Pitocin (oxytocin) dosing, indications, interactions, adverse effects, and more

Black Box Warnings

Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction.

Because the available data are inadequate to evaluate the benefits-to-risks onsiderations, oxytocin is not indicated for elective induction of labor.

Contraindications

Significant cephalopelvic disproportion

Unfavorable fetal positions or presentations, eg, transverse lies,which are undeliverable without conversion prior to delivery

Obstetric emergencies that favor surgery

Fetal distress where delivery is not imminent

Where adequate uterine activity fails to achieve satisfactory progress

Hyperactive or hypertonic uterus

Contraindicated vaginal delivery, eg, invasive cervical carcinoma, active herpes genitalis, total placenta previa, vasa previa, & cord presentation or prolapse of cord

Hypersensitivity

Fetal distress, polyhydramnios, partial placenta previa, prematurity, borderline cephalopelvic disproportion, previous major surgery of cervix or uterus (incl C-section), overdistension of uterus, grand multiparity, invasive cervical carcinoma, history of uterine sepsis or traumatic delivery

Hyperstimulation of the uterus, with strong (hypertonic) &/or prolonged (tetanic) contractions, or a resting uterine tone of 15-20 mm h3O between contractions may occur, possibly resulting in uterine rupture, cervical & vaginal lacerations, postpartum hemorrhage, abruptio placentae, impaired uterine blood flow, amniotic fluid embolism, & fetal trauma including intracranial hemorrhage

Not indicated for elective labor induction

Cautions

If uterine hyperactivity occurs, discontinue immediately

Intravenous preparations should be be administered by trained personnel

Risk of severe water intoxication on prolonged administration due to its antidiuretic effects

Restricting fluid intake may be warranted

Uterine hypertonicity, spasm, rupture of the uterus, and tetanic contractions may occur from high doses

IM not recommended for labor induction/augmentation

Pitocin (oxytocin) dose, indications, adverse effects, interactions… from PDR.net

BOXED WARNING

Abnormal fetal position, cephalopelvic disproportion, cervical cancer, elective induction of labor, fetal distress, fetal prematurity, herpes infection, multiparity, placenta previa, surgery, uterine prolapse, vasa previa

Parenteral oxytocin should be used only by qualified professional personnel in a setting where intensive care and surgical facilities are immediately available. Furthermore, according to the manufacturer, oxytocin should only be used when induction of labor is necessary for medical reasons. It should not be used for elective induction of labor as available data are insufficient to evaluate the risk-benefit ratio in this indication. During oxytocin administration, uterine contractions, fetal and maternal heart rate, maternal blood pressure, and, if possible, intrauterine pressure should be continuously monitored to avoid complications. If uterine hyperactivity occurs, oxytocin administration should be immediately discontinued; oxytocin-induced stimulation of the uterine contractions usually decreases soon after discontinuance of the drug. The induction or continuance of labor with oxytocin should be avoided when the following conditions or situations are present: evidence of fetal distress, fetal prematurity, abnormal fetal position (including unengaged head), placenta previa, uterine prolapse, vasa previa, cephalopelvic disproportion, cervical cancer, grand multiparity, previous surgery of the uterus or cervix (including 2 or more cesarean deliveries), active genital herpes infection, or in any condition presenting as an obstetric emergency requiring surgical intervention. Use of oxytocin in any of these settings can aggravate the condition or cause unnecessary fetal or maternal distress.

DESCRIPTION

Parenteral hormone with all the naturally occurring actions of endogenous oxytocin released from the posterior pituitary
Used clinically to induce labor, aid in delivery of the placenta (third stage of labor), and control postpartum bleeding
Used only in situations where vaginal delivery is acceptable

COMMON BRAND NAMES

Pitocin

HOW SUPPLIED

Oxytocin/Pitocin Intramuscular Inj Sol: 1mL, 10U
Oxytocin/Pitocin Intravenous Inj Sol: 1mL, 10U

DOSAGE & INDICATIONS

For labor augmentation in patients with a medical necessity for labor induction, at or near to term, when delivery is in the best interests of the mother and the fetus.

Intravenous dosage (low-dose continuous infusion)

Adult females

Start with 0.5 to 2 milliunits/minute via continuous IV infusion. The rate of infusion may be slowly increased (1 to 2 milliunits/minute increments at 15 to 60 minute intervals) until the required contraction pattern is established; the rate of infusion should be slowly decreased (1 to 2 milliunits/minute decrements at 15 to 60 minute intervals) when labor is established and progressed to 5 to 6 cm dilation. Patients with an unfavorable cervix may be more effectively induced using incremental increases of 2 milliunits/minute every 15 minutes. Low- and high-dose infusions, as well as pulsatile administration regimens, are considered acceptable by the ACOG. Low-dose regimens and less frequent increases in dose are associated with decreased uterine hyperstimulation.

Intravenous dosage (high-dose continuous infusion)

Adult females

6 milliunits/minute via continuous IV infusion initially. The rate of infusion may be increased (6 milliunits/minute increments at 15 to 60 minute intervals) until the required contraction pattern is established. In the presence of uterine hyperstimulation, the infusion rate should be decreased to 3 milliunits/minute, and further reduced to 1 milliunits/minute with recurrent hyperstimulation. Low- and high-dose infusions, as well as pulsatile administration regimens, are considered acceptable by the ACOG. High-dose regimens and more frequent dose increases are associated with shorter labor and less frequent cases of chorioamnionitis and cesarian delivery for dystocia, but increased rates of uterine hyperstimulation.

Intravenous dosage (pulsatile regimen)

Adult females

Give 1 milliunit oxytocin by intravenous injection every 8 to 10 minutes. Low- and high-dose infusions, as well as pulsatile administration regimens, are considered acceptable by the ACOG. Pulsatile administration of oxytocin is just as effective as continuous infusions, with a lower total amount of oxytocin being necessary to achieve similar results.

For reduction and control of postpartum bleeding and to produce uterine contractions during the third stage of labor.

Intravenous dosage

Adult females

10 to 40 units may be added to existing IV infusion (max concentration: 40 units added per 1,000 mL), after delivery of the placenta. The infusion rate must be adjusted to sustain uterine contraction and control uterine atony.

Intramuscular dosage

Adult females

10 units IM after delivery of the placenta.

For the adjunctive treatment of inevitable or incomplete abortion.

Intravenous dosage

Adult females

10 to 20 milliunits/minute via continuous IV infusion. Do not exceed 30 units in a 12-hour period. Intravenous oxytocin is usually safe and effective for inducing labor for near term fetal demise, but is less effective remote from term.

For the evaluation of fetal distress† using an oxytocin-induced contraction stress test (aka, oxytocin challenge test or CST)†.

Intravenous dosage

Adult females

Protocols may vary slightly by institution. Following baseline monitoring for 20 to 30 minutes, initiate at a low dose (e.g., 0.5 to 2.33 milliunits/minute) via continuous IV infusion to the mother. Double the infusion rate every 10 to 30 minutes until the frequency of the contractions are 3 within a 10-minute period (1 contraction every 3 to 4 minutes) and the duration is 40 to 60 seconds. When the desired number of contractions is obtained, record fetal heart rate and contractions until sufficient, then discontinue the infusion. Compare baseline and oxytocin-induced recordings.

†Indicates off-label use

MAXIMUM DOSAGE

No specific maximum dosage limit recommendations are available. Dosage regimens of oxytocin depend upon the patient’s age, sex, weight, condition being treated, product chosen, and the prescribing clinician’s judgment. Therefore, doses may vary widely and must be carefully individualized.

DOSING CONSIDERATIONS

Hepatic Impairment

Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

Renal Impairment

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

ADMINISTRATION

Injectable Administration

Administer by intravenous infusion or intramuscular injection.
Prior to administration, an IV infusion of 0.9% Sodium Chloride should be already running for use in case of adverse reactions.
Magnesium sulfate should be readily available if relaxation of the myometrium is necessary.
Visually inspect parenteral product for particulate matter and discoloration prior to administration whenever solution and container permit.

Intravenous Administration

Intravenous infusion:
Induction of labor: Dilute 1 mL (10 units) in 1,000 mL of a compatible IV infusion solution. Rotate infusion bottle for thorough mixing. The resultant infusion should contain 10 milliunits/mL.
Control of postpartum uterine bleeding: Dilute 10 to 40 units in a compatible IV solution or to an already infusing compatible IV solution. The maximum concentration is 40 units in 1,000 mL of solution.
Incomplete, inevitable, or elective abortion: Dilute 10 units in 500 mL of a compatible IV solution.
Administer using an infusion pump to ensure accurate dosing.

