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High Alert
oxytocin (ox-i-toe-sin)
Pitocin
Classification
Therapeutic: hormones
Pharmacologic: oxytocics
Pregnancy Category X
Plate # 0-Composite
pg 1 # 1
ternal— hypotension; fetal, arrhythmias. F and E: maternal— hypochloremia,
hyponatremia, water intoxication. Misc: maternal—q uterine motility, painful
contractions, abruptio placentae,puterine blood flow, hypersensitivity.
Interactions
Drug-Drug: Severe hypertension may occur if oxytocin follows administration of
vasopressors.
Route/Dosage
Induction/Stimulation of Labor
Indications
IV: Induction of labor at term. IV: Facilitation of threatened abortion. IV, IM: Postpartum control of bleeding after expulsion of the placenta.
IV (Adults): 0.5– 1 milliunits/min;qby 1– 2 milliunits/min q 30– 60 min until desired contraction pattern established; dose may bepafter desired frequency of contractions is reached and labor has progressed to 5-6 cm dilation.
Action
Postpartum Hemorrhage
Stimulates uterine smooth muscle, producing uterine contractions similar to those in
spontaneous labor. Has vasopressor and antidiuretic effects. Therapeutic Effects: Induction of labor. Control of postpartum bleeding.
Pharmacokinetics
Absorption: IV administration results in 100% bioavailability.
Distribution: Widely distributed in extracellular fluid. Small amounts reach fetal
circulation.
Metabolism and Excretion: Rapidly metabolized by liver and kidneys.
Half-life: 3– 9 min.
TIME/ACTION PROFILE (reduction in uterine contractions)
ROUTE
IV
IM
ONSET
immediate
3–5 min
PEAK
unknown
unknown
DURATION
1 hr
30–60 min
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Anticipated nonvaginal delivery.
Use Cautiously in: OB: First and second 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.
Adverse Reactions/Side Effects
Maternal adverse reactions are noted for IV use only CNS: maternal— COMA, SEIZURES; fetal, INTRACRANIAL HEMORRHAGE. Resp: fetal— ASPHYXIA, hypoxia. CV: ma⫽ Canadian drug name.
⫽ Genetic Implication.
IV (Adults): 10 units infused at 20– 40 milliunits/min.
IM (Adults): 10 units after delivery of placenta.
Incomplete/Inevitable Abortion
IV (Adults): 10 units at a rate of 20– 40 milliunits/min.
NURSING IMPLICATIONS
Assessment
● Fetal maturity, presentation, and pelvic adequacy should be assessed prior to ad-
ministration 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.
● Lab Test Considerations: Monitor maternal electrolytes. Water retention may
result in hypochloremia or hyponatremia.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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03/14/2014 07:53AM
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Potential Nursing Diagnoses
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
Implementation
● 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 in-
fusion fluid (0.9% NaCl, D5W, or LR). Concentration: 10 milliunits/mL. Rate:
Begin infusion at 0.5– 2 milliunits/min (0.05– 0.2 mL); increase in increments of
1– 2 milliunits/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 milliunits/mL. Rate: Begin infusion at a rate of 20– 40 milliunits/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 milliunits/mL. Rate: Infuse at a rate of 20– 40 milliunits/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, cefoperazone,
cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, ciprofloxacin, cisatracurium, clindamycin, cyanocobalamin, cyclosporine, daptomycin, dexamethasone, dexmedetomidine, digoxin, digoxin, diphenhydramine, dobutamine, dolasetron, dopamine, doxycycline, droperidol,
enalaprilat, ephedrine, epinephrine, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, famotidine, fenoldopam, fentanyl, fluconazole, folic acid, foscarnet, fosphenytoin, furosemide, ganciclovir, gentamicin, glycopyrrolate, grani-
Plate # 0-Composite
pg 2 # 2
setron, 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, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, ondansetron,
oxacillin, palonosetron, pamidronate, papaverine, penicillin G , pentamdine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium
phosphates, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, sodium acetate, sodium
bicarbonate, sodium phosphates, streptokinase, succinylcholine, sufentanil, tacrolimus, theophylline, thiamine, ticarcillin/clavulanate, 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.
Patient/Family Teaching
● Advise patient to expect contractions similar to menstrual cramps after adminis-
tration has started.
Evaluation/Desired Outcomes
● Onset of effective contractions.
● Increase in uterine tone.
● Reduction in postpartum bleeding.
Why was this drug prescribed for your patient?
䉷 2015 F.A. Davis Company
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