(oks i TOE sin)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Pitocin: 10 units/mL (1 mL, 10 mL, 50 mL [DSC]) [contains chlorobutanol (chlorobutol)]
Generic: 10 units/mL (1 mL, 10 mL, 30 mL)
Generic: 10 units/1000 mL in Dextrose 5% (1000 mL); 10 units/1000 mL in Dextrose 5% and Lactated Ringers (1000 mL); 10 units/1000 mL in Lactated Ringers (1000 mL); 10 units/500 mL in Dextrose 5% and Lactated Ringers (500 mL); 10 units/500 mL in Lactated Ringers (500 mL); 10 units/500 mL in NaCl 0.9% (500 mL); 15 units/250 mL in Dextrose 5% (250 mL); 15 units/250 mL in Lactated Ringers (250 mL); 15 units/250 mL in NaCl 0.9% (250 mL); 15 units/500 mL in Dextrose 5% and Lactated Ringers (500 mL [DSC]); 15 units/500 mL in Lactated Ringers (500 mL [DSC]); 20 units/1000 mL in Dextrose 5% (1000 mL); 20 units/1000 mL in Dextrose 5% and Lactated Ringers (1000 mL); 20 units/1000 mL in Lactated Ringers (1000 mL); 20 units/1000 mL in NaCl 0.45% (1000 mL); 20 units/1000 mL in NaCl 0.9% (1000 mL); 20 units/500 mL in Dextrose 5% and Lactated Ringers (500 mL); 20 units/500 mL in Lactated Ringers (500 mL); 30 units/1000 mL in Dextrose 5% and Lactated Ringers (1000 mL); 30 units/1000 mL in Lactated Ringers (1000 mL); 30 units/1000 mL in NaCl 0.9% (1000 mL); 30 units/500 mL in Dextrose 5% and Lactated Ringers (500 mL); 30 units/500 mL in Lactated Ringers (500 mL); 30 units/500 mL in NaCl 0.9% (500 mL); 40 units/1000 mL in Dextrose 5% (1000 mL [DSC]); 40 units/1000 mL in Dextrose 5% and Lactated Ringers (1000 mL); 40 units/500 mL in Lactated Ringers (500 mL); 60 units/1000 mL in NaCl 0.9% (1000 mL)
Brand Names: U.S.
- Oxytocic Agent
Oxytocin stimulates uterine contraction by activating G-protein-coupled receptors that trigger increases in intracellular calcium levels in uterine myofibrils. Oxytocin also increases local prostaglandin production, further stimulating uterine contraction.
Urine (small amount unchanged)
Onset of Action
Uterine contractions: IM: 3 to 5 minutes; IV: ~1 minute
Duration of Action
IM: 2 to 3 hours; IV: 1 hour
1 to 6 minutes; decreased in late pregnancy and during lactation
Use: Labeled Indications
Antepartum: Induction of labor in patients with a medical indication (eg, Rh problems, maternal diabetes, preeclampsia, at or near term); stimulation or reinforcement of labor (as in selected cases of uterine inertia); adjunctive therapy in management of incomplete or inevitable abortion
Postpartum: To produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage.
Hypersensitivity to oxytocin or any component of the formulation; significant cephalopelvic disproportion; unfavorable fetal positions or presentations (such as transverse lies); fetal distress when delivery is not imminent; hypertonic or hyperactive uterus; contraindicated vaginal delivery (invasive cervical cancer, active genital herpes, prolapse of the cord, cord presentation, total placenta previa, or vasa previa); obstetrical emergencies where surgical intervention is favored; where adequate uterine activity fails to achieve satisfactory progress
Note: Dosage is determined by uterine response and must be individualized and initiated at a very low level for each patient.
Induction or stimulation of labor: IV: Administration requires the use of an infusion pump. The ideal dosing regimen has not been determined (Leduc 2013) and various protocols are available (ACOG 2009; Leduc 2013; Wei 2010). Discontinue the oxytocin infusion immediately in the event of uterine hyperactivity and/or fetal distress. If uterine contractions become too powerful, the infusion can be stopped abruptly.