Intramuscular Administration

Intramuscular injection:
Inject into a large muscle mass. Aspirate prior to injection to avoid injection into a blood vessel.

STORAGE

Pitocin:
– Discard product if it contains particulate matter, is cloudy, or discolored
– Store at controlled room temperature (between 68 and 77 degrees F)

CONTRAINDICATIONS / PRECAUTIONS

Pregnancy

Oxytocin is indicated during pregnancy to induce labor; it precipitates uterine contractions and abortion.

Breast-feeding

Endogenous oxytocin is involved in the process of lactation and therefore, oxytocin has been used in mothers having difficulty with engorgement and breast-feeding. Because several small studies have failed to show a beneficial effect, oxytocin is not used for this indication. Oxytocin is excreted in the breast-milk, but is not expected to have adverse effects in the infant.

Abnormal fetal position, cephalopelvic disproportion, cervical cancer, elective induction of labor, fetal distress, fetal prematurity, herpes infection, multiparity, placenta previa, surgery, uterine prolapse, vasa previa

Parenteral oxytocin should be used only by qualified professional personnel in a setting where intensive care and surgical facilities are immediately available. Furthermore, according to the manufacturer, oxytocin should only be used when induction of labor is necessary for medical reasons. It should not be used for elective induction of labor as available data are insufficient to evaluate the risk-benefit ratio in this indication. During oxytocin administration, uterine contractions, fetal and maternal heart rate, maternal blood pressure, and, if possible, intrauterine pressure should be continuously monitored to avoid complications. If uterine hyperactivity occurs, oxytocin administration should be immediately discontinued; oxytocin-induced stimulation of the uterine contractions usually decreases soon after discontinuance of the drug. The induction or continuance of labor with oxytocin should be avoided when the following conditions or situations are present: evidence of fetal distress, fetal prematurity, abnormal fetal position (including unengaged head), placenta previa, uterine prolapse, vasa previa, cephalopelvic disproportion, cervical cancer, grand multiparity, previous surgery of the uterus or cervix (including 2 or more cesarean deliveries), active genital herpes infection, or in any condition presenting as an obstetric emergency requiring surgical intervention. Use of oxytocin in any of these settings can aggravate the condition or cause unnecessary fetal or maternal distress.

Eclampsia, uterine atony

Oxytocin may possess antidiuretic effects, and prolonged use can increase the possibility of an antidiuretic effect. Prolonged use of oxytocin and administration in large volumes of low-sodium infusion fluids are not recommended, particularly in patients with eclampsia or who have unresponsive uterine atony. Antidiuretic effects have the potential to lead to water intoxication and convulsive episodes due to hypertension.

ADVERSE REACTIONS

Severe

uterine rupture / Early / Incidence not known
cervical laceration / Early / Incidence not known
postpartum hemorrhage / Early / Incidence not known
intracranial bleeding / Delayed / Incidence not known
afibrinogenemia / Delayed / Incidence not known
retinal hemorrhage / Delayed / Incidence not known
arrhythmia exacerbation / Early / Incidence not known
pulmonary edema / Early / Incidence not known
coma / Early / Incidence not known
water intoxication / Delayed / Incidence not known
ocular hemorrhage / Delayed / Incidence not known
seizures / Delayed / Incidence not known
anaphylactoid reactions / Rapid / Incidence not known

Moderate

uterine contractions / Early / Incidence not known
hematoma / Early / Incidence not known
bleeding / Early / Incidence not known
hypertension / Early / Incidence not known
fetal bradycardia / Delayed / Incidence not known
premature ventricular contractions (PVCs) / Early / Incidence not known
blurred vision / Early / Incidence not known
hyperbilirubinemia / Delayed / Incidence not known
jaundice / Delayed / Incidence not known

Mild

vomiting / Early / Incidence not known
nausea / Early / Incidence not known

DRUG INTERACTIONS

Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Acetaminophen; Dextromethorphan; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Acetaminophen; Guaifenesin; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Articaine; Epinephrine: (Major) Simultaneous use of epinephrine with oxytocics can cause severe, prolonged hypertension.
Brompheniramine; Carbetapentane; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Carbetapentane; Chlorpheniramine; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Carbetapentane; Diphenhydramine; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Carbetapentane; Guaifenesin; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Carbetapentane; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Carbetapentane; Phenylephrine; Pyrilamine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Carbinoxamine; Hydrocodone; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Carbinoxamine; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Carboprost Tromethamine: (Major) Carboprost tromethamine may augment the activity of other oxytocics. Augmentation can result in uterine hypertonus with subsequent uterine rupture, particularly in the absence of adequate cervical dilation. The concurrent use of carboprost tromethamine and other oxytocic drugs is not recommended.
Chlophedianol; Guaifenesin; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Chlorpheniramine; Dextromethorphan; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Chlorpheniramine; Hydrocodone; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Chlorpheniramine; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Codeine; Phenylephrine; Promethazine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Dextromethorphan; Diphenhydramine; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Dextromethorphan; Guaifenesin; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Diclofenac; Misoprostol: (Major) In certain cases, oxytocin can be used in combination with other oxytocics for therapeutic purposes. However, in the augmentation of labor, oxytocin administration is usually withheld until after the last dose of intravaginal misoprostol. There is a risk of severe uterine hypertony occurring, with possible uterine rupture or cervical laceration when misoprostol and oxytocin are used at the same time. These products should be used concomitantly only under adequate supervision, with particular attention to ensure adequate cervical dilation has occurred.
Dinoprostone, Prostaglandin E2: (Major) In certain cases, oxytocin can be used in combination with other oxytocics for therapeutic purposes. There is a risk, however, of severe uterine hypertony occurring, with possible uterine rupture or cervical laceration. The concurrent use of dinoprostone, prostaglandin E2 and oxytocin is not recommended; following the removal of the dinoprostone vaginal insert, an interval of at least 30 minutes is recommended prior to the use of another oxytocic agent. These products should be used sequentially only under adequate obstetric supervision.
Diphenhydramine; Hydrocodone; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Diphenhydramine; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Dopamine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjuction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Ephedrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjuction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Epinephrine: (Major) Simultaneous use of epinephrine with oxytocics can cause severe, prolonged hypertension.
Ergonovine: (Major) Ergonovine and oxytocin both control uterine atony, and if used in combination there may be a risk of severe uterine hypertony, with possible uterine rupture or cervical laceration.
General anesthetics: (Major) Adverse cardiovascular effects can develop as a result of concomitant administration of oxytocin with general anesthetics, especially in those with preexisting valvular heart disease. Cyclopropane, when administered with or without oxytocin, has been implicated in producing maternal sinus bradycardia, abnormal atrioventricular rhythms, hypotension, and increases in heart rate, cardiac output, and systemic venous return. In addition, halogenated anesthetics decrease uterine responsiveness to oxytocics (e.g., oxytocin) and, in high doses, can abolish it, increasing the risk of uterine hemorrhage. Halothane is a potent uterine relaxant. Enflurane displaces the myometrial response curve to oxytocin so that at lower concentrations of enflurane oxytocin will restore uterine contractions. However, as the dose of enflurane progresses (somewhere between 1.5 to 3% delivered enflurane) the response to oxytocin is inhibited. It is not clear if other halogenated anesthetics would interact with oxytocics in this manner.
Guaifenesin; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Hydrocodone; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Methohexital: (Major) Adverse cardiovascular effects can develop as a result of concomitant administration of oxytocin with general anesthetics.
Methylergonovine: (Major) Methylergonovine and oxytocin both control uterine atony, and if used in combination there may be a risk of severe uterine hypertony, with possible uterine rupture or cervical laceration.
Midodrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjuction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Misoprostol: (Major) In certain cases, oxytocin can be used in combination with other oxytocics for therapeutic purposes. However, in the augmentation of labor, oxytocin administration is usually withheld until after the last dose of intravaginal misoprostol. There is a risk of severe uterine hypertony occurring, with possible uterine rupture or cervical laceration when misoprostol and oxytocin are used at the same time. These products should be used concomitantly only under adequate supervision, with particular attention to ensure adequate cervical dilation has occurred.
Norepinephrine: (Moderate) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Phenylephrine; Promethazine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.
Prilocaine; Epinephrine: (Major) Simultaneous use of epinephrine with oxytocics can cause severe, prolonged hypertension.
Thiopental: (Major) Adverse cardiovascular effects can develop as a result of concomitant administration of oxytocin with general anesthetics.

PREGNANCY AND LACTATION

Pregnancy

Oxytocin is indicated during pregnancy to induce labor; it precipitates uterine contractions and abortion.

