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Drugs: oxytocin (synthetic injection)
SAFETY ALERT!
oxytocin (synthetic injection)
oks-i-TOE-sin
Pitocin
Therapeutic class: Oxytocics
Pharmacologic class: Exogenous hormones
Available Forms
Injection: 10 units/mL
Indications & Dosages
!"To induce or stimulate labor
Adults: Initially, 0.5 to 1 milliunit/minute IV infusion. Increase rate by 1 to 2 milliunits/minute at 30- to
60-minute intervals until normal contraction pattern is established. Decrease rate when labor is firmly
established. Rates exceeding 9 to 10 milliunits/minute are rarely required.
!"To reduce postpartum bleeding after expulsion of placenta
Adults: 10 to 40 units in 1,000 mL of lactated Ringer solution, or NSS IV infused at rate needed to
sustain uterine contraction and control uterine atony. Also, may give 10 units IM after delivery of
placenta.
!"Incomplete, inevitable, or elective abortion
Adults: 10 units IV infusion at 10 to 20 milliunits (20 to 40 drops)/minute. Don’t exceed 30 units in 12
hours.
Administration
IV
!"Never give drug simultaneously by more than one route.
!"To induce or stimulate labor, dilute drug by adding 10 units to 1 L of NSS or lactated Ringer solution.
!"To produce intense uterine contractions and reduce postpartum bleeding, dilute drug by adding 10 units
to 1,000 mL of NSS or lactated Ringer solution.
!"To treat abortion, add 10 units to 500 mL NSS.
!"Don’t give bolus injection; use an infusion pump. Give drug only by piggyback infusion so that it may be
stopped without interrupting IV line.
!"Incompatibilities: None listed by manufacturer. Consult a drug incompatibility reference for more
information.
IM
!"Drug isn’t recommended for routine IM use, but 10 units may be given IM after delivery of placenta to
control postpartum uterine bleeding.
!"Never give drug simultaneously by more than one route.
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Action
Causes potent and selective stimulation of uterine and mammary gland smooth muscle.
Route
Onset
Peak
Duration
IV
1 min
Unknown
1 hr
Unknown
2–3 hr
IM
3–5 min
Half-life: 1 to 6 minutes.
Adverse Reactions
Maternal
CNS: subarachnoid hemorrhage, seizures, coma.
CV: arrhythmias, HTN, PVCs, hypotension, tachycardia.
GI: nausea, vomiting.
GU: abruptio placentae, tetanic uterine contractions, postpartum hemorrhage, uterine rupture,
impaired uterine blood flow, pelvic hematoma, increased uterine motility.
Hematologic: afibrinogenemia, possibly related to postpartum bleeding, pelvic hematoma.
Other: anaphylaxis, death from oxytocin-induced water intoxication, hypersensitivity reactions.
Fetal
CNS: infant brain damage, seizures.
CV: bradycardia, arrhythmias, PVCs.
EENT: neonatal retinal hemorrhage.
Hepatic: neonatal jaundice.
Other: low Apgar scores at 5 minutes, death.
Interactions
Drug-drug
Carboprost tromethamine: May enhance adverse/toxic effect of oxytocin. Avoid combination.
Cyclopropane anesthetics: May cause less pronounced bradycardia and hypotension. Use together
cautiously.
Dinoprostone: May enhance oxytocic effects of oxytocin. Concomitant use isn’t recommended. If used
sequentially, monitor uterine activity closely. Administer oxytocin 30 minutes after removing dinoprostone
vaginal insert and 6 to 12 hours after application of dinoprostone gel.
Drugs that prolong QT interval: May increase risk of life-threatening cardiac arrhythmias, including torsades
de pointes. Use together cautiously.
Misoprostol: May increase oxytocin adverse effects. Don’t use together.
Vasoconstrictors: May cause severe HTN if oxytocin is given within 3 to 4 hours of vasoconstrictor in
patient receiving caudal block anesthetic. Avoid using together.
Effects on Lab Test Results
None reported.
Contraindications & Cautions
!"Contraindicated in patients hypersensitive to drug.
!"Contraindicated when vaginal delivery isn’t advised (placenta previa, vasa previa, invasive cervical
carcinoma, genital herpes), when cephalopelvic disproportion is present, or when delivery requires
conversion, as in transverse lie.
!"Contraindicated in fetal distress when delivery isn’t imminent, in prematurity, in other obstetric
emergencies, and in patients with severe toxemia or hypertonic uterine patterns.
!"Use cautiously, if at all, in patients with invasive cervical cancer and in those with previous cervical or
uterine surgery (including cesarean section), grand multiparity, uterine sepsis, traumatic delivery, or
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overdistended uterus.
!"Alert: May cause antidiuretic effect and risk of severe water intoxication, seizures, or death, particularly
with large doses or when given by slow infusion over 24 hours and if patient is receiving fluids by mouth.
!"Dialyzable drug: Unknown.
!"Overdose Signs & Symptoms: Uterine hypersensitivity, tumultuous labor, uterine rupture, cervical and
vaginal lacerations, postpartum hemorrhage, uteroplacental hypoperfusion, variable deceleration of fetal
HR, fetal hypoxia, hypercapnia, perinatal hepatic necrosis, water intoxication, seizures, death.
Pregnancy-Lactation-Reproduction
Black Box Warning: Drug is only indicated for the medical, rather than the elective, induction of labor.
!"Use cautiously during first and second stages of labor because uterine hypertonicity, tetanic contraction,
cervical laceration, uterine rupture, and maternal and fetal death have been reported.
!"Drug wouldn’t be expected to cause fetal abnormalities when used as indicated. Use cautiously in
pregnant or breastfeeding women. Administration of exogenous oxytocin may disrupt initiation of
breastfeeding.
Nursing Considerations
!"Alert: All patients receiving oxytocin IV must be under continuous observation by trained personnel who
have a thorough knowledge of the drug and are qualified to identify complications.
!"Alert: Discontinue oxytocin infusion immediately if uterine hyperactivity or fetal distress occurs.
Administer oxygen to the mother. Mother and fetus must be evaluated by the responsible physician.
!"Drug is used to induce or reinforce labor only when pelvis is known to be adequate, when vaginal
delivery is indicated, when fetal maturity is assured, and when fetal position is favorable. Use drug only
in hospital where critical care facilities and prescriber are immediately available.
!"Monitor fluid intake and output. Antidiuretic effect may lead to fluid overload, seizures, and coma from
water intoxication.
!"Monitor and record uterine contractions, HR, BP, intrauterine pressure, fetal HR, and character of blood
loss at least every 15 minutes.
Patient Teaching
!"Explain use and administration of drug to patient and family.
!"Instruct patient to promptly report adverse reactions (site irritation, nausea, bleeding, blurred vision,
difficulty speaking, wheezing, itching, swelling).
INSERT_HANDOUTS
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