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【 Pharmacokinetics 】
Oxytocin is usually administered intravenously for stimulation
of labor. It is also available as a nasal spray to induce lactation
postpartum. It is inactive if swallowed, because it is destroyed in
the stomach and intestine.
Oxytocin is not bound to plasma proteins and is catabolized by
the kidneys and liver, with a circulating half-life of 5 minutes.
【 Pharmacologic effects 】
Oxytocin alters transmembrane ionic currents in myometrial
smooth muscle cells to produce sustained uterine contraction.
The sensitivity of the uterus to oxytocin is increased during
pregnancy. Oxytocin-induced myometrial contractions can be
inhibited by β-adrenoceptor agonists, magnesium sulfate, or
inhalation anesthetics.
Oxytocin also causes contraction of myoepithelial cells
surrounding mammary alveoli, which leads to milk ejection.
Without oxytocin-induced contraction, normal lactation cannot
occur.
Oxytocin has weak antidiuretic and pressor activity.
【 Therapeutic uses 】
Oxytocin is used to induce labor and augment
dysfunctional labor for
(1) conditions requiring early vaginal delivery
(eg, maternal diabetes, or preeclampsia);
(2) uterine inertia;
(3) incomplete abortion.
Oxytocin can also be used for control of postpartum
uterine hemorrhage. Impaired milk ejection may
respond to nasal oxytocin.
【 Dosage 】
For induction of labor, oxytocin should be administered
intravenously via an infusion pump with appropriate fetal and
maternal monitoring. An initial infusion rate of 1 mU/min is
gradually increased to 5-20 mU/min until a physiologic
contraction pattern is established.
For postpartum uterine bleeding, 10-40 units is added to 1 L of
5% dextrose, and the infusion rate is titrated to control uterine
atony. Alternatively, 10 units can be given intramuscularly after
delivery of the placenta.
To induce milk let-down, one puff is sprayed into each nostril
in the sitting position 2-3 minutes before nursing.
【 Adverse reactions & contraindications 】