Endogenous oxytocin is involved in the process of lactation and therefore, oxytocin has been used in mothers having difficulty with engorgement and breast-feeding. Because several small studies have failed to show a beneficial effect, oxytocin is not used for this indication. Oxytocin is excreted in the breast-milk, but is not expected to have adverse effects in the infant.

MECHANISM OF ACTION

Synthetic oxytocin elicits the same pharmacological response produced by endogenous oxytocin, with cervical dilation, parity, and gestational age as predictors of the dose response to oxytocin administration for labor stimulation. Oxytocin increases the sodium permeability of uterine myofibrils, indirectly stimulating contraction of the uterine smooth muscle. The uterus responds to oxytocin more readily in the presence of high estrogen concentrations and with the increased duration of pregnancy. There is a gradual increase in uterine response to oxytocin for 20 to 30 weeks gestation, followed by a plateau from 34 weeks of gestation until term, when sensitivity increases. Women who are in labor have a greater response to oxytocin compared to women who are not in labor; only very large doses will elicit contractions in early pregnancy. In the term uterus, contractions produced by exogenous oxytocin are similar to those that would occur during spontaneous labor. Oxytocin increases the amplitude and frequency of uterine contractions, which transiently impede uterine blood flow and decrease cervical activity, causing dilation and effacement of the cervix.
 
Oxytocin causes contraction of the myoepithelial cells surrounding the alveolar ducts of the of the breast. This forces milk from the alveolar channels into the larger sinuses, and thus facilitates milk ejection. While oxytocin possesses no galactopoietic properties, if it is absent the milk-ejection reflex in the breast fails.
 
Oxytocin causes dilation of vascular smooth muscle, thus increasing renal, coronary, and cerebral blood flow. Blood pressure usually remains unaffected, but with the administration of very large doses or high concentration solutions blood pressure may decrease transiently. This transient decrease in blood pressure leads to reflex tachycardia and an increase in cardiac output; any fall in blood pressure is usually followed by a small, but sustained, increase in blood pressure.
 
Oxytocin does possess antidiuretic effects, but they are minimal. If oxytocin is administered with an excessive volume of electrolyte-free IV solution and/or at too rapid a rate, the antidiuretic effects are more apparent and water intoxication can result.
 
Oxytocin appears to have important roles in sexual function and bonding responses in both males and females.

PHARMACOKINETICS

Oxytocin administered effectively by parenteral injection or nasal inhalation. Steady state, following parenteral administration, is usually achieved in plasma by 40 minutes. Oxytocin’s plasma half-life is between 1 and 6 minutes. The drug distributes throughout the extracellular fluid, with minimal amounts reaching the fetus.
 
Oxytocinase, a glycoprotein aminopeptidase that is capable of degrading oxytocin, is produced during pregnancy and is present in the plasma. Enzyme activity increases gradually until term approaches, when there is a sharp rise in plasma levels and activity is high in the plasma, placenta and uterus. After delivery enzyme activity declines. Oxytocinase most likely originates from the placenta and regulates the amount of oxytocin in the uterus; there is little or no degradation of oxytocin in men, nonpregnant women, or cord blood. Oxytocin is rapidly removed from plasma by the liver and the kidneys, with only small amounts being excreted unchanged in the urine. Oxytocin is metabolized in the lactating mammary gland and is distributed into breast-milk.

Oral Route

Chymotrypsin, present in the GI tract, destroys oxytocin, rendering oral administration ineffective.

Intravenous Route

When administered by IV infusion, the uterus responds almost immediately to oxytocin, with response subsiding in about an hour.

Intramuscular Route

When oxytocin is administered by IM injection, the uterus responds within 3—5 minutes, with response subsiding in approximately 2—3 hours.

Topical Route

Following intranasal use of oxytocin, contractions of the myoepithelial tissue surrounding the alveoli of the breasts begin within minutes and persist for about 20 minutes.

Oxytocin: Uses, Interactions, Mechanism of Action

Oxytocin

Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section | BJA: British Journal of Anaesthesia

Abstract

Background. The cardiovascular effects of oxytocin in animal models and women undergoing Caesarean section include tachycardia, hypotension and decrease in cardiac output. These can be sufficient to cause significant compromise in high-risk patients. We aimed to find a simple way to decrease these risks whilst retaining the benefits of oxytocin in decreasing bleeding after delivery.

Method. We recruited 30 women undergoing elective Caesarean section. They were randomly allocated to receive 5 u of oxytocin either as a bolus injection (bolus group) or an infusion over 5 min (infusion group). These women had their heart rate and intra-arterial blood pressure recorded every 5 s throughout the procedure. The haemodynamic data, along with the estimated blood loss, were compared between the groups.

Results. Marked cardiovascular changes occurred in the bolus group; the heart rate increased by 17 (10.7) beats min⁻¹ [mean (sd)] compared with 10 (9.7) beats min⁻¹ in the infusion group. The mean arterial pressure decreased by 27 (7.6) mm Hg in the bolus group compared with 8 (8.7) mm Hg in the infusion group. There were no differences in the estimated blood loss between the two groups.

Conclusion. We recommend that bolus doses should be used with caution, and further studies should ascertain if oxytocin is equally effective in reducing blood loss when given at a slower rate.

Oxytocin is given to women during Caesarean section to decrease blood loss. When given as a rapid i.v. bolus, it causes hypotension and tachycardia.1 Whilst its cardiovascular side-effects are widely known there is little agreement as to the mechanism by which they occur.2–5 Some studies suggest that the preservative, chlorobutanol, is the cause of these haemodynamic changes.6 The magnitude of these effects is dose-related.7 However, these effects are not widely appreciated by clinicians as highlighted in the Confidential Enquiry into Maternal Deaths (CEMD) published in 2001.8 The significant haemodynamic changes from administering 10 u of oxytocin could have contributed to the deaths of two women who were already cardiovascularly unstable. More recently, Pinder and colleagues9 studied the haemodynamic effects of i.v. boluses of oxytocin, 5 and 10 u, in women having Caesarean section under spinal anaesthesia. The dose-related effects of oxytocin were again confirmed.

Weis and colleagues7 showed that patients receiving an infusion were more haemodynamically stable; these workers used 10 u of oxytocin. We compared the effects of the recommended dose (i.e. 5 u) of oxytocin10 when given as an i.v. bolus or as an infusion over 5 min.

Methods

After approval and informed consent from the local Ethics Committee was obtained, we recruited women undergoing elective Caesarean section. They were randomly allocated to receive oxytocin either as an i.v. bolus or infusion. Women were excluded if they were known to have placenta praevia, hypertension, diabetes mellitus or pre-eclampsia as these could lead to cardiovascular instability during Caesarean section. Also women were excluded if there was cardiovascular instability or technical problems in the time leading up to the administration of oxytocin.

The monitoring and anaesthetic techniques were the same for all the women. They received ranitidine 150 mg and sodium citrate 0.3 M (30 ml) on the morning of surgery. On arrival at the theatre ECG and pulse oximetry monitoring were commenced, and a radial arterial cannula and a large bore i.v. cannula were sited under local anaesthesia. Hartmann’s solution 500 ml was infused, and thereafter, spinal anaesthesia was established in the sitting position at L3/4 using 24G pencil point needles. Hyperbaric bupivacaine 0.5% (2.4 ml) with fentanyl 25 μg were injected intrathecally. Block height was measured by temperature and fine touch bilaterally. Surgery was commenced once the block reached T4 or above to cold sensation, and to T6 to fine touch. Hypotension was treated with ephedrine 3 mg boluses aiming to restore mean arterial pressure (MAP) to within 20% of preoperative values.

Oxytocin was administered at delivery either as an i.v. bolus of 5 u diluted to 5 ml with normal saline given as quickly as possible (approximately over 1 s), or 5 u diluted to 15 ml with normal saline given over 5 min using a Graseby infusion pump.

A laptop computer was used to retrieve and record the data from a Datex anaesthetic monitor. MAP and heart rate (HR) were recorded every 5 s. The study period started 15 s before giving oxytocin, and it continued for a further 5 min. The first 15 s were taken to provide baseline data. The next 5 min allowed us to compare the haemodynamic changes between the two methods of administration of oxytocin. The study period of 5 min was set after a small pilot study.

The estimated blood loss during Caesarean section was recorded by the investigators. A difference in MAP of 10 mm Hg or above between the two groups was considered clinically significant. For the study to have 90% power at P<0.05, a sample of 13 patients per group was required. Data were analysed using SPSS 12.0.1. for unpaired t-test and generalized model for repeated measures test.

