Oxytocin prescription in Latin on pharmacology. How does Oxytocin work? Instructions for use. Oxytocin - what is it

Oxytocin is a drug that has a stimulating effect on the smooth muscles of the uterus. Under its influence, the tone and contractile activity of the myometrium and the concentration of calcium in the cells increase. The agent causes contraction of myoepithelial cells that are adjacent to the alveoli of the mammary glands, thereby contributing to lactation.

As a result of the effect of Oxytocin on the smooth muscles of the vascular walls, the lumen of the blood vessels and blood flow in the vessels of the brain, coronary vessels and kidneys increase. In addition, against the background of the use of Oxytocin, there is a slightly pronounced antidiuretic effect.

In this article, we will consider why doctors prescribe Oxytocin, including instructions for use, analogues and prices for this drug in pharmacies. If you have already used Oxytocin, leave feedback in the comments.

Composition and form of release

Solution for injection (1 ml in ampoules, 10 ampoules in contour plastic packs, 1 pack in a cardboard pack);
Solution for injection and local use (1 ml each in glass ampoules: 10 ampoules in contour plastic packs, 1 or 2 packs in a cardboard pack; 5 ampoules in contour plastic packs, 2 packs in a cardboard pack);
Solution for intravenous and intramuscular injection (1 ml in ampoules: 5 or 10 ampoules in cardboard packs; 5 ampoules in contour plastic packs, 1 or 2 packs in a cardboard pack; 10 ampoules in blister packs, 1 pack in a pack cardboard).

Clinical and pharmacological group: a drug that increases the tone and contractile activity of the myometrium.

What is Oxytocin used for?

There are several main indications for which a specialist prescribes the use of a synthetic hormone to his patients. Let's take a closer look at what exactly the drug is used for:

To stimulate the primary and secondary weakness of labor;
To call early labor in connection with the death of the fetus;
For the prevention and treatment of uterine bleeding;
To increase uterine contractions during caesarean section;
To eliminate the pain of premenstrual syndrome.

The action of oxytocin is not shown to all patients, a specialist in prescribing the drug should also take into account contraindications. If, for some reason, the patient was not warned about this, then all the main contraindications can easily be found in the attached instructions, which are inside absolutely every box.

Oxytocin - what is it?

Oxytocin is a synthetic hormonal agent that interacts with oxytocin-specific receptors in the muscular layer of the uterus. In late pregnancy, the body's reaction to the action of Oxytocin increases significantly and reaches a maximum by its end.

According to the instructions, oxytocin stimulates labor activity by increasing the permeability of cell membranes for calcium, as well as increasing its amount inside the cells, which provokes an increase in the excitability of the membrane.

The action of Oxytocin for a short period of time impairs the blood supply to the uterus, which causes contractions that are similar to normal spontaneous childbirth. In addition, the use of Oxytocin stimulates the production of breast milk and leads to a reduction in myoepithelial cells in the alveoli of the mammary glands.

Instructions for use

Usually more preferred is intramuscular injection of the drug. If intramuscular administration does not work or an immediate effect is needed, then intravenous administration of oxytocin is resorted to, which should be done slowly.

Oxytocin is prescribed intramuscularly or intravenously at a dose of 1-3 IU. For caesarean section, it is injected into the muscles of the uterus at a dose of 5 IU. According to gynecological indications, it is prescribed subcutaneously or intramuscularly at a dose of 5-10 IU.

Before the introduction of oxytocin, the syringe, if stored in alcohol, must be washed in distilled water.

Contraindications

Hypersensitivity, fetal distress, partial placenta previa, preterm labor, mismatch between the size of the fetal head and the pelvis of the mother, conditions with a predisposition to uterine rupture, excessive uterine distension, uterus after multiple births, cases of uterine sepsis, invasive cervical carcinoma, increased blood pressure, kidney failure.

Side effects

It must be understood that the drug can cause a number of side effects both in women in labor during the termination of pregnancy and in the fetus. The impact is carried out at the level of several systems at once. Such problems are extremely rare, but if they do occur, every effort should be made promptly to ensure that they are corrected.

Consider the negative effects in a woman in labor, which correspond to the use of the drug:

From the side of the heart and blood vessels: if the drug is administered too quickly, subarachnoid hemorrhage and bradycardia may occur. Also, the rapid administration of the drug can lead to the fact that the patient's blood pressure may rise or vice versa, it may decrease, and reflex tachycardia may begin.
Reproductive system: tetany, spasm, uterine hypertension, uterine rupture.
Digestive system: dyspeptic phenomena.
Immune system: allergy, anaphylaxis.
Water and electrolyte metabolism: with prolonged intravenous administration, severe hyperhydration is possible, sometimes accompanied by convulsions and coma.

The fetus or newborn from oxytocin may experience manifestations of jaundice, he may experience retinal hemorrhage. In very rare cases, tachycardia, sinus bradycardia, arrhythmia, damage to the brain and central nervous system may begin. To prevent this from happening, everything should be very well controlled by a doctor who can quickly take action at the first changes.

