Oxytocin Injection USP 5 IU/ml Taj Pharma

Oxytocin Injection USP 5 IU/ml

1. Name of the medicinal product

Oxytocin 5 IU/ml USP Concentrate for solution for infusion Taj Pharma
Oxytocin 10 IU/ml USP Concentrate for solution for infusion Taj Pharma

2. Qualitative and quantitative composition

Oxytocin.

Concentrate for solution for infusion (in 1mL ampoule) containing 5 IU/mL

Concentrate for solution for infusion (in 1mL ampoule) containing 10 IU/mL

Excipient(s) with known effect:

Ethanol 5.000mg

For the full list of excipients, see section 6.1.

3. Pharmaceutical form

Concentrate for solution for infusion.

A clear, colourless, sterile solution in 1ml clear glass ampoules

4. Clinical particulars

4.1 Therapeutic indications

Antepartum

• Induction of labour for medical reasons, e.g. in cases of post-term gestation, premature rupture of the membranes, pregnancy-induced hypertension (pre-eclampsia)
• Stimulation of labour in hypotonic uterine inertia
• Early stages of pregnancy as adjunctive therapy for the management of incomplete, inevitable, or missed abortion.

Postpartum

• During caesarean section, but following delivery of the child
• Prevention and treatment of postpartum uterine atony and haemorrhage

4.2 Posology and method of administration

Induction or enhancement of labour: Oxytocin should not be started for 6 hours following administration of vaginal prostaglandins. Oxytocin should be administered as an intravenous (i.v.) drip infusion or, preferably, by means of a variable-speed infusion pump. For drip infusion it is recommended that 5 IU of Oxytocin be added to 500ml of a physiological electrolyte solution (such as sodium chloride 0.9%). For patients in whom infusion of sodium chloride must be avoided, 5% dextrose solution may be used as the diluent (see Section 4.4 “Special warnings and precautions for use”). To ensure even mixing, the bottle or bag must be turned upside down several times before use.

The initial infusion rate should be set at 1 to 4 milliunits/minute (2 to 8 drops/minute). It may be gradually increased at intervals not shorter than 20 minutes and increments of not more than 1-2 milliunits/minute, until a contraction pattern similar to that of normal labour is established. In pregnancy near term this can often be achieved with an infusion of less than 10 milliunits/minute (20 drops/minute), and the recommended maximum rate is 20 milliunits/minute (40 drops/minute). In the unusual event that higher rates are required, as may occur in the management of foetal death in utero or for induction of labour at an earlier stage of pregnancy, when the uterus is less sensitive to oxytocin, it is advisable to use a more concentrated Oxytocin solution, e.g., 10 IU in 500ml.

When using a motor-driven infusion pump which delivers smaller volumes than those given by drip infusion, the concentration suitable for infusion within the recommended dosage range must be calculated according to the specifications of the pump.

The frequency, strength, and duration of contractions as well as the foetal heart rate must be carefully monitored throughout the infusion. Once an adequate level of uterine activity is attained, aiming for 3 to 4 contractions every 10 minutes, the infusion rate can often be reduced. In the event of uterine hyperactivity and/or foetal distress, the infusion must be discontinued immediately.

If, in women who are at term or near term, regular contractions are not established after the infusion of a total amount of 5 IU, it is recommended that the attempt to induce labour be ceased; it may be repeated on the following day, starting again from a rate of 1 to 4 milliunits/minute (see Section 4.3 “Contra-indications”).

In women given Oxytocin for induction or enhancement of labour, the infusion should be continued at an increased rate during the third stage of labour and for the next few hours thereafter.

Incomplete, inevitable, or missed abortion: 5 IU by i.v. infusion (5 IU diluted in physiological electrolyte solution and administered as an i.v. drip infusion or, preferably, by means of a variable-speed infusion pump over 5 minutes), if necessary followed by i.v. infusion at a rate of 20 to 40 milliunits/minute.

Caesarean section: 5 IU by i.v. infusion (5 IU diluted in physiological electrolyte solution and administered as an i.v. drip infusion or, preferably, by means of a variable-speed infusion pump over 5 minutes) immediately after delivery.

Prevention of postpartum uterine haemorrhage: The usual dose is 5 IU by i.v. infusion (5 IU diluted in physiological electrolyte solution and administered as an i.v. drip infusion or, preferably, by means of a variable-speed infusion pump over 5 minutes) after delivery of the placenta.

Treatment of postpartum uterine haemorrhage: 5 IU by i.v. infusion (5 IU diluted in physiological electrolyte solution and administered as an i.v. drip infusion or, preferably, by means of a variable-speed infusion pump over 5 minutes), followed in severe cases by i.v. infusion of a solution containing 5 to 20 IU of oxytocin in 500ml of an electrolyte-containing diluent, run at the rate necessary to control uterine atony.