Results

Thirty women were successfully recruited. Two were excluded from analysis; one developed bigeminy during surgery before administration of oxytocin, and the other required vasopressors in addition to the study protocol for maintaining MAP after the onset of spinal anaesthesia.

The patient characteristics are shown in Table 1. A small (3.6 yr) but statistically significant difference was seen in the women’s ages in the two groups. Use of ephedrine, postoperative infusion of oxytocin (40 u over 4 h), and estimated blood loss were similar in both groups. No ephedrine was used during the study period.

Table 1

The patient characteristics in the two groups. Data are given as mean (sd) or numbers. ^*P<0.05

Table 1

The patient characteristics in the two groups. Data are given as mean (sd) or numbers. ^*P<0.05

Baseline MAP and HR were similar in both groups; mean MAP bolus group 89 mm Hg (sd 9.3), infusion group 87 mm Hg (8.7), mean HR bolus group 102 beats min⁻¹ (18.6), infusion group 93 beats min⁻¹ (13.4). A rapid increase in HR of [mean (sd) 17 (10.7)] beats min⁻¹ was seen at 35 s in the bolus group, with an apparent rebound bradycardia (<10 beats min⁻¹) at 120 s (Fig. 1). In contrast, the HR increased by 10 (9.7) beats min⁻¹ in the infusion group, a change which occurred slowly over the duration of the infusion. The MAP changes are shown in Figure 2. A decrease in MAP of up to 27 (7.6) mm Hg occurred at 35 s in the bolus group, with recovery to baseline at 110 s. The infusion group, in contrast, had a decrease in MAP of up to 8 (8.7) mm Hg during the study period. These cardiovascular changes in the two groups were statistically significant with P<0.01.

Fig 1

Heart rate before and after oxytocin administration (time 0). The data points shown are the mean (2 sem).

Fig 1

Heart rate before and after oxytocin administration (time 0). The data points shown are the mean (2 sem).

Fig 2

Mean arterial pressure recordings before and after oxytocin administration (time 0). The data points are mean (2 sem).

Fig 2

Mean arterial pressure recordings before and after oxytocin administration (time 0). The data points are mean (2 sem).

Discussion

Our study shows that slower injection of oxytocin can effectively minimize the cardiovascular side-effects of a bolus dose without compromising the therapeutic benefits.

The cardiovascular effects of oxytocin have been described previously but the extent of physiological compromise had not been described using intra-arterial measurements. Our study demonstrated an average decrease in MAP of 27 (7.6) mm Hg in healthy women having an elective Caesarean section who received 5 u of oxytocin as a rapid bolus. Two women had decreases in MAP of 45 mm Hg. The women in our study took more than 90 s for their MAP to return to baseline after the bolus injection. Whilst this magnitude of decrease in MAP may be well tolerated normally, it may not be desirable if there is concomitant severe blood loss or when there is unsuspected myocardial disease. It is interesting to note that during this reduction in MAP there were no complaints of nausea or faintness. We have no explanation for this other than the short period of time that these women experienced the maximal reduction in MAP.

The changes in HR were significantly different in the two groups. The increase in the bolus group at 30 s could be expected. It was interesting that it decreased to below baseline at recovery of MAP. However, the gentler increase of HR in the infusion group is preferable clinically. It is reassuring to the anaesthetist who prefers to maintain cardiovascular equipoise that this physiological insult can be avoided simply by giving the oxytocin over 5 min. The decrease in MAP of 8 (8.7) mm Hg and the small increase in HR are certainly clinically preferable.

Our study was designed to be single blinded with the analysis of data being separate from its collection to prevent bias. We had considered attempting to double blind the study but were unable to have sufficient investigators present to allow the administration of oxytocin to be a separate blinded process. We felt this would not have led to any bias as the investigator present was unable to influence the data collection via the laptop and no vasoactive agents were used during the study period.

Obviously there have been discussions within the obstetric anaesthesia community about the correct dose of oxytocin and its method of administration.11 Despite the controversy it seems more anaesthetists are using the lower dose of 5 u as recommended by the CEMD.12 This is supported by the work of Pinder and colleagues9 who showed dose-related haemodynamic effects, although they underestimated the potential reduction in MAP attributable to the use of non-invasive blood pressure measurements. Our study has further reinforced this trend to the use of lower dosage by showing greater haemodynamic stability when 5 u is administered over 5 min.

Whilst the cardiovascular results of this study are unequivocal, we have to accept that there are limitations in the estimations of blood loss. The prime reason for this estimation was to highlight any excesses that might have contributed to the haemodynamics being measured. As such the blood loss estimations were made by the investigator who was aware of the mode of oxytocin administration. A larger study with more accurate and independent measurement of blood loss is required to confirm the efficacy of both methods of oxytocin administration.

In summary this study supports the need for caution using oxytocin as a bolus in cardiovascularly unstable patients and offers relative reassurance of the effects when given as an infusion over 5 min.

We would like to thank all staff at the Birmingham Women’s Hospital for their help and support during this study.

References

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Haemodynamic changes caused by oxytocin during caesarean section under spinal anaesthesia

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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: [email protected]

Oxytocin in high versus low doses for augmentation of delayed labour

Women have different lengths of labour, with first labours lasting on average eight hours (and unlikely to last more than 18 hours) and second and subsequent labours lasting an average of five hours and unlikely to last more than 12 hours. Assessment of progress in labour takes into account not just cervical dilatation, but also descent and rotation of the fetal head and the strength, duration and frequency of contractions. Some evidence suggests that up to one-third of women in their first labour experience delay. They are often given a synthetic version of the hormone oxytocin  to increase uterine contractions and shorten labour. Surprisingly for such a routine treatment, the ideal dose at which it should be given is not known, although some comparisons suggest that higher-dose regimens of oxytocin could shorten labour and reduce the chance of caesarean section with an increase in the numbers of women having a spontaneous vaginal birth compared with lower-dose regimens. However, there are potentially harmful side effects as oxytocin may cause the uterus to contract too quickly, and the baby to become distressed. Clinicians attempt to mitigate these side effects by adjusting the dose of oxytocin with the contractions to reduce the chances of the baby being distressed in labour.

From the four randomised controlled trials involving 644 pregnant women that we included in this review, results indicate that a higher dose of oxytocin (4-7 mU per minute, compared with 1-2 mU per minute) reduced the length of labour and the rate of caesarean sections with increased spontaneous vaginal births, but the studies did not provide enough evidence on possible differences between the high- and low-dose regimens on adverse events including hyperstimulation of the uterus, and outcomes for the newborn infant. Only one trial reported on the possible effect on women. The overall quality of the included trials was mixed, but this might reflect how clinical trials were reported in the past.  

While the current evidence is promising and suggests that the high-dose regimens reduce the length of labour and the rate of caesarean sections, this evidence is not strong enough to recommend that high-dose regimens are used routinely for women delayed in labour. We recommend that further research is carried out. 

Haemodynamic Effects of Oxytocin Given as I.V. Bolus or Infu… : Obstetric Anesthesia Digest

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Oxytocin instructions for use: indications, contraindications, side effects – description Oxytocin solution for intravenous and intramuscular administration 5 IU / ml: 1 ml amp. 5 or 10 pcs. (42600)

Instructions for use Utrozhestan capsules 200 mg 14 pcs

Active ingredients

Form of issue

Capsules

Composition

Active ingredient: Progesterone Active ingredient concentration: 200 mg

Pharmacological effect

Progestational drug.Progesterone, the active substance of the drug Utrozhestan, is a hormone of the corpus luteum. By binding to receptors on the surface of cells of target organs, it penetrates into the nucleus, where by activating DNA, it stimulates RNA synthesis.

Promotes the transition of the uterine mucosa from the proliferation phase caused by follicular hormone into the secretory phase. After fertilization, it promotes the transition to the state necessary for the development of a fertilized egg. Reduces the excitability and contractility of the muscles of the uterus and fallopian tubes, stimulates the development of the terminal elements of the mammary gland.

Stimulating protein lipase, increases fat stores, increases glucose utilization. By increasing the concentration of basal and stimulated insulin, it promotes the accumulation of glycogen in the liver, increases the production of pituitary gonadotropic hormones, reduces azotemia, and increases the excretion of nitrogen in the urine.

Activates the growth of the secretory acini of the mammary glands, induces lactation.

Promotes the formation of a normal endometrium.