Pregnancy and lactation

In the first trimester of pregnancy, oxytocin is used only for spontaneous or induced abortions. Numerous data on the use of oxytocin, its chemical structure and pharmacological properties indicate that, if the recommendations are followed, the likelihood of an effect of oxytocin on an increase in the incidence of fetal malformations is small.

Small amounts are excreted in breast milk. When using the drug to stop uterine bleeding, breastfeeding can only be started after the completion of the course of treatment with oxytocin.

special instructions

Carry out treatment with Oxytocin only under the supervision of a doctor in a hospital under the control of the contractile activity of the uterus, the condition of the fetus, blood pressure and the general condition of the woman.

Analogues

Oxytocin-Vial, Oxytocin-Ferein, Oxytocin-Grindeks, Oxytocin-Richter, Oxytocin-MEZ, Pitocin, Syntocinon.

Attention: the use of analogues must be agreed with the attending physician.

Prices

The average price of OXYTOCIN in pharmacies (Moscow) is 60 rubles.

Terms and conditions of storage

Keep away from children. To store in the place protected from light at a temperature from 2 to 15 °C. Shelf life - 3 years.

Recipe (international)

Rp. Oxytocini sinthetici 1.0 (5 units)
D.t. d. N. 6 in ampul.
S. 1 ml 1-2 times a day intramuscularly

pharmachologic effect

It has a stimulating effect on the smooth muscles of the uterus, increases the contractile activity and tone of the myometrium (the muscular layer of the uterus), helps to reduce the myoepithelial cells (special secretory cells) surrounding the alveoli (structural and functional formations) of the mammary glands (which facilitates the movement of milk into large ducts and mammary sinuses), has weak vasopressin-like antidiuretic properties (increases the reverse absorption of water by the kidneys, i.e. reduces urination).

With rapid jet administration, it relaxes the smooth muscles of the vessels, which leads to temporary arterial hypotension (lowering blood pressure) and reflex tachycardia (rapid heart rate).

Mode of application

For adults: Usually for the drug Oxytocin, intramuscular injection of the drug is more preferable. If intramuscular administration does not work or an immediate effect is needed, then intravenous administration of oxytocin is resorted to, which should be done slowly.

Oxytocin is prescribed intramuscularly or intravenously at a dose of 1-3 IU. For caesarean section, it is injected into the muscles of the uterus at a dose of 5 IU. According to gynecological indications, it is prescribed subcutaneously or intramuscularly at a dose of 5-10 IU.

Before the introduction of oxytocin, the syringe, if stored in alcohol, must be washed in distilled water.

Indications

Stimulation of labor activity in the first and second stages of labor with weakness (primary or secondary) of labor pains;

Labor induction in the late or close to it period of pregnancy, in case of need for preterm birth due to intrauterine growth retardation of the fetus, Rhesus conflict, preeclampsia, premature or early rupture of the fetal membranes and rupture of amniotic fluid, intrauterine death of the fetus, post-term pregnancy (after 42 weeks ); Prevention and treatment of hypotonic bleeding after abortion, childbirth, caesarean section (after the birth of a child and separation of the placenta) (in order to accelerate postpartum involution of the uterus);
Additional therapy for failed or incomplete abortion.

Contraindications

Hypersensitivity to oxytocin;
presence of contraindications for vaginal delivery (for example, presentation or prolapse of the umbilical cord, complete or partial (vasa previa) placenta previa; narrow pelvis (mismatch between the size of the fetal head and the pelvis of the woman in labor); transverse and oblique position of the fetus, preventing spontaneous delivery; emergency, requiring surgical intervention situations caused by the state of the mother or fetus; states of fetal distress long before the end of pregnancy; long-term use with uterine inertia; severe preeclampsia (high blood pressure, impaired renal function); uterine hypertonicity (not occurring during childbirth); uterine sepsis, heart disease , arterial hypertension, impaired renal function, facial presentation of the fetus, excessive uterine distension, fetal compression.
Except in special circumstances, the drug is also contraindicated in the following situations: premature birth; volume surgery on the uterus or cervix (including caesarean section) in history; uterine hypertonicity; multiple pregnancy; invasive stage of cervical carcinoma.

Side effects

In relation to the mother: anaphylactic reaction (an allergic reaction of an immediate type), hypertonicity (increased tone) of the uterus, tetanic (persistent) uterine contractions and rupture, short-term arterial hypotension (lowering blood pressure), hot flashes and reflex tachycardia (rapid heartbeats), nausea, vomiting, cardiac arrhythmias. In relation to the fetus: compression, asphyxia (impaired blood supply) and death of the fetus.

Release form

solution for injection in ampoules.

ATTENTION!

The information on the page you are viewing was created for informational purposes only and does not promote self-treatment in any way. The resource is intended to familiarize healthcare professionals with additional information about certain medicines, thereby increasing their level of professionalism. The use of the drug "" without fail provides for a consultation with a specialist, as well as his recommendations on the method of application and dosage of the medicine you have chosen.

In case of violation of labor, to prevent uterine bleeding, increase lactation after the birth of a child, with painful menstrual syndrome, the drug Oxytocin is used. Injections are made strictly under medical supervision to avoid serious complications.