Route of administration: Intravenous infusion.

Special populations

Renal impairment

No studies have been performed in renally impaired patients.

Hepatic impairment

No studies have been performed in hepatically impaired patients.

Paediatric population

No studies have been performed in paediatric patients.

Elderly population

No studies have been performed in elderly patients (65 years old and over).

4.3 Contraindications

• Hypersensitivity to the active substance or to any of the excipients listed in section 6.1
• Hypertonic uterine contractions, mechanical obstruction to delivery, foetal distress.

Any condition in which, for foetal or maternal reasons, spontaneous labour is inadvisable and/or vaginal delivery is contra-indicated: e.g.:

• Significant cephalopelvic disproportion
• Foetal malpresentation
• Placenta praevia and vasa praevia
• Placental abruption
• Cord presentation or prolapse
• Overdistension or impaired resistance of the uterus to rupture as in multiple pregnancy
• Polyhydramnios
• Grand multiparity
• In the presence of a uterine scar resulting from major surgery including classical caesarean section.

Oxytocin should not be used for prolonged periods in patients with oxytocin-resistant uterine inertia, severe pre-eclamptic toxaemia or severe cardiovascular disorders.

Oxytocin must not be administered within 6 hours after vaginal prostaglandins have been given (see section 4.5 Interaction with other medicinal products and other forms of interaction).

4.4 Special warnings and precautions for use

Oxytocin must only be administered as an i.v. infusion and never by i.v. bolus injection as it may cause an acute short-lasting hypotension accompanied with flushing and reflex tachycardia.

Induction of labour

The induction of labour by means of oxytocin should be attempted only when strictly indicated for medical reasons. Administration should only be under hospital conditions and qualified medical supervision.

Cardiovascular disorders

Oxytocin should be used with caution in patients who have a pre-disposition to myocardial ischaemia due to pre-existing cardiovascular disease (such as hypertrophic cardiomyopathy, valvular heart disease and/or ischaemic heart disease including coronary artery vasospasm), to avoid significant changes in blood pressure and heart rate in these patients.

QT syndrome

Oxytocin should be given with caution to patients with known ‘long QT syndrome’ or related symptoms and to patients taking drugs that are known to prolong the QTc interval (see section 4.5 Interaction with other medicinal products and other forms of interaction).

When Oxytocin is given for induction and enhancement of labour:

• Foetal distress and foetal death: Administration of oxytocin at excessive doses results in uterine overstimulation which may cause foetal distress, asphyxia and death, or may lead to hypertonicity, tetanic contractions or rupture of the uterus. Careful monitoring of foetal heart rate and uterine motility (frequency, strength, and duration of contractions) is essential, so that the dosage may be adjusted to individual response.
• Particular caution is required in the presence of borderline cephalopelvic disproportion, secondary uterine inertia, mild or moderate degrees of pregnancy-induced hypertension or cardiac disease, and in patients above 35 years of age or with a history of lower-uterine-segment caesarean section.
• Disseminated intravascular coagulation: In rare circumstances, the pharmacological induction of labour using uterotonic agents, including oxytocin increases the risk of post partum disseminated intravascular coagulation (DIC). The pharmacological induction itself and not a particular agent is linked to such risk. This risk is increased in particular if the woman has additional risk factors for DIC such as being 35 years of age or over, complications during pregnancy and gestational age more than 40 weeks. In these women, oxytocin or any other alternative drug should be used with care, and the practitioner should be alerted by signs of DIC.

Intrauterine death

In the case of foetal death in utero, and/or in the presence of meconium-stained amniotic fluid, tumultuous labour must be avoided, as it may cause amniotic fluid embolism.

Water intoxication

Because oxytocin possesses slight antidiuretic activity, its prolonged i.v. administration at high doses in conjunction with large volumes of fluid, as may be the case in the treatment of inevitable or missed abortion or in the management of postpartum haemorrhage, may cause water intoxication associated with hyponatraemia. The combined antidiuretic effect of oxytocin and the i.v. fluid administration may cause fluid overload leading to a haemodynamic form of acute pulmonary oedema without hyponatraemia. To avoid these rare complications, the following precautions must be observed whenever high doses of oxytocin are administered over a long time: an electrolyte-containing diluent must be used (not dextrose); the volume of infused fluid should be kept low (by infusing oxytocin at a higher concentration than recommended for the induction or enhancement of labour at term); fluid intake by mouth must be restricted; a fluid balance chart should be kept, and serum electrolytes should be measured when electrolyte imbalance is suspected.

Renal Impairment

Caution should be exercised in patients with severe renal impairment because of possible water retention and possible accumulation of oxytocin (see section 5.2 Pharmacokinetics).