Pharmacokinetics

Ingestion

Absorption Micronized progesterone is absorbed from the gastrointestinal tract.The concentration of progesterone in the blood plasma gradually increases during the first hour, Cmax is observed in 1-3 hours after administration. The concentration of progesterone in the blood plasma increases from 0.13 ng / ml to 4.25 ng / ml after 1 hour, to 11.75 ng / ml after 2 h and is 8.37 ng / ml after 3 hours, 2 ng / ml – after 6 hours and 1.64 ng / ml – 8 hours after ingestion. α-pregnanolone and 5-α-dihydroprogesterone.

Excretion

It is excreted in the urine in the form of metabolites, 95% of them are glucuron-conjugated metabolites, mainly 3-alpha, 5-beta-pregnanediol (pregnandione).These metabolites, which are determined in blood plasma and urine, are similar to substances formed during the physiological secretion of the corpus luteum. With intravaginal administration

Absorption

Absorption occurs quickly, progesterone accumulates in the uterus. A high level of progesterone is observed 1 hour after administration. Cmax of progesterone in blood plasma is achieved 2-6 hours after administration. With the introduction of the drug at 100 mg 2 times / day, the average concentration remains at the level of 9.7 ng / ml for 24 hours When administered in doses of more than 200 mg / day, the concentration of progesterone corresponds to the first trimester of pregnancy.

Metabolism

Metabolized with the formation of predominantly 3-alpha, 5-beta-pregnanediol. Plasma levels of 5-beta-pregnanolone are not increased.

Excretion

Excreted in the urine as metabolites, the main part is 3-alpha, 5-beta-pregnanediol (pregnandione). This is confirmed by a constant increase in its concentration (Cmax 142 ng / ml after 6 hours).

Readings

Progesterone deficiency disorders.

Contraindications

Oral route of administration in case of severe liver dysfunctions.

Precautions

The drug Utrozhestan should be taken with caution in patients with diseases and conditions that can be aggravated by fluid retention (arterial hypertension, cardiovascular diseases, chronic renal failure, epilepsy, migraine, bronchial asthma), in patients with diabetes mellitus, impaired liver function mild to moderate severity, photosensitivity.

Use during pregnancy and lactation

During pregnancy, the drug can only be used intravaginally.

The drug should be used with caution in the II and III trimesters of pregnancy due to the risk of cholestasis.

Progesterone passes into breast milk, therefore, the use of the drug is contraindicated during breastfeeding.

Method of administration and dosage

Oral route of administration, vaginal route of administration.

Side effects

Drowsiness or transient dizziness, appearing 1 to 3 hours after taking the drug.

Reduction of the menstrual cycle and intermenstrual spotting. These side effects were observed only when the drug was taken orally.

Overdose

Symptoms: drowsiness, transient dizziness, euphoria, shortening of the menstrual cycle, dysmenorrhea.

In some patients, the average therapeutic dose may be excessive due to the existing or emerging unstable endogenous secretion of progesterone, special sensitivity to the drug, or too low a concentration of estradiol.

Treatment: – in case of drowsiness or dizziness, it is necessary to reduce the daily dose or prescribe the drug before bedtime for 10 days of the menstrual cycle, on the 19th instead of the 17th), – in perimenopause and with HRT in postmenopause, it is necessary to make sure that the concentration of estradiol is optimal.

In case of overdose, symptomatic treatment is carried out if necessary.

Interaction with other drugs

When administered orally, Progesterone enhances the effect of diuretics, antihypertensive drugs, immunosuppressants, anticoagulants. Reduces the lactogenic effect of oxytocin.

Simultaneous use with drugs-inducers of microsomal liver enzymes CYP3A4, such as barbiturates, antiepileptic drugs (phenytoin), rifampicin, phenylbutazone, spironolactone, griseofulvin, is accompanied by an acceleration of progesterone metabolism in the liver.

The simultaneous administration of progesterone with some antibiotics (penicillins, tetracyclines) may lead to a decrease in its effectiveness due to a violation of the intestinal-hepatic recirculation of sex hormones due to changes in the intestinal microflora.

The severity of these interactions may vary in different patients, therefore, the prognosis of the clinical effects of these interactions is difficult. Ketoconazole can increase the bioavailability of progesterone. Progesterone can increase the concentration of ketoconazole and cyclosporine.

Progesterone may decrease the effectiveness of bromocriptine.

Progesterone can cause a decrease in glucose tolerance, as a result of which – an increase in the need for insulin or other hypoglycemic drugs in patients with diabetes mellitus.

The bioavailability of progesterone can be reduced in smoking patients and with excessive alcohol consumption. With intravaginal use

The interaction of progesterone with other drugs with intravaginal use has not been evaluated.The simultaneous use of other drugs used intravaginally should be avoided in order to avoid impaired release and absorption of progesterone.

Special instructions

The drug Utrozhestan can not be used for contraception.

The drug should not be taken with food, because food intake increases the bioavailability of progesterone.

Patients with a history of depression should be monitored, and if severe depression develops, the drug should be discontinued.

Patients with concomitant cardiovascular diseases or a history of them should also be periodically observed by a doctor.

The use of the drug Utrozhestan after the first trimester of pregnancy can cause the development of cholestasis.

With long-term progesterone treatment, regular medical examinations (including liver function tests) should be carried out, treatment should be canceled in case of deviations from normal liver function tests or cholestatic jaundice.

With the use of progesterone, a decrease in glucose tolerance and an increase in the need for insulin and other hypoglycemic drugs in patients with diabetes mellitus are possible.

In case of amenorrhea during treatment, it is necessary to exclude the presence of pregnancy.

If the course of treatment is started too early at the beginning of the menstrual cycle, especially before the 15th day of the cycle, a shortening of the cycle and / or acyclic bleeding may occur. In the case of acyclic bleeding, the drug should not be used until their cause is clarified, including a histological examination of the endometrium.

Patients with a history of chloasma or a tendency to develop it are advised to avoid UV exposure. More than 50% of spontaneous abortions in early pregnancy are due to genetic disorders. In addition, infectious processes and mechanical damage can be the cause of spontaneous abortions in early pregnancy. The use of the drug Utrozhestan in these cases can only lead to a delay in the rejection and evacuation of a non-viable ovum.

The use of the drug Utrozhestan to prevent threatened abortion is justified only in cases of progesterone deficiency.

The composition of the drug Utrozhestan contains soy lecithin, which can cause hypersensitivity reactions (urticaria and anaphylactic shock).

When carrying out HRT with estrogens during perimenopause, it is recommended to use the drug Utrozhestan for at least 12 days of the menstrual cycle.

With continuous HRT in postmenopausal women, it is recommended to use the drug from the first day of estrogen intake.

HRT increases the risk of venous thromboembolism (deep vein thrombosis or pulmonary embolism), the risk of ischemic stroke, coronary artery disease. Due to the risk of thromboembolic complications, the drug should be discontinued if: , exophthalmos, double vision, vascular lesions of the retina, migraines, – venous thromboembolism or thrombotic complications, regardless of their location.

If there is a history of thrombophlebitis, the patient should be closely monitored.

When using the drug Utrozhestan with estrogen-containing drugs, refer to the instructions for their use regarding the risks of venous thromboembolism. Results of the Women Health Initiative Study (WHI) clinical study indicate a slight increase in the risk of breast cancer with prolonged, more than 5 years, joint use of estrogen-containing drugs with synthetic gestagens. It is not known whether there is an increased risk of breast cancer in postmenopausal women with HRT with estrogen-containing drugs in combination with progesterone.The results of the WHI study also revealed an increased risk of dementia when starting HRT over the age of 65. Before starting HRT and regularly during it, a woman should be examined to identify contraindications to its use. In the presence of clinical indications, an examination of the mammary glands and a gynecological examination should be carried out.

The use of progesterone can affect the results of some laboratory tests, including indicators of liver function, thyroid gland, coagulation parameters, pregnanediol concentration.

Influence on the ability to drive vehicles and control mechanisms

With oral administration of the drug, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

Prescription

Yes

Clinical Study Failed Oxytocin Induction (Labor): Pulsatile Oxytocin, Continuous Oxytocin – Clinical Trial Registry

The study population included 120 cases of spontaneous childbirth admitted to the maternity ward at Ain Shams University Maternity Hospital.

Required sample size was calculated using IBM © SamplePower © software (IBM © Corp., Armonk, NY, USA). A previous study by Tribe et al., 2012 reported that the mean delivery time associated with continuous infusion of oxytocin was 7.17 hours with a 95% confidence interval (95% CI) 6.58 to 7.77 hours versus 9.61 hours (95% CI, 8.95 to 10.27 hours) in combination with pulsating oxytocin. Sample size for any regimen in this study included 240 patients or 241 patients, respectively.From a study by Tribe et al. (2012), it can be estimated that the standard deviation (SD) from infusion to delivery time was 4.66 hours or 5.23 hours for continuous or pulsed oxytocin, respectively. This calculation is done by solving any of the following equations for Standard deviation with the mean, lower, or upper limit of the 95% confidence interval and sample size:

Lower limit, 95% CI = mean – (1.96 * SD / √n) .. … Equation 1 Upper limit 95% CI = mean + (1.96 * SD / √n… .. Equation 2, where SD is the standard deviation and n is the sample size (Chow et al., 2003).

