Generality
The use of oxytocin as a drug is carried out in all those cases in which it is necessary to induce labor .
Oxytocin is a molecule of natural origin; more precisely, it is a peptide hormone produced by the hypothalamus and released by the posterior pituitary gland . Oxytocin is a hormone implicated in various functions of the body, both female and male; however, it is particularly important during pregnancy. In fact, it is able to stimulate contractions and induce labor when the gestation ends, while during the breastfeeding phase it stimulates the ejection reflex of the milk .
Given its properties, oxytocin is administered to pregnant women in the form of a drug for the purpose of inducing labor, thus giving birth and giving birth to the child. In addition to this, oxytocin as a drug can also be used to counteract any post-partum bleeding.
Clearly, oxytocin as a drug present in the currently available medicinal specialties is obtained synthetically.
Examples of Medicinal Specialties Containing Oxytocin
- Organic Oxytocin Italia®
- Syntocinon®
Therapeutic indications
When is the use of oxytocin indicated?
The use of oxytocin as a drug is indicated for:
- Induce labor in the event that:
- The pregnancy lasted beyond the term;
- There is a premature rupture of the membranes;
- There is pre-eclampsia, a particular condition characterized by hypertension, proteinuria and edema starting from the twentieth week of gestation;
- There is primary or secondary uterine inertia (only selected cases), that is a condition in which the musculature of the uterus is not able to contract adequately to complete the birth.
- Treating postpartum hemorrhages.
Warnings
Warnings and precautions for the use of oxytocin
The administration of oxytocin as a drug should be carried out only and exclusively by specialized medical or health personnel and only and exclusively in a hospital setting.
Before the administration of oxytocin as a drug, healthcare professionals should be informed if the pregnant woman:
- It presents some of the conditions reported in the contraindications to the administration of oxytocin (see chapter "Contraindications");
- He underwent a caesarean section;
- Suffers from cardiovascular diseases of any kind;
- Suffers from kidney disorders or diseases;
- It is being treated with drugs that induce a lengthening of the QT interval.
Furthermore, during administration of oxytocin as a drug, healthcare professionals should take into account that there is an increased risk of disseminated intravascular coagulation (CID); this risk increases further if the pregnant woman is over 35, in the event of complications during pregnancy and in the presence of gestational age above 40 weeks.
Please note
When administering oxytocin as a drug, it is good to minimize the amount of fluid taken.
Pharmacological Interactions
Interactions of Oxytocin with Other Drugs
Because of the drug interactions that may occur, oxytocin as a drug should not be administered in combination with other medicines containing active ingredients capable of exerting actions similar to oxytocin itself ( oxytocic drugs ).
Furthermore, oxytocin should be administered with great caution in association with:
- Prostaglandins or analogues, some of which are used precisely to induce labor;
- Active ingredients able to induce a lengthening of the QT interval (they can increase the hypotensive effect induced by oxytocin);
- Inhalation anesthetics (can decrease the action of oxytocin on the uterine muscles);
- Caudal anesthetics used to reduce pain during childbirth (may increase the hypotensive effect induced by oxytocin).
However, before the administration of oxytocin as a drug, each patient should inform their doctor and health care professional if they are taking - or have recently taken - products or medicines of any kind, including over-the-counter drugs (OTC), medications without medical prescription (SOP) or any herbal products.
Side effects
Side effects caused by the assumption of oxytocin
Although it is an active ingredient of natural origin, as is the case for any other drug, even the administration of oxytocin can give rise to side effects, although not all patients manifest them or manifest them in the same way. In fact, each woman reacts subjectively to the administration of the active ingredient in question. However, the following are the main side effects that can occur after taking the active ingredient in question.
Cardiovascular disorders
The administration of oxytocin as a drug could lead to the appearance of:
- Cardiac arrhythmias;
- Lengthening of the QT interval;
- Hypotension;
- Myocardial ischemia.
Immune system disorders
Oxytocin as a drug can give rise to:
- Anaphylactoid reactions associated with dyspnea;
- Hypotension or shock.
Gastrointestinal disorders
Nausea and vomiting may occur following the administration of oxytocin as a drug.