Initial: 0.5 to 1 milliunits/minute; gradually increase dose in increments of 1 to 2 milliunits/minute every 30 to 60 minutes until desired contraction pattern is established; dose may be decreased by similar increments after desired frequency of contractions is reached and labor has progressed to 5 to 6 cm dilation. Higher infusion rates may be needed prior to term due to a lower sensitivity of the uterus. Infusion rates up to 6 milliunits/minute provide oxytocin levels similar to those with spontaneous labor; rates >9 to 10 milliunits/minute are rarely required.
Low-dose regimen (off-label dose): Initial 0.5 to 2 milliunits/minute, incrementally increase by 1 to 2 milliunits/minute every 15 to 40 minutes (ACOG 2009).
High-dose regimen (off-label dose): Initial 6 milliunits/minute, incrementally increase by 3 to 6 milliunits/minute every 15 to 40 minutes. Reduce the incremental increase to 3 milliunits/minute if hyperstimulation occurs; reduce the incremental increase to 1 milliunit/minute for recurrent hyperstimulation (ACOG 2009).
Postpartum uterine bleeding:
IM: 10 units after delivery of the placenta
IV: 10 to 40 units added to a running infusion solution depending on amount of infusion fluid remaining (maximum: 40 units in 1,000 mL of IV fluid); adjust infusion rate to sustain uterine contraction and control uterine atony. Slow IV injections (5 or 10 units over 1 minute) are preferred for women without cardiovascular risk factors although rapid injections may be considered; very slow injections (≥5 minutes) are preferred for women with cardiovascular risk factors (Sentilhes 2016).
Adjunctive treatment of abortion: IV:
Incomplete, inevitable, or elective abortion: 10 units as an IV infusion after suction or a sharp curettage (used to help contract the uterus)
Midtrimester elective abortion: 10 to 20 milliunits/minute; maximum total dose: 30 units/12 hours (may decrease injection to abortion time)
Dosing: Renal Impairment
There are no dosage adjustments provided in the manufacturer's labeling.
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer's labeling.
Induction or stimulation of labor: Add oxytocin 10 units to NS or LR 1,000 mL to yield a solution containing oxytocin 10 milliunits/mL. Rotate solution to mix.
Postpartum uterine bleeding: Add oxytocin 10 to 40 units to running IV infusion; maximum: 40 units to 1,000 mL.
Adjunctive management of abortion: Add oxytocin 10 units to 500 mL of a physiologic saline solution or D5W.
Induction or stimulation of labor: Administer as an IV infusion (drip method) by use of an infusion pump; accurate control of the rate of infusion flow is essential.
Incomplete or inevitable abortion: Administer by IV infusion
Postpartum uterine bleeding: Administer by IV or IM.
Store at 20°C to 25°C (68°F to 77°F).
Carboprost Tromethamine: May enhance the adverse/toxic effect of Oxytocic Agents. Specifically, oxytocic effects may be enhanced. Avoid combination
Dinoprostone: May enhance the adverse/toxic effect of Oxytocin. Specifically, oxytocic effects may be enhanced. Management: Concomitant use of dinoprostone and oxytocin is not recommended. If used sequentially, monitor uterine activity closely. Administer oxytocin 30 minutes after removing dinoprostone vaginal insert and 6 to 12 hours after the application of dinoprostone gel. Consider therapy modification
EPHEDrine (Nasal): Oxytocin may enhance the hypertensive effect of EPHEDrine (Nasal). Monitor therapy
EPHEDrine (Systemic): Oxytocin may enhance the hypertensive effect of EPHEDrine (Systemic). Monitor therapy
Gemeprost: May enhance the adverse/toxic effect of Oxytocin. Avoid combination
MiFEPRIStone: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Indeterminate Risk and Risk Modifying). Management: Though the drugs listed here have uncertain QT-prolonging effects, they all have some possible association with QT prolongation and should generally be avoided when possible. Consider therapy modification
MiSOPROStol: May enhance the adverse/toxic effect of Oxytocin. Specifically, oxytocic effects may be enhanced. Management: The manufacturer of misoprostol recommends avoiding concomitant use with oxytocin. Misoprostol may augment effects of oxytocin, particularly when given within 4 hours of oxytocin initiation. Consider therapy modification
QTc-Prolonging Agents (Highest Risk): QTc-Prolonging Agents (Indeterminate Risk and Risk Modifying) may enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Management: Avoid such combinations when possible. Use should be accompanied by close monitoring for evidence of QT prolongation or other alterations of cardiac rhythm. Consider therapy modification
QTc-Prolonging Agents (Moderate Risk): QTc-Prolonging Agents (Indeterminate Risk and Risk Modifying) may enhance the QTc-prolonging effect of QTc-Prolonging Agents (Moderate Risk). Monitor therapy
Frequency not defined.
