Oxytocin 10 IU/ml Concentrate for Solution for Infusion

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, midwife or nurse.
• If you get any side effects, talk to your doctor, midwife or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Oxytocin is and what it is used for
2. What you need to know before you receive Oxytocin
3. How Oxytocin is given to you
4. Possible side effects
5. How to store Oxytocin
6. Contents of the pack and other information

• if you are allergic to oxytocin or any of the ingredients of this medicine (listed in section 6)
• if your doctor thinks that to start or increase contractions of the womb would be unsuitable for you, for example:
  • where contractions of the womb are unusually strong
  • where there are obstructions that may prevent delivery
  • where your baby may be short of oxygen
• where labour or vaginal delivery is not advisable, for example:
  • if your baby’s head is too large to fit through your pelvis
  • if your baby is wrongly positioned in the birth canal
  • if the placenta lies near or over the neck of your womb
  • if your baby lacks oxygen due to blood vessels running across the neck of your womb
  • if the placenta separates from the womb before the baby is born
  • if there are one or more loops of umbilical cord between the baby and the neck of the womb, either before or after your waters break
  • if your womb is over-extended and more likely to tear, for example if you are carrying more than one baby or have too much water (amniotic fluid) in your womb
  • if you have had five or more pregnancies in the past or if your womb is scarred by previous caesarean section or other surgery
• if you have been given medicines called prostaglandins (used to bring on labour or treat stomach ulcers). Oxytocin should not be used for 6 hours after vaginal prostaglandins as the effects of both medicines may be increased

• your contractions do not increase with the treatment
• you have a condition known as severe pre-eclamptic toxaemia (high blood pressure, protein in the urine and swelling)
• you have severe problems with your heart or blood circulation.

Oxytocin should only be administered by a healthcare professional in a hospital setting.

Oxytocin should not be given as rapid injection into a vein as this may cause decreased blood pressure, a sudden brief sensation of heat (often over the entire body), and an increased heart rate.

Before you receive Oxytocin tell your doctor or midwife if:

• you are prone to chest pain due to pre-existing heart and/or circulation problems
• you have a known irregular heart beat (‘long QT syndrome’) or related symptoms, or are taking medicines known to cause the syndrome (see section ‘Other medicines and Oxytocin’)
• you have had a previous caesarean section
• you are more than 35 years old
• you have raised blood pressure or heart problems
• your womb was contracting strongly but has now begun to contract less strongly
• you have been told by a doctor or midwife that normal delivery may be difficult for you due to the small size of your pelvis
• you have kidney problems, as Oxytocin can cause water retention
• you have had complications during your pregnancy
• you are more than 40 weeks pregnant.

When Oxytocin is given to induce and enhance labour, the infusion rate should be set to maintain a contraction pattern similar to normal labour and adjusted to individual response. Too high doses may cause very strong continuous contractions and possibly tearing of the womb, with serious complications for you and your baby.

Oxytocin may rarely cause disseminated intravascular coagulation which causes symptoms including abnormal blood clotting, bleeding and anaemia.

High doses of Oxytocin may force amniotic fluid from your womb into your blood. This is known as amniotic fluid embolism.

Large doses of Oxytocin over a long period of time, whilst drinking or receiving large volumes of fluid may make your stomach feel very full, cause difficulty in breathing and lower salt levels in your blood.

Latex allergy – The active substance in Oxytocin might cause a severe allergic reaction (anaphylaxis) in patients with latex allergy. Please tell you doctor if you know you are allergic to latex.

If any of the above applies to you, or if you are not sure, speak to your doctor or midwife before you receive Oxytocin.

Tell your doctor or midwife if you are taking or have recently taken any of the following medicines as they may interfere with Oxytocin:

• prostaglandins (used to start labour or to treat stomach ulcers) and similar drugs as the effects of both drugs may be increased
• medicines that can cause an irregular heartbeat, as Oxytocin may increase this effect
• anaesthetics which you breathe in (e.g. to put you to sleep during surgery), such as halothane, cyclopropane, sevoflurane or desflurane) as these may weaken your contractions, or cause problems with your heartbeat
• anaesthetic medicines for local or regional pain relief, in particular an epidural for pain relief during labour. Oxytocin may increase the blood vessel narrowing effect of these medicines and cause an increase in blood pressure.