Other side effects
Other side effects that could occur with the use of oxytocin as a drug consist of:
- Skin rash;
- Uterine hypertonicity;
- Uterine rupture;
- Tetanic contractions;
- Water poisoning and hyponatremia (adverse effects that occur especially in the case of prolonged administration of high doses of oxytocin with a large quantity of liquids without electrolytes);
- Acute pulmonary edema;
- Disseminated intravascular coagulation;
- Redness of the face or body (flushing).
Side Effects in the Fetus and the Newborn
Following administration of oxytocin in the mother, the following side effects may occur in the fetus or newborn:
- Fetal distress;
- Neonatal hyponatremia;
- Asphyxiation;
- Death.
Fortunately, these are side effects whose frequency is so rare that it cannot be defined on the basis of the data available so far (frequency not known).
Overdose
In the case of oxytocin overdose as a drug it is possible to develop symptoms such as:
- Cardiovascular disorders;
- Disseminated intravascular coagulation;
- Water poisoning;
- Intrauterine fetal death.
In the event that symptoms of overdose occur during administration of oxytocin, this should be stopped immediately. Treatment is symptomatic and aims to restore normal conditions.
However, since oxytocin as a drug can only be administered in a hospital setting and exclusively by the doctor or by specialized health personnel, the occurrence of an overdose, although possible, is quite rare.
Action mechanism
How does Oxytocin work?
Although oxytocin as a drug is obtained synthetically, it is completely equal to the endogenous oxytocin produced by the body. For this reason, it is able to carry out the same actions of the peptide hormone in question through the same mechanisms of action. More in detail, oxytocin as a drug - similar to the endogenous hormone - is able to interact with the receptors for oxytocin present in the body and, in particular but not exclusively, at the uterine level. Oxytocin receptors are Gq protein-coupled receptors that, when activated by binding to oxytocin, cause the smooth muscle of the uterus to contract.
Method of use and Posology
How to take oxytocin
Oxytocin as a drug is available as an injectable solution that can be administered intravenously or intramuscularly . The dosage of active ingredient to be administered to the patient must be established by the doctor and varies according to the condition to be treated.
Induction and facilitation of labor
To induce and / or facilitate labor, oxytocin should be administered intravenously drop by drop, or through the use of special variable speed infusion pumps. In such circumstances, the usual dose used is 5 IU (International Units).
Treatment of postpartum hemorrhages
In the treatment of postpartum hemorrhage, oxytocin can be administered intramuscularly, or through a slow intravenous infusion.
The usual recommended dose in these cases is 5-10 IU for intramuscular administration; while it is 5 IU for slow intravenous infusion. In the most serious cases, on the other hand, the dose of oxytocin that can be administered varies from 5 to 20 IU by intravenous route. The infusion rate must be such as to control the uterine atony.
Pregnancy and breastfeeding
Can oxytocin be taken in pregnancy and during breastfeeding?
Clearly, oxytocin as a drug can be used at the end of pregnancy, when it is necessary to induce childbirth and immediately after it to treat any bleeding without causing any harm to the mother or child. For obvious reasons, the administration of oxytocin cannot occur during gestation, but only when it has come to an end and there is a need to induce childbirth.
Oxytocin is excreted in small doses in breast milk but this event should not create any side effects to the newborn.
Contraindications
When Oxytocin should not be used
The use of oxytocin as a drug should not be performed in the following cases:
- Known allergy to oxytocin or to any of the excipients contained in the medicinal product to be used;
- Presence of strong uterine contractions;
- Presence of fetal distress when childbirth is not imminent;
- Presence of severe toxemia;
- When there is a predisposition to pulmonary embolism due to amniotic fluid;
- Presence of conditions in which spontaneous labor is not advisable or natural childbirth is contraindicated, such as:
- Cephalo-pelvic disproportion important (the baby's head is too large to pass through the mother's pelvis);
- Position of the child in the incorrect and abnormal birth canal;
- Placenta previa or previuos pots;
- Rupture of the placenta;
- Prolapse of the umbilical cord;
- Overdistension or impaired uterus resistance to rupture.
Finally, it should be remembered that oxytocin as a drug should not be administered in a prolonged manner in the presence of even in oxytocin-resistant uterine inertia, just as it should not be administered for prolonged periods in the presence of serious cardiovascular diseases.