It is important to know the peculiarities of the impact on the body of the mother and fetus, to understand what reactions are possible with an overdose, injections without taking into account contraindications. Information about the hormonal agent will help women understand the mechanism of action of Oxytocin and the possible consequences of uncontrolled use of the drug.

Composition and form of release

The active ingredient is the synthetic hormone oxytocin, similar to the natural peptide of the posterior pituitary gland (1 ml of the hormonal agent contains 5 IU of the active substance).

Additional components:

water for injections,
chlorobutanol hydrate.

The package contains 5 or 10 ampoules, the volume of a clear liquid in each container is 1 ml.

The drug belongs to the pharmacological group "Hormones of the posterior pituitary". The solution is intended for injection into the cervix or the wall of the uterus and / in, intranasal application (instillation of the composition into the nose).

Action

After intramuscular or intravenous administration, oxytocin is actively absorbed, penetrates into the uterus. The drug exhibits vasopressin-like, lactotropic and mild antidiuretic action.

Hormone oxytocin:

activates the contraction of the smooth muscles of the uterus;
increases the tone of the myometrium and its contractile activity;
reduces the ability to contract epithelial cells, facilitates the movement of milk during lactation into the sinuses and large ducts of the mammary glands;
does not affect the contraction of the walls of the intestine and bladder.

The rate of manifestation of the effect from the use of a hormonal agent depends on the method of administration: with intramuscular use - after 1-2 minutes, the period of exposure - up to half an hour, intranasally - for three to four minutes. With drip administration, the active effect of the active substance is manifested in less than a minute after the start of the infusion.

Indications for use

Intravenous and intramuscular injections of Oxytocin are prescribed to pregnant women and women in childbirth:

to start and stimulate optimal labor activity against the background of the Rhesus conflict of the mother and fetus;
in case of urgent delivery;
with intrauterine death of the fetus;
with weak uterine contractions.

Other indications for the use of Oxytocin:

low lactation after childbirth;
prevention of bleeding after an abortion at different stages of pregnancy;
to activate uterine contractions to remove the placenta after cesarean section;
for the speedy return of the uterus to its usual physiological state after childbirth;
with severe signs of premenstrual syndrome: a sharp weight gain, pronounced swelling, pain in the ovaries and uterus.

Contraindications

Improper use of Oxytocin injections can cause serious consequences for the body, even death. It is important to take into account the limitations, assess the risk of adverse reactions depending on the condition of the mother and fetus.

The hormone Oxytocin in ampoules is not prescribed in the following situations:

arterial hypertension;
oblique or transverse position of the fetus;
development of preeclamptic toxemia;
placenta previa;
invasive carcinoma develops in the cervical region;
large fruit;
excessive sensitivity to oxytocin;
the uterus is stretched after numerous births;
severe pathologies of the vascular network, cardiac muscle;
there are scars on the uterus after surgical treatment or caesarean section;
narrow pelvis;
suspicion of placental abruption;
intrauterine oxygen starvation of the fetus;
increased risk of uterine rupture.

Instructions for use

Doctors select the dosage and method of administration of the Oxytocin solution individually. The frequency of injections is determined taking into account the condition of the patient.

Basic Rules:

to stimulate labor activity. Intramuscular injections, from 0.5 to 2 IU of the hormone, repeated administration at intervals of 30 minutes to an hour with a weak effect of the hormonal agent;
for labor induction. Intravenous infusions. Previously, 2 ampoules of a hormonal agent are diluted in 1 liter of a 5% dextrose solution. The initial infusion rate is from 5 to 8 drops per minute, the rate is gradually increased depending on the degree of activation of labor activity (maximum, up to 40 drops in 60 seconds). Be sure to monitor the heart rate of the fetus and the activity of the muscles of the uterus;
in the treatment of incomplete or imminent abortion Oxytocin solution is administered intravenously by drip. For the procedure, a dextrose solution of a concentration of 5% (500 ml) is combined with 10 IU of the hormone. The optimal rate of administration of the drug is from 20 to 40 drops within 60 seconds;
to prevent mastitis with congestion against the background of lactation, the patient receives intramuscularly 2 IU of a hormonal preparation;
for removal of placenta after caesarean section sections in the wall of the uterus make an injection of Oxytocin, a single dose - from 3 to 5 IU of the active substance;
to reduce the risk of hypotonic bleeding from the uterus prescribe i / m injections 2 or 3 times a day for two to three days. The optimal amount of the hormone is from 3 to 5 IU. During the period of treatment of dangerous uterine bleeding, the duration of therapy is three days, the amount of oxytocin is from 5 to 8 IU, the frequency of i / m administration is two to three times a day;
with severe premenstrual syndrome appoint intranasal use of a hormonal agent. It is necessary to instill the solution into the nose from the 20th day of the menstrual cycle to the 1st day of the next monthly bleeding.

To reduce the risk of reflex tachycardia and a drop in blood pressure, a slow jet injection of the solution during infusion at a rate of 0.012 to 0.02 IU / min is required. When confirming optimal labor activity, it is important to gradually reduce the rate of intravenous administration.