Thus, it is assumed that the sample size of 66 patients in each study group (132 patients in total) will reach 80% power (Type II error, 0.2) to statistically detect a significant difference between the two groups in terms of time from infusion to delivery. using a two-tailed unpaired Student’s t-test with a 95% confidence level (type I error, 0.05).the mean ± SD of infusion time to delivery in both groups is assumed to be the same and equal to 9.61 ± 5.23 hours under the null hypothesis. According to an alternative hypothesis, the mean ± SD time from infusion to delivery is assumed to be 7.17 ± 4.66 hours for continuous infusion. in the group with 9.61 ± 5.23 hours in the group with pulsation.

This sample size of 66 patients in each study group will have a power of 93% (Type II error, 0.07) to detect a statistically significant difference between the two groups in terms of successful induction of labor with a mean effect size (w) of 0. 3 using a two-tailed chi-square test with a 95% confidence level (type I error 0.05).2 / N), where χ2 is the chi-square statistic and N is the total sample size. (Chow et al., 2003).

After hospitalization, all patients will undergo a full clinical examination and detailed examination. A medical history will be obtained as follows:

A. Personal history. B. Obstetric history: gestational age is calculated by the date of the last menstrual period or by ultrasound on unreliable dates.

C. Gynecological history.

Grouping:

Patients requiring an increase in the first stage of labor will be equally divided in two.groups:

1st group (main; 60 patients):

Patients during childbirth are prescribed pulsatile oxytocin augmentation.

Group 2 (control; 60 patients):

Patients are prescribed oxytocin during childbirth in a continuous method.

Intervention:

Pulse Group:

A pulse infusion protocol is used using a programmable syringe pump. oxytocin regimen (syntocinon, stock solution: 10 IU / ml) is administered over 10 seconds.every 6 minutes and the dose (2 mU / pulse) will double every 30 minutes until contractions are established (3-4 in 10 minutes). This regimen stems from the observation that physiological oxytocin can be released in a pulsating manner every 4-6 minutes (Dawood et al., 1979)

Continuous group:

Continuous group will be injected with oxytocin (syntocinone, stock solution: 10 IU / ml) at the initial dose (2 mU / min) it was continuously doubled every 30 minutes until the onset of the uterine contractions (3-4 after 10 minutes).

Then each patient will have a medical history form in which the following data will be recorded:

1. Initials of the patient.

2. Study number.

3. Group.

4. Parity.

5. Gestatinal age (the first day of the last menstruation – early ultrasound).

6. Rupture of membranes.

7. Duration of rupture of membranes.

8. Duration of the first stage of labor.

9. Duration of the second stage of labor.

10. The need for instrumental delivery.

11. The need for a cesarean section.

12. Side effect.

13. Neonatal outcome.

14. Complications from the mother.

15. Side effects associated with oxytocin.

16. Total dose of oxytocin administered.

17. Previous complicated vaginal delivery.

Science is looking for a cure for love

Photo by Natalia Domrina.

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What is love? Shakespeare put it this way on this ever-topical topic:

Interfere with the connection of two hearts
I don’t intend to.Can treason
To put an end to immeasurable love?
Love does not know loss and decay.

Love is a beacon raised over the storm,
Not fading in darkness and fog.
Love is the star by which the sailor
Determines the location in the ocean.

Love is not a pathetic doll in the hands of
At the time that erases roses
On fiery lips and cheeks,
And threats are not scary to her at the time.

And if I’m wrong and my verse is lying,
Then there is no love – and there are no my poems!
Translated by S. Marshak

And what does science say about this state?

Biologically, love is a complex neurobiological complex based on the brain’s positive reinforcement system. The biochemical hormonal “orchestra” is responsible for experiencing trust, affection, attraction. Of course, if we are talking about a person, then one cannot discount his higher cognitive functions, but still, if love is just a configuration of biochemical processes, maybe it is possible to consider the deviation of this configuration from the norm – for example, love suffering – as a disease? And if so, is there a cure for it?

Psychiatry professor Larry Young from Emery University (USA) studies the mechanisms of formation of love relationships and attachment on steppe voles – popular model animals among biologists.Why voles? They are monogamous: once mated, they remain with each other for life.

For the emergence of “love”, a female vole does not need so much: the hormone oxytocin, which is responsible for empathy and the emergence of attachment (a fairly large number of oxytocin receptors are located in the region of the so-called nucleus accumbens in the brain), endorphins, which cause pleasant sensations from sex, and dopamine – mediator of the positive reinforcement system.

If you introduce oxytocin to a female vole and put it in a cage with a male, then she will become attached to him even without intimacy.In males, the hormone vasopressin, which is chemically similar to oxytocin, is responsible for attachment. If female or male voles are injected with oxytocin or vasopressin blockers, respectively, then attachment will not form and the individuals will become polygamous.

In humans, oxytocin, administered internally, promotes a sense of empathy and trust and, as shown in one ingenious experiment at the University of Bonn, Germany, helps married men keep beautiful girls at a distance.The study involved 86 men, half of whom were single and the others were in permanent partnerships (marriage or civil union). The subjects were instilled with either oxytocin or a placebo, after which an attractive girl began to approach each participant in the experiment and the man had to say when he would feel discomfort from invading his personal zone. It turned out that oxytocin has almost no effect on bachelors, the girl could come close to them, but significantly increases the distance of comfort for married or quasi-married.

Parting with a partner turns out to be a difficult test not only for humans, but also for the steppe vole. The stress and depression that these animals experience during separation are due to the release of the hormone corticoliberin. Larry Young and colleagues showed that administration of the antagonist corticoliberin reduced the severity of depression in voles.

However, do not think that it is enough to inject a person with blockers of receptors for corticoliberin, oxytocin or vasopressin – and he will easily survive the separation.This “treatment” has many mental side effects, such as dulling the entire spectrum of emotions, loss of social skills. What is the hope for inconsolable and hopelessly in love?

Dr. Helen Fisher of Rutgers University (USA) found that, compared to people in stable relationships, people who have just broken up with a partner have increased neuronal activity in the so-called pallidus, a structure in the anterior region of the brain.Over time, this activity decreases, which, presumably, indicates a gradual fading away of attachment, so that the old saying “Time heals” has received scientific confirmation. And for those who do not want to wait, neurophysiologists are studying whether it is possible to reduce the activity of the globus pallidus, due to which the “cure” from love will occur several times faster.

In some cases, increased attention to a partner is more like not love, but a pathology called obsessive-compulsive disorder (OCD): the person suffering from it is absorbed in obsessive thoughts, memories and actions.Biologist Donatella Maracitti from the University of Pisa (Italy) decided to compare the biochemical symptoms of those who recently experienced separation from a loved one with the picture that is observed in patients with OCD. The first survey recorded in both groups a reduced content of a protein that is responsible for the transport of serotonin, a hormone involved in the regulation of mood, in the brain. A year later, Maracitti again examined the participants who survived the separation: it turned out that their serotonin levels returned to normal and they no longer obsess over their former partner.

Drugs that increase serotonin levels are used in the treatment of patients with obsessive-compulsive disorder, so it is logical to assume that they can also alleviate the suffering after separation from a loved one, but, unfortunately, there is a side effect here: such therapy makes it difficult to form new romantic relationships …

So what is love – just the coordinated work of a hormonal “orchestra” and neurotransmitters? For a vole mouse, the answer is yes.And a person, to his happiness or grief, is a more complex being. So the “pill for unhappy love” will not appear in pharmacies soon.

New properties of the oxytocin hormone have been discovered

Fear, food addictions and even love do not arise from scratch. In one case, evolutionary “best practices” are manifested in this way, in the other, protective mechanisms, and so on. The conductor, as it should be, is the brain. And the performers are special chemical compounds synthesized at his command.How susceptible are we to their influence, how do love hormones actually work, and why in some cases they can cause not euphoria, but depression?

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Chemistry and Life

Since we have already heard that hormones have a great influence on people, we are to some extent inclined to almost demonize them. Hormones are just certain chemicals that are produced by some cells to activate other cells. Much like in the case of a gear train, where without one wheel, everything else does not work.

