Otocin

Description

Otocin Injection (Oxytocin)

Otocin 5IU Injection, manufactured by National Healthcare Pvt. Ltd., is available in Nepal. Its generic name is Oxytocin.

Indications

Otocin Injection is used for:

• Postpartum hemorrhage (prevention and treatment of uterine atony after childbirth)
• Labor induction
• Abortion (to manage incomplete or inevitable abortion)
• Note: Facilitating lactation is listed as an indication, but for injection, this is generally not the primary use; oxytocin nasal sprays are typically used for this purpose.

Dosage Information

Important: Dosage must be carefully titrated based on patient response and fetal/maternal monitoring.

Adult Dosing (Intravenous)

• Postpartum Hemorrhage:
  • 10-40 units added to 1000 mL of non-hydrating IV solution.
  • Infuse at the necessary rate to control uterine atony.
  • Do not exceed 40 units.
• Labor Induction:
  • Start with 0.5-1 mUnit/min IV.
  • Titrate (increase) by 1-2 mUnit/min every 15-60 minutes until a contraction pattern similar to normal labor is achieved (usually around 6 mUnits/min).
  • The dose may be decreased after the desired frequency of contractions is reached and labor has progressed to 5-6 cm dilation.
• Incomplete or Inevitable Abortion:
  • 10-20 mUnit/min IV.
  • Do not exceed 30 units per 12 hours.

Pediatric Dose, Renal Dose

• Specific pediatric and renal dosing information is not provided in the original text.

Administration

• Administration specifics (e.g., dilution for various uses) should always be followed as per the product insert and clinical guidelines.

Contraindications

Otocin Injection is contraindicated in the following situations:

• Cephalopelvic disproportion (fetal head too large for maternal pelvis).
• Abnormal presentation of the fetus.
• Hydramnios (excess amniotic fluid).
• Multiparae (women who have given birth multiple times).
• Previous Cesarean section or other uterine surgery.
• Hyperactive or hypertonic uterus.
• Uterine rupture (or high risk of).
• Contraindicated vaginal delivery due to:
  • Invasive cervical cancer
  • Active genital herpes
  • Prolapse of the cord
  • Cord presentation
  • Total placenta previa or vasa previa
• Fetal distress where delivery is not imminent.
• Severe pre-eclamptic toxemia.

Precautions

Use Otocin Injection with extreme caution and under close monitoring in patients with:

• Cardiovascular disorders.
• Age >35 years.
• Lactation (see detailed note below).

Monitoring Parameters:

• Closely monitor fetal and maternal heart rate, maternal blood pressure, and uterine motility.
• Monitor fluid intake and output during treatment to assess for water intoxication.
• Discontinue immediately if the uterus becomes hypertonic or hyperactive, or if there are signs of fetal distress.
• The use of oxytocin nasal spray may lead to maternal dependence on its effects.
• Intramuscular (IM) administration is not regularly used due to unpredictable effects of oxytocin.
• Not to be used for prolonged periods in cases of resistant uterine inertia, severe pre-eclampsia, or severe cardiovascular disorders.
• There is a risk of water intoxication when used at high doses for prolonged periods.

Pregnancy and Lactation

• Lactation: Oxytocin may be distributed into breast milk. Commencement of nursing should be delayed for at least 1 day when the drug is discontinued. Use caution when administering to breastfeeding women.
• Pregnancy: Used for labor induction, abortion management, and postpartum hemorrhage. However, numerous contraindications and precautions apply during pregnancy (see above).

Drug Interactions

• Possible severe hypertension: If given within 3-4 hours of a vasoconstrictor in association with caudal block anesthesia.
• Cyclopropane anesthesia: May increase the risk of hypotension and maternal sinus bradycardia with abnormal AV rhythms.
• Dinoprostone and Misoprostol: May increase the uterotonic effect of oxytocin. Therefore, oxytocin should not be used within 6 hours after administration of vaginal prostaglandins.
• Sympathomimetics: Concurrent use may increase the vasopressor effect.
• Potentially Fatal Interactions:
  • Concomitant use with prostaglandins significantly increases the risk of uterine rupture and cervical lacerations.

Adverse Effects

Side effects of Oxytocin (affecting fetus/neonate and mother):

• Fetus or Neonate: Jaundice; arrhythmias, bradycardia; brain, CNS damage; seizure; retinal hemorrhage; low Apgar score.
• Mother: Transient hypotension, reflex tachycardia; nasal irritation, rhinorrhea, lacrimation (following nasal administration, not typically IV); uterine bleeding, violent contractions, hypertonicity; spasm; nausea, vomiting.

Potentially Fatal Adverse Effects:

• Maternal water intoxication (especially with slow infusion over 24 hours).
• Prolonged uterine contractions causing fetal hypoxia and death.
• Rupture of gravid uterus.
• Afibrinogenemia.
• Subarachnoid hemorrhage.

Mechanism of Action

Oxytocin is a uterine stimulant with vasopressive and antidiuretic effects. It activates G-protein-coupled receptors that trigger increases in intracellular calcium levels in uterine myofibrils, leading to uterine contractions. It also increases local prostaglandin production, which further stimulates uterine contraction.

Disclaimer: This information is for general knowledge and is not intended for diagnosis, medical advice, or treatment. It is not a substitute for professional medical judgment. Always consult with a healthcare professional for any medical concerns