Important! Oxytocin injections are used strictly according to indications, but with individual sensitivity or a combination of negative factors, negative reactions are possible. A drug that stimulates uterine contractions is allowed to be used only in a hospital under constant medical supervision.

Side effects

Possible side effects in the mother:

headache, dizziness;
fluid retention in the body, nausea, vomiting;
increased platelet levels;
anaphylactic shock with excessive sensitization of the body;
bradycardia, arrhythmia, decrease or increase in blood pressure, ventricular extrasystole;
uterine cramps, uterine hypertonicity and uterine rupture;
death during childbirth;
hemorrhage in the pelvic area.

Complications in a newborn or fetus:

sinus bradycardia, palpitations, arrhythmia, extrasystole;
hemorrhage in the area of the retina;
asphyxia, in the absence of timely assistance - fetal death;
damage to the brain and central nervous system;
neonatal jaundice.

Uncontrolled use of the drug Oxytocin can lead to dangerous complications. Injections, infusions are carried out only in a hospital. It is important to monitor the condition of the mother and fetus, showed blood pressure, heart rate, uterine contractility.

Overdose

An excess of oxytocin is dangerous to health and life: severe side reactions develop:

convulsions;
hypoxia;
birth trauma;
uterine rupture;
hypercapnia;
tetanus of the uterus;
fetal bradycardia;
asphyxia and fetal death;
severe postpartum bleeding;
a sharp slowing of the heartbeat in the fetus.

On the page, read the information on how to treat an ovarian cyst without surgery using medications.

Treatment:

immediate cancellation of injections based on oxytocin;
rapid decrease in fluid intake;
conducting forced diuresis;
administration of hypertonic saline (sodium chloride);
stabilization of water and electrolyte balance;
constant medical supervision.

drug interaction

Important nuances:

combination with Cyclopropane and Halopan may lead to hypotension;
when used simultaneously with MAO inhibitors, there is a high probability of an increase in blood pressure;
the combination of Oxytocin with sympathomimetic amines increases the pressor effect of the use of ionotropic drugs that bind myocardial pt-receptors.

Price

The price of Oxytocin depends on the number of ampoules and the pharmaceutical company. Hungarian drug (manufacturer - Gedeon-Richter) - the price is 85 rubles for 5 ampoules, the Russian remedy (Moscow Endocrine Plant) - 45 rubles for 10 ampoules.

Store the drug on the bottom shelf or refrigerator door at a temperature of +2 C to +15 C. It is forbidden to freeze the medicine. Ampoules with a hormonal composition should not get to children. Solution for injection Oxytocin is suitable for three years.

Analogues

Many women leave positive feedback about oxytocin if the hormone was used to stimulate proper labor. Often, a second injection is required if the contractions are not intense enough. It is important that physicians take into account contraindications to reduce the risk of adverse reactions, including life-threatening women and fetuses.

With weak labor activity, congestion in the chest during lactation, poor contraction of the uterus after an abortion or childbirth, doctors recommend injections of Oxytocin. The hormonal agent is successfully used for severe manifestations of premenstrual syndrome, for the prevention of hypotonic bleeding from the uterus. An analogue of the natural hormone has an active effect on the elements of the reproductive system, gives a positive result without serious complications for the body. If Oxytocin is used incorrectly, dangerous side reactions are possible.

Video about who and why the hormone Oxytocin is prescribed in injections:

A drug that increases the tone and contractile activity of the myometrium

Active substance

Oxytocin (oxytocin)

Release form, composition and packaging

Solution for infusions and intramuscular injections colorless, transparent.

Excipients: glacial acetic acid - 2.0 mg, chlorobutanol hemihydrate - 3 mg, ethanol 96% - 40 mg, water for injection - up to 1 ml.

1 ml - glass ampoules (5) - contour plastic packaging (1) - cardboard packs.

pharmachologic effect

Synthetic hormonal preparation. In terms of pharmacological and clinical properties, it is similar to endogenous oxytocin in the posterior pituitary gland. Interacts with oxytocin-specific receptors in the uterine myometrium, belonging to the G-protein superfamily. The number of receptors and the response to the action of oxytocin increase as pregnancy progresses and reach a maximum towards its end. It stimulates the labor activity of the uterus by increasing the permeability of cell membranes for calcium ions and increasing its intracellular concentration, followed by a decrease in the resting potential of the membrane and an increase in its excitability. Causes contractions similar to normal spontaneous childbirth, temporarily impairing the blood supply to the uterus. With an increase in the amplitude and duration of muscle contractions, the uterine os expands and smoothes. In appropriate quantities, it can increase the contractility of the uterus from moderate in strength and frequency, characteristic of spontaneous motor activity, to the level of prolonged tetanic contractions.

Causes contraction of myoepithelial cells adjacent to the alveoli of the mammary gland, improving the secretion of breast milk.

