ox-i-TOE-sin

• IV: Induction of labor at term.
• IV: Facilitation of threatened abortion.
• IV, IM: Postpartum control of bleeding after expulsion of the placenta.

• Stimulates uterine smooth muscle, producing uterine contractions similar to those in spontaneous labor.
• Has vasopressor and antidiuretic effects.

• Induction of labor.
• Control of postpartum bleeding.

Absorption: IV administration results in 100% bioavailability.

Distribution: Widely distributed in extracellular fluid. Small amounts reach fetal circulation.

Metabolism/Excretion: Rapidly metabolized by liver and kidneys.

Half-life: 3–9 min.

Contraindicated in:

• Hypersensitivity
• Anticipated nonvaginal delivery.

Use Cautiously in:

• OB: 1st and 2nd stages of labor; slow infusion over 24 hr has caused water intoxication with seizure and coma or maternal death due to oxytocin's antidiuretic effect.

Maternal adverse reactions are noted for IV use only

Neuro: maternal: COMA, SEIZURES.
fetal: INTRACRANIAL HEMORRHAGE.

Resp: fetal: ASPHYXIA, hypoxia.

CV: maternal: hypotension.
fetal: arrhythmias.

F and E: maternal: hypochloremia, hyponatremia, water intoxication.

Misc: maternal: ↑uterine motility, painful contractions, abruptio placentae, ↓ uterine blood flow, hypersensitivity.

Drug-Drug:

• Severe hypertension may occur if oxytocin follows administration of vasopressors.

Induction/Stimulation of Labor

• IV (Adults): 0.5–1 mU/min; ↑ by 1–2 mU/min every 30–60 min until desired contraction pattern established; dose may be ↓ after desired frequency of contractions is reached and labor has progressed to 5–6 cm dilation.

Postpartum Hemorrhage

• IV (Adults): 10 units infused at 20–40 mU/min.
• IM (Adults): 10 units after delivery of placenta.

Incomplete/Inevitable Abortion

• IV (Adults): 10 units at a rate of 20–40 mU/min.

• Do not administer oxytocin simultaneously by more than one route.

IV Administration:

