Medical Management: Uterotonic Medications
Drug
Oxytocin
(Pitocin)
Misoprostol
(Cytotec, PGE1)
Dose/Route/Frequency
Contraindications/Side Effects/Comments
IV: 10-40 units in 1000 ml of IV fluid at a 
rate sufficient to control uterine atony,

onset: immediate, duration: 20 min after
infusion is stopped

IM: 10 units, onset: 3-7 min, duration:
30-60 min
SL: 400-600 mcg one time dose, onset:
20-30 min, duration: 6 hours
PR: 800-1000 mcg one time dose,
onset: 40-60 min, duration: 6 hours
Methylergonovine IM/IMM: 0.2 mg every 2-4 hours, onset:
2-5 min, duration: 3 hours
(Methergine)

Avoid undiluted rapid IV infusion, which causes hypotension
Higher doses of oxytocin (up to 80 units in 1000 ml) can be
administered IV for a short duration to manage uterine atony
Prolonged administration may cause anti-diuretic effect and
water intoxication
Maximum dose: 80 units




No contraindications.
Various doses have been prescribed PR, PO, and SL.
May cause fever, chills, and shivering
Maximum dose: total 800-1000 mcg


Ergot alkaloids are contraindicated in hypertension.
Should not be routinely administered IV because of possibility
of inducing sudden hypertension and cerebrovascular accident.
Maximum dose: total 1 mg (5 doses)

15-methyl PGF2α
(carboprost)
(Hemabate)
IM/IMM: 250 mcg, onset: 3-5 min,
duration: 2-4 hr


May repeat at 15- to 90- minute
intervals


Dinoprostone
(Prostin E2)
Suppository; vaginal or rectal: 20 mg


May cause vomiting, diarrhea, fever, headaches,
bronchoconstriction, and uterine rupture.
Contraindicated for asthmatic patients; relative
contraindication for active cardiac, pulmonary, renal, or hepatic
disease.
Do not inject IV.
Maximum dose: total 2 mg (8 doses)
Contraindicated for hypotensive patients. Frequently causes
fever.
Must be thawed to room temperature before use.
PG= prostaglandin IM= intramuscular mcg= microgram PV= per vagina IV= intravascular PR= per rectum IMM= intramyometrial PO= per orem SL= sublingually
PPH=postpartum hemorrhage
3/19/2014