By acting on the smooth muscles of the vessels, it causes vasodilation and increases blood flow in the kidneys, coronary vessels and cerebral vessels. Usually, blood pressure remains unchanged, however, when administered intravenously in high doses or a concentrated solution of oxytocin, blood pressure may temporarily decrease with the development of reflex tachycardia and a reflex increase in ejection. Following the initial decrease in blood pressure, a prolonged, albeit slight, increase follows.

Unlike vasopressin, oxytocin has a minimal antidiuretic effect, however, overhydration is possible when oxytocin is administered with large amounts of electrolyte-free solutions and / or if they are administered too quickly. Does not cause contraction of the muscles of the bladder and intestines.

Pharmacokinetics

With intravenous administration, the effect of oxytocin on the uterus appears almost instantly and lasts for 1 hour. With intramuscular administration, the myotonic effect occurs in the first 3-7 minutes and lasts for 2-3 hours.

Like vasopressin, oxytocin is distributed throughout the extracellular space. Small amounts of oxytocin appear to enter the fetal circulation. T 1/2 is 1-6 minutes and becomes shorter in late pregnancy and lactation. Most of the drug is rapidly metabolized in the liver and kidneys. In the process of enzymatic hydrolysis, it is inactivated, primarily under the action of tissue oxytokinase (oxytokinase is also found in the placenta and). Only a small amount of oxytocin is excreted unchanged by the kidneys.

Indications

- for labor induction and stimulation of labor activity (primary and secondary weakness of labor activity; the need for early delivery due to preeclampsia, Rhesus conflict, intrauterine fetal death; post-term pregnancy; premature discharge of amniotic fluid, labor in breech presentation);

- for the prevention and treatment of hypotonic uterine bleeding after an abortion (including with long pregnancy);

- in the early postpartum period to accelerate the postpartum involution of the uterus;

- to reduce the uterus during caesarean section (after removal of the placenta).

Contraindications

- narrow pelvis (anatomical and clinical);

- transverse or oblique position of the fetus;

- facial presentation of the fetus;

- premature birth;

- threatening uterine rupture;

- scars on the uterus (after a previous caesarean section, operations on the uterus);

- excessive stretching of the uterus;

- uterus after multiple births;

- partial placenta previa;

- uterine sepsis;

- invasive carcinoma of the cervix;

- uterine hypertonicity (which did not occur during childbirth);

- chronic renal failure;

- Hypersensitivity to the components of the drug.

Dosage

In / in or in / m.

In order to induce and enhance labor activity, oxytocin is used exclusively in / in, in a hospital, under appropriate medical supervision. The simultaneous use of the drug in / in and / m is contraindicated. The dose is selected taking into account the individual sensitivity of the pregnant woman and the fetus.

For induction and stimulation of labor Oxytocin is used exclusively in the form of an intravenous drip infusion. Strict control of the prescribed infusion rate is essential. The safe use of oxytocin during induction and intensification of labor requires the use of an infusion pump or other similar device, as well as monitoring the strength of uterine contractions and fetal cardiac activity. In the event of an excessive increase in the contractile activity of the uterus, the infusion should be stopped immediately, as a result, the excess muscle activity of the uterus quickly decreases.

1. Before proceeding with the administration of the drug, you should begin to inject a saline solution that does not contain oxytocin.

2. To prepare a standard infusion of oxytocin in 1000 ml of non-hydrating liquid, dissolve 1 ml (5 IU) of oxytocin and mix thoroughly by swirling the vial. In 1 ml of the infusion prepared in this way contains 5 honey of oxytocin. For accurate dosing of the infusion solution, an infusion pump or other similar device should be used.

3. The rate of administration of the initial dose should not exceed 0.5-4 mU / min, which corresponds to 2-16 drops / min, because 1 drop of infusion contains 0.25 honey of oxytocin). Every 20-40 minutes it can be increased by 1-2 mU / min until the desired degree of contractile activity of the uterus is reached. Upon reaching the desired frequency of uterine contractions, corresponding to spontaneous labor, and with the opening of the cervix of the uterus up to 4-6 cm, in the absence of signs of fetal distress, the infusion rate can be gradually reduced at a pace similar to its acceleration.

In late pregnancy, infusion at a higher rate requires caution, only in rare cases may a rate exceeding 8-9 mU / min be required. In the case of preterm labor, a high rate may be required, which in rare cases may exceed 20 mU / min (80 drops / min).

1. Fetal heart rate, uterine tone at rest, frequency, duration and strength of its contractions should be monitored.

2. In case of uterine hyperactivity or fetal distress, oxytocin administration should be stopped immediately and oxygen therapy should be provided to the woman in labor. The condition of the woman in labor and the fetus should be re-checked by a specialist doctor.

Prevention and treatment of hypotonic bleeding in the postpartum period

1. In / in drip infusion: dissolve 10-40 IU of oxytocin in 1000 ml of non-hydrating liquid; for the prevention of uterine atony, 20-40 mU / min of oxytocin is usually needed.

2. In / m administration: 5 IU / ml of oxytocin after separation of the placenta.

Incomplete or missed abortion

Add 10 IU/ml of oxytocin to 500 ml of saline or a mixture of 5% with saline. The rate of intravenous infusion is 20-40 drops / min.