• Continuous Infusion: Rotate infusion container to ensure thorough mixing. Store solution in refrigerator, but do not freeze.
  • Infuse via infusion pump for accurate dose. Oxytocin should be connected via Y-site injection to an IV of 0.9% NaCl for use during adverse reactions.
  • Magnesium sulfate should be available if needed for relaxation of myometrium.
• Induction of Labor:
  Diluent: Dilute 1 mL (10 units) in 1 L of compatible infusion fluid (0.9% NaCl, D5W, or LR).Concentration: 10 mU/mL.
• Rate: Begin infusion at 0.5–2 mU/min (0.05–0.2 mL); increase in increments of 1–2 mU/min at 15–30-min intervals until contractions simulate normal labor.
• Postpartum Bleeding:
  Diluent: For control of postpartum bleeding, dilute 1–4 mL (10–40 units) in 1 L of compatible infusion fluid.Concentration: 10–40 mU/mL.
• Rate: Begin infusion at a rate of 20–40 mU/min to control uterine atony. Adjust rate as indicated.
• Incomplete or Inevitable Abortion:
  Diluent: For incomplete or inevitable abortion, dilute 1 mL (10 units) in 500 mL of 0.9% NaCl or D5W.Concentration: 20 mU/mL.
• Rate: Infuse at a rate of 20–40 mU/min.
• Y-Site Compatibility:
  • acyclovir
  • alfentanil
  • allopurinol
  • amikacin
  • aminocaproic acid
  • aminophylline
  • amphotericin B liposome
  • anidulafungin
  • argatroban
  • ascorbic acid
  • atropine
  • azathioprine
  • azithromycin
  • aztreonam
  • benztropine
  • bivalirudin
  • bumetanide
  • buprenorphine
  • butorphanol
  • calcium chloride
  • calcium gluconate
  • capreomycin
  • caspofungin
  • cefazolin
  • cefepime
  • cefotaxime
  • cefotetan
  • cefoxitin
  • ceftazidime
  • ceftriaxone
  • cefuroxime
  • chloramphenicol
  • ciprofloxacin
  • cisatracurium
  • clindamycin
  • cyanocobalamin
  • cyclosporine
  • daptomycin
  • dexamethasone
  • dexmedetomidine
  • digoxin
  • digoxin
  • diphenhydramine
  • dobutamine
  • dopamine
  • doxycycline
  • droperidol
  • enalaprilat
  • ephedrine
  • epinephrine
  • epoetin alfa
  • eptifibatide
  • ertapenem
  • erythromycin
  • esmolol
  • famotidine
  • fenoldopam
  • fentanyl
  • fluconazole
  • folic acid
  • foscarnet
  • fosphenytoin
  • furosemide
  • ganciclovir
  • gentamicin
  • glycopyrrolate
  • granisetron
  • heparin
  • hydrocortisone sodium succinate
  • hydromorphone
  • imipenem/cilastatin
  • isoproterenol
  • ketamine
  • ketorolac
  • labetalol
  • leucovorin calcium
  • levofloxacin
  • lidocaine
  • linezolid
  • lorazepam
  • magnesium sulfate
  • mannitol
  • meperidine
  • meropenem
  • metaraminol
  • methyldopate
  • methylprednisolone
  • metoclopramide
  • metoprolol
  • metronidazole
  • midazolam
  • milrinone
  • morphine
  • moxifloxacin
  • multivitamins
  • mycophenolate
  • nafcillin
  • nalbuphine
  • naloxone
  • nicardipine
  • nitroglycerin
  • nitroprusside
  • norepinephrine
  • ondansetron
  • oxacillin
  • palonosetron
  • pamidronate
  • papaverine
  • penicillin G
  • pentamidine
  • pentobarbital
  • phenobarbital
  • phentolamine
  • phenylephrine
  • phytonadione
  • piperacillin/tazobactam
  • potassium acetate
  • potassium chloride
  • potassium phosphates
  • procainamide
  • prochlorperazine
  • promethazine
  • propranolol
  • protamine
  • pyridoxime
  • quinupristin/dalfopristin
  • sodium acetate
  • sodium bicarbonate
  • sodium phosphates
  • succinylcholine
  • sufentanil
  • tacrolimus
  • theophylline
  • thiamine
  • tigecycline
  • tirofiban
  • tobramycin
  • tolazoline
  • vancomycin
  • vasopressin
  • verapamil
  • vitamin B complex with C
  • voriconazole
  • warfarin
  • zidovudine
  • zoledronic acid
• Y-Site Incompatibility:
  • dantrolene
  • diazepam
  • diazoxide
  • indomethacin
  • methohexital
  • phenytoin
  • remifentanil
  • trimethoprim/sulfamethoxazole
• Solution Compatibility:
  • dextrose/Ringer’s or lactated Ringer’s combinations
  • dextrose/saline combinations
  • Ringer’s or lactated Ringer’s injection
  • D5W
  • D10W
  • 0.45% NaCl
  • 0.9% NaCl
.

Pitocin

Therapeutic Classification: hormones

Pharmacologic Classification: oxytocics

(Generic available)

• Solution for injection: 10 units/mL;

(reduction in uterine contractions)

• Fetal maturity, presentation, and pelvic adequacy should be assessed prior to administration of oxytocin for induction of labor.
• Assess character, frequency, and duration of uterine contractions; resting uterine tone; and fetal heart rate frequently throughout administration. If contractions occur <2 min apart and are >50–65 mm Hg on monitor, if they last 60–90 sec or longer, or if a significant change in fetal heart rate develops, stop infusion and turn patient on her left side to prevent fetal anoxia. Notify health care professional immediately.
• Monitor maternal BP and pulse frequently and fetal heart rate continuously throughout administration.
• This drug occasionally causes water intoxication. Monitor patient for signs and symptoms (drowsiness, listlessness, confusion, headache, anuria) and notify physician or other health care professional if they occur.

