a uterine scar resulting from major surgery including classical caesarean section); avoid intravenous injection during labour; avoid prolonged administration in oxytocin-resistant uterine inertia; avoid rapid intravenous injection (may transiently reduce blood pressure); fetal distress (discontinue immediately if this occurs); hypertonic uterine contractions (discontinue immediately if this occurs); severe cardiovascular disease; severe pre-eclamptic toxaemia
Side effects
Common or very common Arrhythmias; headache; nausea; vomiting Rare or very rare Dyspnoea; hypotension; rash Frequency not known Anaphylactic reaction; angioedema; disseminated intravascular coagulation; electrolyte imbalance; flushing; haemorrhage; myocardial ischaemia; pulmonary oedema; QT interval prolongation; uterine rupture; water intoxication Side-effects, further information Avoid rapid intravenous injection (may transiently reduce blood pressure). Uterine hyperstimulation -usually with excessive doses-may cause fetal distress, asphyxia, and death, or may lead to hypertonicity, tetanic contractions, soft-tissue damage or uterine rupture. Overdose Placental abruption and amniotic fluid embolism reported on overdose.
Interactions
**Other interactions (6):**
- Interaction resulting in a concomitant use not recommended Prostaglandins and their analogues Prostaglandins and its analogues facilitate contraction of the myometrium hence oxytocin can potentiate...
- Drugs prolonging the QT interval Oxytocin should be considered as potentially arrhythmogenic, particularly in patients with other risk factors for Torsades de Pointes such as drugs which prolong the...
- Interactions to be considered Inhalation anaesthetics Inhalation anaesthetics (e.g.
- Their concurrent use with oxytocin has also been reported to cause cardiac rhythm disturbances.
- Vasoconstrictors/Sympathomimetics Oxytocin may enhance the vasopressor effects of vasoconstrictors and sympathomimetics, even those contained in local anaesthetics.
- Caudal anaesthetics When given during or after caudal block anaesthesia, oxytocin may potentiate the pressor effect of sympathomimetic vasoconstrictor agents.
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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