Side effects

At women in labor

From the reproductive system: at high doses or hypersensitivity - uterine hypertonicity, spasm, tetany, uterine rupture; increased bleeding in the postpartum period as a result of oxytocin-induced thrombocytopenia, afibrinogenemia and hypoprothrombinemia, sometimes hemorrhages in the pelvic organs. With careful medical supervision during childbirth, the risk of bleeding in the postpartum period is reduced.

From the side of the cardiovascular system: when used in high doses - arrhythmia, ventricular extrasystole, severe arterial hypertension (in the case of the use of vasopressor drugs), arterial hypotension (when used simultaneously with the anesthetic cyclopropane), reflex tachycardia, shock, if administered too quickly - bradycardia, subarachnoid hemorrhage.

From the digestive system: nausea, vomiting.

From the side of water-electrolyte metabolism: severe overhydration with prolonged intravenous administration (usually at a rate of 40-50 mU / min) with a large amount of fluid (antidiuretic effect of oxytocin), can also occur with a 24-hour slow infusion of oxytocin, accompanied by convulsions and coma; rarely - lethal outcome.

Allergic reactions: anaphylaxis and other allergic reactions, with too rapid administration of bronchospasm; rarely - lethal outcome.

In a fetus or newborn

As a result of the introduction of oxytocin to the mother - within 5 minutes, a low Apgar score, neonatal jaundice, if administered too quickly - a decrease in the level of fibrinogen in the blood, hemorrhage in the retina of the eye; as a result of increased contractile activity of the uterus - sinus bradycardia, tachycardia, ventricular extrasystole and other arrhythmias, changes in the central nervous system, fetal death as a result of asphyxia.

Overdose

Symptoms depend mainly on the degree of hyperactivity of the uterus, regardless of the presence of hypersensitivity to the drug. Hyperstimulation with hypertonic and tetanic contractions or with basal tone ≥15-20 mm aq. Art. between two contractions leads to discoordination of labor, rupture of the body or cervix, vagina, bleeding in the postpartum period, uteroplacental insufficiency, fetal bradycardia, hypoxia, hypercapnia, compression, or death. Hyperhydration with convulsions as a result of the antidiuretic effect of oxytocin is a serious complication and develops with prolonged administration of the drug at high doses (40-50 ml / min).

Treatment hyperhydration: withdrawal of oxytocin, restriction of fluid intake, use of diuretics to force diuresis, intravenous administration of hypertonic saline, correction of electrolyte imbalance, relief of seizures with appropriate doses of barbiturates, and careful care of the patient in a coma.

drug interaction

With the introduction of oxytocin 3-4 hours after the use of vasoconstrictors in conjunction with caudal anesthesia, severe arterial hypertension is possible.

When anesthesia with cyclopropane, it is possible to change the cardiovascular action of oxytocin with the unforeseen development of arterial hypotension, sinus bradycardia and AV rhythm in the parturient woman during anesthesia.

special instructions

Until the fetal head is inserted into the pelvic inlet, oxytocin cannot be used to stimulate labor.

Before proceeding with the use of oxytocin, the expected benefit of therapy should be weighed against the possibility, albeit small, of the development of hypertension and tetany of the uterus.

Each patient receiving intravenous oxytocin should be in the hospital under the constant supervision of experienced professionals experienced in the use of the drug and the recognition of complications. If necessary, the immediate assistance of a medical specialist should be provided. In order to avoid complications during the use of the drug, uterine contractions, the cardiac activity of the woman in labor and the fetus, and the blood pressure of the woman in labor should be constantly monitored. With signs of uterine hyperactivity, the administration of oxytocin should be stopped immediately, as a result of which the uterine contractions caused by the drug usually subside soon.

With adequate use, oxytocin causes uterine contractions similar to spontaneous childbirth. Excessive stimulation of the uterus with improper use of the drug is dangerous for both the woman in labor and the fetus. Even with adequate use of the drug and appropriate monitoring, hypertensive uterine contractions occur with increased sensitivity of the uterus to oxytocin.

The risk of developing afibrinogenemia and increased blood loss should be taken into account.

There are known cases of death of a woman in labor as a result of hypersensitivity reactions, subarachnoid hemorrhage, uterine rupture and fetal death for various reasons associated with parenteral administration of the drug for induction of labor and stimulation of labor in the first and second stages of labor.

As a result of the antidiuretic effect of oxytocin, hyperhydration may develop, especially with the use of a constant infusion of oxytocin and oral fluid intake.

The drug can be diluted in solutions of sodium lactate, and glucose. Ready solution should be used in the first 8 hours after its preparation. Compatibility studies were conducted with 500 ml infusions.

Influence on the ability to drive vehicles and mechanisms

Oxytocin does not affect the ability to drive a car and mechanisms, work on which is associated with an increased risk of injury.

Pregnancy and lactation

Small amounts are excreted in breast milk.

When using the drug to stop uterine bleeding, breastfeeding can only be started after the completion of the course of treatment with oxytocin.

For impaired renal function

Contraindicated in chronic renal failure.

