Oxtimon Special Precautions

The induction of labour by means of oxytocin should be attempted only when strictly indicated for medical reasons. Administration should only be under hospital conditions and qualified medical supervision. When given for induction and enhancement of labour, Oxytocin Injection must only be administered as an intravenous infusion and never by intravenous bolus injection. Careful monitoring of fetal heart rate and uterine motility (frequency, strength, and duration of contractions) is essential, so that the dosage may be adjusted to individual response.
When Oxytocin Injection is given for induction or enhancement of labour, particular caution is required in the presence of borderline cephalopelvic disproportion, secondary uterine inertia, mild to moderate degrees of pregnancy-induced hypertension or cardiac disease and in patients above 35 years of age or with a history of lower-uterine-segment cesarean sections.
In the case of fetal death in utero, and/or in the presence of meconium-stained amniotic fluid, tumultuous labour must be avoided, as it may cause amniotic fluid embolism.
Because oxytocin possesses slight antidiuretic activity, its prolonged intravenous administration at high doses in conjunction with large volumes of fluid, as may be the case in the treatment of inevitable or missed abortion, or in the management of postpartum hemorrhage, may cause water intoxication associated with hyponatremia. To avoid this rare complication, the following precautions must be observed whenever high doses of oxytocin are administered over a long time; an electrolyte-containing diluent must be used (not dextrose); the volume of infused fluid should be kept low (by infusing oxytocin at a higher concentration than recommended for the induction or enhancement of labour at term); fluid intake by mouth must be restricted; a fluid balance chart should be kept, and serum electrolytes should be measured when electrolyte imbalance is suspected.
When Oxytocin Injection is used for prevention or treatment of uterine hemorrhage, rapid intravenous injection should be avoided, as it may cause an acute short-lasting drop in blood pressure. Prostaglandins may potentiate the uterotonic effect of oxytocin and vice versa; therefore, concomitant administration requires very careful monitoring. Some inhalation anesthetics, e.g. cyclopropane or halothane, may enhance the hypotensive effects of oxytocin and reduce its oxytocic action. Their concurrent use with oxytocin has also been reported to cause cardiac rhythm disturbances.
When given during or after caudal block anesthesia, oxytocin may potentiate the pressor effect of sympathomimetic vasoconstrictor agents.
Oxytocin Injection should not be infused via the same apparatus as blood or plasma, because the peptide linkages are rapidly inactivated by oxytocin-inactivating enzymes. Oxytocin Injection is incompatible with solutions containing sodium metabisulfite as a stabilizer.
Oxytocin Injection is compatible with the following infusions fluids, but due attention should be paid to the advisability of using electrolyte fluids in individual patients: Dextrose 5%, Sodium/potassium chloride (103 mmol Na and 51 mmol K), Laevulose 20%, Macrodex 6%, Sodium bicarbonate 1.39%, Sodium chloride 0.9%, Sodium lactate 1.72%, Rheomacrodex 10%, Ringer's solution.