Please tell your doctor or midwife if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

You may be told to keep the amount of fluids you drink to a minimum.

Based on wide experience of use and the nature of this medicine, it is not expected that Oxytocin would be a risk to your baby when used correctly. Oxytocin may be found in small amounts in breast milk but is not expected to have harmful effects because it is quickly inactivated by your baby’s digestive system.

Oxytocin can start labour. Women with contractions should not drive or use machines.

The rate of infusion will start at 2 to 8 drops per minute. This may be gradually increased to a maximum rate of 40 drops per minute. The infusion rate can often be reduced once the contractions reach an adequate level, about 3- 4 contractions every 10 minutes.

If your contractions do not reach the adequate level after 5 IU the attempt to start labour should be stopped and then repeated the following day.

Miscarriage

The dose is 5 IU by infusion into a vein. In some cases this may be followed by a drip at 40 to 80 drops per minute.

Caesarean section

The dose is 5 IU by infusion into a vein immediately after delivery of your baby.

Prevention of bleeding after delivery

The dose is 5 IU by infusion into a vein after delivery of the placenta.

Treatment of bleeding after delivery

The dose is 5 IU by infusion into a vein. In some cases this may be followed by a drip containing 5 to 20 IU of oxytocin.

Elderly (65 years and over)

There is no information on use in elderly patients. Oxytocin is not intended for use in the elderly.

Children and adolescents

There is no information on use in children (2-11 years) or adolescents (12-17 years). Oxytocin is not intended for use in children or adolescents.

Patients with kidney disease

There is no information on use in patients with kidney disease. However, you should tell your doctor if you suffer from kidney problems (see section 2 ‘Warnings and precautions’).

Patients with liver disease

There is no information on use in patients with liver disease.

As this medicine is given to you in hospital, it is very unlikely that you will receive an overdose.

If anyone accidentally receives this medicine, tell the hospital accident and emergency department or a doctor immediately. Show any left over medicines or the empty packet to the doctor.

An overdose of Oxytocin could cause:

• very strong contractions of your womb
• damage to your womb which could include tearing
• the placenta to come away from your womb
• amniotic fluid (the fluid around the baby) to enter your bloodstream
• harm to your baby.

As a doctor or midwife is giving you this medicine, you are unlikely to miss a dose.

Effects in the mother:

• haemorrhage (bleeding)
• chest pain (angina)
• irregular heartbeat
• excessive or continuous contractions
• tearing of the womb
• fluid retention (water intoxication). Symptoms may include headache, anorexia (loss of appetite), feeling or being sick, stomach pain, sluggishness, drowsiness, unconsciousness, low levels of certain chemicals in the blood (e.g. sodium or potassium), fits
• low blood salt levels
• sudden fluid overload in the lungs
• sudden brief sensation of heat often over the whole body
• abnormal clotting, bleeding and anaemia
• spasm of the muscles of the womb

Effects in the baby:

Excessive contractions may cause low blood salt levels, shortage of oxygen, suffocation and death.

If you get any side effects, talk to your doctor, midwife or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

The active substance is oxytocin.

The other ingredients are Sodium acetate trihydrate, acetic acid glacial (for pH adjustment), sodium chloride, sodium hydroxide (for pH adjustment) and Water for Injections.

This medicine contains less than 1 mmol sodium (23mg) per 1ml ampoule, that is to say essentially ‘sodium-free’.

Oxytocin is a clear, colourless, sterile liquid which comes in a 1ml (millilitre) clear glass ampoule. Oxytocin comes in packs of ten ampoules. Each Oxytocin ampoule contains 10 IU (International Units) oxytocin.

The information in this leaflet applies only to Oxytocin. If you have any questions or you are not sure about anything, ask your doctor, midwife or a nurse.