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

Terms and conditions of storage

The drug should be stored out of the reach of children, protected from light at a temperature of 2° to 15°C. Shelf life - 3 years. Do not use the drug after the expiration date.

Name:

Oxytocin

Pharmacological
action:

Has a stimulating effect on the smooth muscles of the uterus, increases the contractile activity and tone of the myometrium (the muscular layer of the uterus), promotes the reduction of myoepithelial cells (special secretory cells) surrounding the alveoli (structural and functional formations) of the mammary glands (which facilitates the movement of milk into large ducts and milk sinuses), has weak vasopressin-like antidiuretic properties (increases the reverse absorption of water by the kidneys, i.e. reduces urination).
With fast jet injection relaxes the smooth muscles of the vessels, which leads to temporary arterial hypotension (lowering blood pressure) and reflex tachycardia (rapid heart rate).

Pharmacokinetics. With intravenous administration, the effect of oxytocin on the uterus appears almost instantly and lasts for 1 hour. When administered, the myotonic effect occurs in the first 3-7 minutes and lasts for 2-3 hours.
Like vasopressin, oxytocin is distributed throughout the extracellular space. A small amount of oxytocin is likely to enter the fetal circulation.
T1 / 2 of oxytocin is 1-6 minutes, it is shorter in the late period of pregnancy and lactation. Most of the drug is metabolized in the liver and kidneys. In the process of enzymatic hydrolysis, oxytocin is inactivated, mainly under the action of tissue oxytokinase (oxytokinase is also found in the placenta and blood plasma). Only a small amount of oxytocin is excreted in the urine unchanged.

Indications for
application:

Oxytocin applied for induction and stimulation of contractile activity of the uterus.

Indications for use in the prenatal period
Labor induction: Induction of labor with oxytocin is indicated in the last or near stages of pregnancy in the presence of hypertension (eg, preeclampsia, eclampsia, or in the presence of cardiovascular and renal disease), fetal erythroblastosis, maternal or gestational diabetes mellitus, prenatal bleeding, or the need for early delivery , premature rupture of the membranes, in which there is no spontaneous contractile activity of the uterus. Planned induction of contractile activity of the uterus with oxytocin can be indicated for post-term pregnancy (more than 42 weeks). The induction of contractile activity of the uterus can also be shown in cases of intrauterine fetal death, intrauterine growth retardation of the fetus.
Strengthening the contractile activity of the uterus: In the first or second stage of labor, it can be used in / in the form of an infusion to increase contractions during prolonged labor, in the absence or lethargy of uterine contractions.

Indications in the postpartum period
With hypotension of the uterus, to stop postpartum hemorrhage.
Other indications for use: As adjuvant therapy for incomplete or missed abortion.
Application for diagnostic purposes: To determine the fetal-placental respiratory capacity of the fetus (stress test with oxytocin).

Mode of application:

The dose is determined taking into account individual sensitivity pregnant woman and fetus.
For the induction or stimulation of labor, oxytocin is used exclusively in the form of an intravenous drip infusion. Compliance with the proposed infusion rate is mandatory. The safe use of oxytocin requires the use of an infusion pump or other similar device, as well as monitoring of uterine contractions and fetal cardiac activity. In the event of an excessive increase in the contractile activity of the uterus, the infusion should be stopped immediately, as a result, the excess muscle activity of the uterus quickly decreases.
Oxytocin infusion should not be carried out during the first 6 hours after the use of vaginal prostaglandins.
1. Before proceeding with the administration of the drug, you should start administering a physiological solution that does not contain oxytocin.
2. To prepare a standard solution for infusion, dissolve the contents of 1 ampoule - 1 ml (5 IU) of oxytocin under sterile conditions in 1000 ml of a solvent (0.9% sodium chloride solution, 5% glucose solution) and mix thoroughly by rotating the container. 1 ml of solution prepared in this way contains 5 mIU of oxytocin. For accurate dosing of the infusion solution, an infusion pump or other similar device should be used.
3. The rate of administration of the initial dose should not exceed 0.5-4 mIU / min. Every 20-40 minutes it can be increased by 1-2 mIU / min until the desired degree of contractile activity of the uterus is reached. After reaching the desired frequency of uterine contractions, corresponding to normal labor activity, in the absence of signs of fetal distress and with the opening of the cervix by 4–6 cm, the infusion rate can be gradually reduced at a rate similar to its acceleration. In late pregnancy, infusion at a high rate requires caution, only in rare cases may a rate of up to 8-9 mIU / min be required. In case of preterm labor, accelerated administration of oxytocin may be necessary, rarely the rate may exceed 20 mIU / min.
If a woman in the last or close stages of pregnancy has not achieved adequate contractile activity of the uterus after an infusion of a total of 5 IU of oxytocin, then it is recommended to stop trying to stimulate labor. Labor induction may be resumed the next day, starting at a dose of 0.5–4 mIU/min.
4. Fetal heart rate, uterine tone at rest, frequency, duration and strength of its contractions should be monitored.
5. In case of uterine hyperactivity or fetal distress, the administration of oxytocin should be stopped immediately. The woman in labor should be provided with oxygen therapy. The condition of the mother and fetus should be under the supervision of a physician.
Control of uterine bleeding in the postpartum period:
a) IV infusion (drip method): dissolve 10-40 IU of oxytocin in 1000 ml of a solvent (0.9% sodium chloride solution, 5% glucose solution), 20-40 mIU is usually needed to prevent uterine atony /min oxytocin;
b) intramuscular injection of 1 ml (5 IU) of oxytocin after separation of the placenta.
Adjuvant therapy for incomplete or missed abortion
IV infusion of 10 IU of oxytocin in 500 ml of 0.9% sodium chloride solution or a mixture of 5% dextrose with physiological solution at a rate of 20-40 drops / min.
Diagnosis of uteroplacental insufficiency (stress test with oxytocin)
Start the infusion at a rate of 0.5 mIU/min and double the rate every 20 minutes until the effective dose is reached, which is usually 5–6 mIU/min, up to 20 mIU/min. After the appearance within a 10-minute period of 3 moderate uterine contractions lasting 40-60 seconds each, the administration of oxytocin should be stopped and the change, that is, the slowing of the fetal cardiac activity, should be monitored.