Cardiovascular: Cardiac arrhythmia (including premature ventricular contraction), hypertension, subarachnoid hemorrhage
Central nervous system: Hypertonia (uterine)
Endocrine & metabolic: Water intoxication (severe water intoxication with seizure and coma is associated with a slow oxytocin infusion over 24 hours)
Gastrointestinal: Nausea, vomiting
Genitourinary: Postpartum hemorrhage, tetanic uterine contractions, uterine rupture, uterine spasm
Hematologic & oncologic: Pelvic hematoma
Concerns related to adverse effects:
• Antidiuretic effect: May produce intrinsic antidiuretic effect (ie, water intoxication). Severe water intoxication with convulsions, coma, and death may occur, particularly with large doses (40 to 50 milliunits/minute) or when given as a slow infusion over 24 hours and if the patient is receiving fluids by mouth.
• Cardiovascular effects: Arrhythmias, hypotension, myocardial ischemia, peripheral vasodilation, and tachycardia have been reported following administration. The risk of adverse events is influenced by dose and route of administration and is increased in women with cardiovascular disease. Use with extreme caution in hemodynamically unstable patients (Dyer 2011).
• Maternal deaths: Maternal deaths caused by hypertensive episodes, subarachnoid hemorrhage, or rupture of the uterus and fetal deaths have occurred with oxytocic medications when used for induction of labor or for augmentation in the first and second stages of labor.
• Uterine effects: High doses or hypersensitivity to oxytocin may cause uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.
• Appropriate use: [US Boxed Warning]: To be used for medical rather than elective induction of labor. Oxytocin is used to initiate or improve uterine contractions in order to achieve a vaginal delivery; it should only be used when medically needed for fetal or maternal reasons. Medical indications for labor induction may include Rh problems, maternal diabetes, preeclampsia at or near term, when delivery is in the best interest of mother or fetus, or premature rupture of membranes when delivery is indicated. Use is generally not recommended in the following conditions: Fetal distress, hydramnios, partial placenta previa, prematurity, borderline cephalopelvic disproportion, or conditions where there is a predisposition for uterine rupture (eg, previous major surgery on cervix or uterus, cesarean section, overdistention of the uterus, grand multiparity, past history of uterine sepsis or traumatic delivery).
• Appropriate use: Abortion: For the adjunctive management of abortion in the first trimester, curettage is generally considered primary therapy. Oxytocin infusion in second trimester abortion will often be effective; however, other therapy may be required.
• Trained personnel: IV preparations should be administered by adequately trained individuals familiar with its use and able to identify complications; continuous observation is necessary for all patients.
Fluid intake and output during administration, uterine activity (tonus, amplitude, and frequency of contractions), maternal blood pressure; fetal heart rate in relation to uterine contractions.
[US Boxed Warning]: To be used for medical rather than elective induction of labor. Small amounts of exogenous oxytocin are expected to reach the fetal circulation. When used as indicated, teratogenic effects would not be expected. Nonteratogenic adverse reactions are reported in the neonate as well as the mother.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience vomiting or nausea. Have patient report immediately to prescriber bleeding (soaking one pad an hour), abnormal heartbeat, difficult urination, severe headache, dizziness, passing out, vision changes, bradycardia, seizures, severe abdominal pain, or signs of severe cerebrovascular disease (change in strength on one side is greater than the other, difficulty speaking or thinking, change in balance, or vision changes) (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
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- Drug class: uterotonic agents