• Monitor maternal electrolytes. Water retention may result in hypochloremia or hyponatremia.

• Deficient knowledge, Relate med (Patient/Family Teaching).

• Advise patient to expect contractions similar to menstrual cramps after administration has started.

• Onset of effective contractions.
• Increase in uterine tone.
• Reduction in postpartum bleeding.

NDC Code^*

• 0143- West-Ward Pharmaceuticals Corp
  • 0143-9742- Oxytocin
    • 0143-9742-25- 25 VIAL in 1 CARTON (0143-9742-25) > 10 mL in 1 VIAL (0143-9742-01)

• 0143- West-Ward Pharmaceuticals Corp
  • 0143-9743- Oxytocin
    • 0143-9743-25- 25 VIAL in 1 CARTON (0143-9743-25) > 1 mL in 1 VIAL (0143-9743-01)

• 0641- West-Ward Pharmaceutical Corp.
  • 0641-6114- Oxytocin
    • 0641-6114-25- 25 VIAL in 1 CARTON (0641-6114-25) > 1 mL in 1 VIAL (0641-6114-01)

• 0641- West-Ward Pharmaceutical Corp.
  • 0641-6115- Oxytocin
    • 0641-6115-25- 25 VIAL in 1 CARTON (0641-6115-25) > 10 mL in 1 VIAL (0641-6115-01)

• 42023- Par Pharmaceutical, Inc.
  • 42023-116- Pitocin
    • 42023-116-01- 1 VIAL in 1 CARTON (42023-116-01) > 10 mL in 1 VIAL

• 42023- Par Pharmaceutical, Inc.
  • 42023-116- Pitocin
    • 42023-116-02- 25 VIAL in 1 CARTON (42023-116-02) > 10 mL in 1 VIAL

• 42023- Par Pharmaceutical, Inc.
  • 42023-116- Pitocin
    • 42023-116-25- 25 VIAL in 1 TRAY (42023-116-25) > 1 mL in 1 VIAL

• 42023- Par Pharmaceutical, Inc.
  • 42023-130- Pitocin
    • 42023-130-06- 6 VIAL in 1 CARTON (42023-130-06) > 50 mL in 1 VIAL

• 55154- Cardinal Health
  • 55154-9356- Oxytocin
    • 55154-9356-5- 5 VIAL in 1 BAG (55154-9356-5) > 1 mL in 1 VIAL

• 55154- Cardinal Health
  • 55154-9577- Oxytocin
    • 55154-9577-5- 5 VIAL in 1 BAG (55154-9577-5) > 1 mL in 1 VIAL

• 63323- Fresenius Kabi USA, LLC
  • 63323-012- Oxytocin
    • 63323-012-01- 25 VIAL in 1 TRAY (63323-012-01) > 1 mL in 1 VIAL (63323-012-00)

• 63323- Fresenius Kabi USA, LLC
  • 63323-012- Oxytocin
    • 63323-012-10- 25 VIAL, MULTI-DOSE in 1 TRAY (63323-012-10) > 10 mL in 1 VIAL, MULTI-DOSE (63323-012-06)

• 63323- Fresenius Kabi USA, LLC
  • 63323-012- Oxytocin
    • 63323-012-11- 25 VIAL in 1 TRAY (63323-012-11) > 1 mL in 1 VIAL (63323-012-03)

• 63323- Fresenius Kabi USA, LLC
  • 63323-012- Oxytocin
    • 63323-012-30- 10 VIAL, MULTI-DOSE in 1 TRAY (63323-012-30) > 30 mL in 1 VIAL, MULTI-DOSE (63323-012-02)

• 63323- Fresenius Kabi USA, LLC
  • 63323-012- Oxytocin
    • 63323-012-12- 25 VIAL in 1 TRAY (63323-012-12) > 1 mL in 1 VIAL