Side effects:

From the endocrine system: vasopressin-like action.
From the digestive system: nausea, vomiting.
From the side of the cardiovascular system: Irregular heart rhythm.
From the reproductive system: uterine hypertonicity, discoordinated or excessively strong labor activity, uterine rupture, intrauterine fetal suffering (bradycardia, arrhythmia, asphyxia), premature detachment of the placenta.
allergic reactions: skin rashes, itching.

Contraindications:

Oxytocin, injection solution, is contraindicated in any of the following conditions:
- clinically narrow pelvis;
- the unfavorable position of the fetus prevents spontaneous delivery without prior intervention (transverse position of the fetus);
- so-called obstetric emergencies, in which the benefit / risk ratio for the fetus or the woman in labor requires surgical intervention;
- in cases of fetal distress long before the end of pregnancy;
- long-term use with inertia of the uterus or sepsis;
- uterine hypertonicity;
- hypersensitivity to the active substance or any of the excipients;
- induction or increase in contractile activity of the uterus in cases where vaginal delivery is contraindicated (for example, with presentation or prolapse of the umbilical cord, complete placenta previa or vasa previa);
- severe cardiovascular disorders.

Interaction
other medicinal
by other means:

Severe hypertension has been reported when oxytocin was administered 3-4 hours after the prophylactic administration of vasoconstrictors in conjunction with caudal anesthesia.
Anesthesia with cyclopropane, enflurane, halothane, isoflurane can change the effect of oxytocin on the cardiovascular system, leading to such unexpected results as arterial hypotension. It is also known that the simultaneous use of oxytocin and cyclopropane anesthesia can cause sinus bradycardia and atrioventricular rhythm.
Oxytocin should be used with caution in patients taking drugs that may prolong the QTc interval.
It turned out that prostaglandins enhance the effect of oxytocin and therefore their use is not recommended. In connection with the increased contractile activity of the uterus, care should be taken with the consistent use of prostaglandins and oxytocin.
Simultaneous use of oxytocin with other inducers of labor or abortion can lead to uterine hypertension (increased tone), rupture or trauma to the cervix (for example, the use of prostaglandins can increase the stimulation of labor and stimulation of the myometrium).
Therefore, when using the drug in patients, it is necessary to strictly control: acid-base balance; frequency, duration and strength of uterine contractions; fetal heartbeat; Heart rate and blood pressure of the mother; uterine tone; fluid balance.

Incompatibility. The drug can be diluted in 0.9% solution of sodium chloride for infusion, 5% solution of glucose, solutions of sodium lactate. The finished solution is physically and chemically stable for 8 hours after preparation. From a microbiological point of view, the drug should be used immediately. It should not be administered in the same volume with other drugs.

Pregnancy:

There are no known indications for use in the first trimester of pregnancy, except in connection with spontaneous or induced abortion. Wide experience in the use of the drug, its chemical structure and pharmacological properties indicate that when used according to indications, this drug does not lead to the formation of fetal malformations.
In small quantities penetrates into breast milk.
In cases of using the drug to stop uterine bleeding, breastfeeding is possible only after the end of the course of treatment with oxytocin.
Children. Do not use in children.

Overdose:

Symptoms depend mainly on the degree of hyperactivity of the uterus, regardless of the presence of hypersensitivity to the drug. Hyperstimulation can lead to intense (hypertonic) and prolonged (tetanic) uterine contractions or rapid labor with a characteristic basal myometrial tone of 15–20 or more mm aq. Art., measured between two contractions, and can also cause rupture of the body or cervix, vagina, bleeding in the postpartum period, uteroplacental hypoperfusion, slowing of fetal cardiac activity, hypoxia, hypercapnia and fetal death.

Injection and local application - 1 ml contains:
Active ingredient - Oxytocin 5 IU
Other Ingredients: acetic acid, chlorobutanol, ethyl alcohol.