More than 50 different hormones are produced in the human body, of which the average person knows only the “promoted” names that are now and then flashing in the press: oxytocin, adrenaline, testosterone, dopamine and some others. Note that each hormone has its own specific tasks, in which there is absolutely no mystical background. Many generally have a very limited scope. For example, insulin “works” only with the liver – it stimulates the conversion of glucose into glycogen (a polysaccharide that acts as an energy reserve in the body).Vasopressin, which most probably have no idea about, lowers blood pressure.

Because we are a gang

Can we say that scientists have studied, described and identified the area of ​​responsibility of each hormone? Yes and no. The problem is, these chemicals manage to surprise you all the time. In addition, some hormones work in pairs, trios, quartets, and so on. As a result, it is not clear to whom exactly to attribute the effect achieved by the joint efforts.A classic example is a group of so-called happiness hormones.

Theoretically, only serotonin is responsible for the feeling of this very cloudless feeling (figuratively speaking, he even recorded it in his passport). But in fact, dopamine and oxytocin help him in this. Further more. Happiness cannot be experienced without the participation of male and female sex hormones – estrogen and testosterone. By the way, all people have them, regardless of gender, just in different quantities. The stress hormone adrenaline also makes its contribution, the main task of which is to mobilize the body in the event of a threat to life.But in the “lucky case”, when adrenaline is released into the blood, the heart beats faster, vision and hearing are sharpened, there is a feeling of a surge of strength and “wings”. Rounding out the list are endorphins, which many mistakenly classify as hormones. In fact, this is a group of polypeptide chemical compounds similar in mode of action to opiates. As they say, comments are superfluous about the action.

Other hormones work according to a similar principle. For example, testosterone, prolactin, norepinephrine and oxytocin are responsible for the process of generating interest in men.Maternal instinct in women is also stimulated by three hormones: oxytocin, prolactin and progesterone. This list can be continued, but the main idea is clear: any feelings and processes in the body are teamwork.

It will not be enough

But hormones are still personally responsible for unpleasant things. For example, insufficient production of “happy” serotonin (by the way, 90% of it is produced by cells of the epithelial lining of the gastrointestinal tract) can be the cause of chronic depression.The result is curious: we are sad because the digestive tract is not doing its job.

The situation is similar with testosterone, which is responsible for masculinity, dominance, purposefulness, and sex drive. Thanks to this hormone, representatives of the strong half of humanity have a good appetite, thick facial hair, and a low voice. On the other hand, those who lack testosterone are more willing to tinker with children and are less aggressive. An excess of this hormone in women turns into their development according to the “male type”, turns them into lovers of harsh entertainment such as car racing, hunting and fishing, makes them more aggressive.

Unexpected turn

Believe it or not, for the “loving” oxytocin, the effect on our senses is, so to speak, a side effect of chopping wood. True, very powerful. Its main task, which was originally fixed when this hormone was discovered, is to stimulate lactation and contracting movements of the uterine muscles during childbirth. For this reason, oxytocin injections are given after gynecological operations to stop uterine bleeding.

As the research progressed, scientists were surprised to learn that the hormone, which at first seemed very simple, is still that “multidimensional”.It turned out that he is responsible for the so-called social attachment – it stimulates interest in communicating with loved ones, friends and lovers, causes tenderness, affection, the need to take care of someone. By the way, the level of oxytocin in the fair sex is much higher than in men. In addition, in women, for some reason, it is also produced at the moment of stress along with adrenaline. It is for this reason that after a quarrel, they have such an illogical behavior from the point of view of men – a desire to lisp, cook something tasty, and so on.You think that she’s weird all over the head, but it turns out that it’s all about oxytocin.

But, as is often said in advertising, this is not all. Recent research, reported by the scientific journal Nature Communications, has revealed new oddities of oxytocin. It turned out that it is also needed in areas of the brain that are not related to positive emotions and sociality. For example, there are many oxytocin receptors in sites associated with learning, fear, smell, and taste. But this is already an interesting new twist.Although what love is without sweets, right?

How a hobby is born

Another hormone of positive emotions, dopamine, is responsible for inspiration and motivation. He pushes us to crazy deeds, incredible accomplishments and deeds, gives optimism and the desire to move mountains. A powerful release of this hormone into the blood occurs when we are just looking forward to some interesting event or activity. After some time, the body asks for repetition. This is how we develop habits, hobbies, things we love, places, food, and music.However, like other hormones, dopamine also has a prosaic side – it eases pain and helps to adapt to uncomfortable situations.

To eat or not to eat – that is the question

In 1994, a new hormone was discovered – leptin, which is synthesized in adipose tissue. Until that time, scientists believed that fat cells were inert and were not capable of such heroism in principle. Moreover, it turned out to be a very curious chemical compound that received the unofficial name “the hormone of satiety.”Leptin acts on the hypothalamus, giving the command that the body has already received enough fat, so you can stop eating and start burning calories. This is how the correct scheme works. Disruptions in the production of this hormone lead to serious consequences: a person can experience either constant hunger, or a steady reluctance to eat at all.

FUN

autogear.ru

In 1999, the famous American parachutist Joan Murray survived a fall from a height of 4400 meters.Her main parachute did not open, and her reserve was deployed late. Joan fell into a forest, broke her bones, lost almost all her teeth and fell right on the dwelling of poisonous red fire ants, already in a state of clinical death. According to doctors, she received over 200 bites instantly. But the poison provoked such a powerful release of adrenaline into the bloodstream that the effect was the same as when using a defibrillator. The woman’s heart began to work, and she remained alive.

bebenina @ sb.by

Safety rules in decree. Part 4. Psychotropic effect of oxytocin

The hormone oxytocin of nursing mothers is called amnestic hormone by physiologists. In Russian – “forgetfulness hormone”. Besides promoting uterine contraction and milk secretion, it is known for its psychotropic effects. First, it inhibits the ability to remember and recall previous experiences. Biologically, this is necessary in order to make the brain work selectively in favor of the child and be “here and now.”The mother literally cannot focus on anything else. Secondly, it strengthens the attachment to the circle of “friends”, but at the same time – increases the hostility towards the “outsiders”. Aliens can be called: life in the city (most of those who have gone to “ecological sects” – mothers on maternity leave!), Vaccinations, meat … Do you understand what I mean? If all your life you calmly drank boiled water, then in the decree you may be “overwhelmed” and you will only drink melt water infused with shungite. It’s all oxytocin, yes, yes!

The other day I threw a tantrum on my husband’s shoulder on the topic: “We urgently need to move to the village, have a goat and guinea fowl, because we will die in the city!”I was sure that the child was sick. My girl threw tantrums, was hyperactive, fell asleep poorly, and ate nothing but pasta. In addition, on TV and on the Internet, there was constant talk about the militants of IG (a terrorist organization banned in the Russian Federation – Ed.) , and I was sure that our Butovo high-rise building, where we were going to live, would be bombed by terrorists in the near future. They will definitely get to the nuclear bomb. Everything! We must sell the apartment and run to Altai! Give up TV and city vegetables with nitrates!

My husband calmly told me everything he knew about a nuclear bomb, calculated the likelihood of such a development scenario, and, confident that he had heeded his logical arguments, added that he was not ready to quit his favorite job in the center of Moscow.But if I want, then in the summer he will take me and the children to my grandmother’s dacha and even allow us to have one guinea fowl.

“Egoist!” – in my hearts I thought and fell asleep. This is not the first time that I have been covered with “flight from the end of the world”. Usually, in such cases, I still think all night about the fact that since my husband does not understand me, we definitely need to get a divorce. True, I have long been immune from such quirks – my profession. And it covers me for a little while.

As a journalist, I talked a lot with all kinds of fanatics and sectarians.Raw food eaters, Anastasians, vegetarians, pagans who fled to ecovillages. Each family had its own list of enemies (meat, vaccinations, city products, city water, “parasites” in the brain, which they removed by “cleansing” and which, of course, were not there …). So, almost all of them had the same story: the news that they “lived wrongly and poisoned themselves” came to all at the same time. During the perinatal period.

One small fad in the psychological portrait of the characters contributed to this development of events: hostility towards strangers.Division of the world into “us” and “foes”. The confidence that someone (baby food manufacturers, scientists, doctors …) wants to purposefully harm you.

I am not qualified to discuss in this column the reasons for this psychological portrait. As a journalist, I observe the consequence: if you have a certain “enemy” in your subconscious, then in the perinatal period, under the influence of oxytocin, your aggression towards this conditional enemy will increase. And if earlier this aggression was needed to escape from the tiger, now, during the period of conditional safety of the surrounding space, our imagination seeks out enemies on its own.

And remember that aggression can be tolerated. It will not always be directed precisely at the enemy that sits in the subconscious (father, mother, himself, for example). It will be meat, antibiotics, doctors, vaccinations … Continue the list yourself. And if you don’t understand yourself and turn to a specialist, such a woman and her family can expect a sad scenario.

I have seen children raised on a raw food diet. These worn out teeth, crooked legs and rickets heads. I saw city people who fled from city to village, having heard enough pastoral nonsense that our ancestors were healthier in nature and without drugs.They do not know how to live there, they cannot build a strong economy. Because the psychological problems had to be solved first. You can’t run away from yourself.

A healthy way out of the “oxytocin quirks” is the Christian worldview, where sin is separated from the sinner, and the world is not divided into “us” and “strangers.”

A practicing Orthodox woman has an enemy within herself, but this is not her, but sin.

Now I understand that separating myself from my sin (it’s not me) and fighting with sin, and not with myself – I love myself, I don’t feel aggression towards myself, I don’t need to transfer it to meat (I was a vegan for two years and looked like a match, I lost my period.Is this not aggression towards yourself?). I also separate “sin” from other people and understand that doctors themselves do not want me to be harmed. Their enemy, as well as mine, is lack of qualifications. Improving your (including scientific intelligibility) qualifications and looking for those who are qualified is an adequate way out.

And when I get kooky, I say to myself, oh honey, remember: first of all, it’s oxytocin. You won’t give a damn about science and the laws of logic. On the reasonable arguments of her husband. If pereklinitis – only an internal pause and calming will help: wait, come to your senses, this is oxytocin.Second, let’s look for the real culprits of your problems. Not city life as such. Not a TV per se. And the way you use it.

Usually in the morning I think about the fourth law of logic – the law of sufficient reason: “Any statement must have sufficient justification.” And about Occam’s principle, which was more clearly formulated by biologist Dmitry Zhukov: “You should resort to more complex explanations when simple ones do not explain the available facts.” And I realized that my child’s hyperactivity was caused by insufficient physical activity (during pregnancy I could not walk with her as much as before) and an abundance of cartoons.Increasing walks and cutting cartoons, I got an improvement. It was not necessary to flee to the village.

And I also thought that it’s good that I promised myself once to use the principle “The husband is always right”, which I also took from the ethics of the Christian family. When during the period of “oxytocin quirks” a la “Ah-ah, my child is dying!” my husband reassured me with logic, I did not believe in logic, because – oxytocin. Because the panic is for a loved one. I said to myself: OK, let’s listen to Sasha now, and when he lets you go, we’ll figure out what he was saying there and whose arguments are more correct.And it helps!

As a rule, oxytocin does not affect the husband to the extent that it poisons the brain of the woman he loves, and he is able to preserve his mind and appeal to science. I watched what happens in families where the wife is the head of the family. Nobody can restrain her “oxytocin quirks”. The family spends extra money, extra time on the consequences of these “quirks”, on this “something needs to be done right now, otherwise we will all die!”

So, oxytocin increases attachment to “friends” and hostility to “outsiders.”And in order to avoid neurotic actions, during the decree, you really need to figure out who these “strangers” are in you and with whom you are actually fighting.

Inhibition of memory and motivation during breastfeeding

Now let’s talk about other psychotropic effects of the magic hormone of a nursing mother. This is the effect of inhibiting mental activity and reducing motivation.

In the first months of breastfeeding, I had to exert extra effort even to pick up the phone and call the hairdresser.I was terrified of forgetting to turn off the stove, and we only went to the clinic with my husband, because I was not able to remember the order of visiting doctors and sort out papers and offices. I reminded myself of the Hedgehog in the fog: “I am the Hedgehog, I fell into the river. Let the river itself carry me downstream. ”

As you know, there can be nothing good downstream, especially if this swimming is uncontrollable. Oxytocin is known to reduce anxiety levels. But at the same time, it weakens motivation, because some level of anxiety is required to motivate.

Oxytocin inhibition of memory, along with other risks of the decree, determines the mother’s inability to “go beyond” the current moment and understand, for example, that the baby’s cry cannot go on forever. Formed the so-called. “Tunnel perception”: fixation on a problem, when a woman thinks that she is in a state of hopelessness, but she has no strength to change something (remember about weakening of motivation!). However, mom needs to start rebuilding her life so as to satisfy her own interests.If you do not start to manage “carrying along the” oxytocin “river” – sooner or later you will find yourself in depression.

Look what we get: there are a lot of calls, and oxytocin inhibition makes a woman’s limited ability to cope with them on her own. So we get the following thoughts: “Everything seems to be fine: a wonderful child, a wonderful husband, a separate apartment. It would seem: here it is, happiness, take it with your hands and eat it. And I feel so sick – even jump out of the window. ” From the outside, your life will seem very happy.Therefore, neither the husband, nor the doctor, nor the girlfriends will be able to understand your condition. It’s hard to help yourself. I see a way out in creating parent support groups.

How and when not to overcome oxytocin inhibition

Your brain will work selectively, but you can get into this “selectivity” by making something a priority besides the child. Any activity interesting to the mother negates the psychotropic effect of the amnestic hormone. In the first months of a child’s life, I very quickly wrote and perfectly defended my diploma on a topic that was interesting to me.At the same time, passing the state exam against the background of lactation turned out to be an almost impossible task, and I was given a good grade out of pity. In the first case, I memorized and processed a huge amount of information easily, in the second I did not succeed due to lack of interest and motivation. Here is the answer: if you are interested in something, it immediately becomes a priority. Find some side interest in an activity that is not given to you during lactation.

Be aware, however, that resistance to oxytocin inhibition can be dangerous.It’s not for nothing that nature has foreseen everything just like that! If a woman is focused on something other than a child (for example, on her terribly important job), then the child literally drops out of priorities at some point. And since the brain works selectively, a nursing and very loving mother can, for example, forget this very sleeping child in a hot car. She can be sure that she has taken him to his destination – to the nanny or grandmother. But something distracts her, and the moment of the actual “transfer of the child” simply falls out of memory, being replaced by an intention.That is why the “terribly important matters” in the decree, which take up too much of your attention, should be delegated to someone else – for example, your husband.

And, of course, you should not expect too much from yourself during this period and force yourself to achieve, achieve and achieve. Sometimes you don’t need to resist oxytocin inhibition, sometimes it is important to allow yourself to enjoy the fact that you are a Hedgehog, you fell into a river and let the river carry you by itself. If only it was your choice and “carrying” was not controlled by oxytocin, but by you.

Slutty hormone. Why are women more likely to become sexually addicted?

Scientists have discovered that the tendency to cheat is most often not sexual promiscuity, but the result of disorders in the brain, which affect hormones, and a person becomes their hostage. And it turns out that women are more likely to suffer from such a violation.

Only recently it became known that the cause of sexual promiscuity is the hormone oxytocin. It turned out that the genes responsible for its production in people with disabilities produce it above the norm.Excess pushes people to constantly search for new sexual partners.

The mechanisms of behavior in people with hypersexual disorder are very similar to how drug addicts behave. A certain percentage of people develop addiction, due to which a person begins to have problems with society. In order to feel normal, a person with a hypersexual disorder needs to constantly expand the circle of sexual partners.

A stereotype has taken root in public opinion that men are primarily prone to “hypersexual disorder”.It would seem that harassment is another proof of this, but no. Most of the disorders, according to experts, are observed in women.

– Oxytocin more affects women, since in men it is produced only during intercourse, and then depending on the “skills” of the partner, – said sexologist and psychologist Alexander Poleev. – In 90,635 women, it is constantly in the blood in one amount or another. Therefore, after the active production of oxytocin during intercourse, women are then irresistibly drawn to their partner.

The expert emphasizes that oxytocin is a female hormone. In addition, in his opinion, women for the sake of “new doses” of oxytocin are ready to go with this partner to any sex experiments or deviations. Psychological attachment only enhances the action of the hormone, but if it is not there, the woman seeks to expand the circle of partners.

Doctors plan to treat hypersexual disorder with medication, but so far the issue is being carefully studied. Researchers believe that even an excess of oxytocin, exceeding the norm by two to three percent, can cause the development of severe forms of depression and schizophrenia.

But a low level of oxytocin is fraught with both physiological and social disorders, because it is he who increases people’s trust in each other and helps men and women to create families.

– Once scientists have found an effective remedy for overeating and excess weight – for this they began to block cannabinoid receptors, which just push us to consume sweet and fatty foods, as well as snacks after six in the evening.