Anaphylaxis in women with latex allergy

There have been reports of anaphylaxis following administration of oxytocin in women with a known latex allergy. Due to the existing structural homology between oxytocin and latex, latex allergy/intolerance may be an important predisposing risk factor for anaphylaxis following oxytocin administration.

4.5 Interaction with other medicinal products and other forms of interaction

Interaction resulting in a concomitant use not recommended

Prostaglandins and their analogues

Prostaglandins and its analogues facilitate contraction of the myometrium hence oxytocin can potentiate the uterine action of prostaglandins and analogues and vice versa (see section 4.3 Contraindications).

Drugs prolonging the QT interval

Oxytocin should be considered as potentially arrhythmogenic, particularly in patients with other risk factors for Torsades de Pointes such as drugs which prolong the QT interval or in patients with history of long QT syndrome (see section 4.4 Special warnings and precautions for use).

Interactions to be considered

Inhalation anaesthetics

Inhalation anaesthetics (e.g. cyclopropane, halothane, sevoflurane, desflurane) have a relaxing effect on the uterus and produce a notable inhibition of uterine tone and thereby, may diminish the uterotonic effect of oxytocin. Their concurrent use with oxytocin has also been reported to cause cardiac rhythm disturbances.

Vasoconstrictors/Sympathomimetics

Oxytocin may enhance the vasopressor effects of vasoconstrictors and sympathomimetics, even those contained in local anaesthetics.

Caudal anaesthetics

When given during or after caudal block anaesthesia, oxytocin may potentiate the pressor effect of sympathomimetic vasoconstrictor agents.

4.6 Fertility, pregnancy and lactation

Pregnancy

Based on the wide experience with this drug and its chemical structure and pharmacological properties, it is not expected to present a risk of foetal abnormalities when used as indicated.

One study has shown that treatment of rats with oxytocin in early pregnancy at doses considered sufficiently in excess of the maximum recommended human dose caused embryonic loss. No standard reproductive performance studies with oxytocin are available

Lactation

Oxytocin may be found in small quantities in mother’s breast milk. However, oxytocin is not expected to cause harmful effects in the newborn because it passes into the alimentary tract where it undergoes rapid inactivation.

Females and males of reproductive potential

Not applicable for Oxytocin because of the targeted indications

Infertility

Not applicable for Oxytocin because of the targeted indications.

4.7 Effects on ability to drive and use machines

Oxytocin can induce labour, therefore caution should be exercised when driving or operating machines. Women with uterine contractions should not drive or use machines.

4.8 Undesirable effects

As there is a wide variation in uterine sensitivity, uterine spasm may be caused in some instances by what are normally considered to be low doses. When oxytocin is used by i.v. infusion for the induction or enhancement of labour, administration at too high doses results in uterine overstimulation which may cause foetal distress, asphyxia, and death, or may lead to hypertonicity, tetanic contractions, soft tissue damage or rupture of the uterus.

Rapid i.v. bolus injection of oxytocin at doses amounting to several IU may result in acute short-lasting hypotension accompanied with flushing and reflex tachycardia (see section 4.4 Special warnings and precautions for use). These rapid haemodynamic changes may result in myocardial ischaemia, particularly in patients with pre-existing cardiovascular disease. Rapid i.v. bolus injection of oxytocin at doses amounting to several IU may also lead to QTc prolongation.

In rare circumstances the pharmacological induction of labour using uterotonic agents, including oxytocin, increases the risk of postpartum disseminated intravascular coagulation (see section 4.4 Special warnings and precautions for use).

Water intoxication

Water intoxication associated with maternal and neonatal hyponatraemia has been reported in cases where high doses of oxytocin together with large amounts of electrolyte-free fluid have been administered over a prolonged period of time (see Section 4.4 “Special warnings and precautions for use”). The combined antidiuretic effect of oxytocin and the i.v. fluid administration may cause fluid overload leading to a haemodynamic form of acute pulmonary oedema without hyponatraemia (see section 4.4. Special warnings and precautions for use).

Symptoms of water intoxication include:

1. Headache, anorexia, nausea, vomiting and abdominal pain.
2. Lethargy, drowsiness, unconsciousness and grand-mal type seizures.
3. Low blood electrolyte concentration.

Undesirable effects (Tables 1 and 2) are ranked under heading of frequency, the most frequent first, using the following convention: very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1,000, < 1/100); rare (≥ 1/10,000, < 1/1,000); very rare (< 1/10,000), including isolated reports; not known (cannot be estimated from the available data).The ADRs tabulated below are based on clinical trial results as well as postmarketing reports.

The adverse drug reactions derived from post-marketing experience with Oxytocin are via spontaneous case reports and literature cases. Because these reactions are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency which is therefore categorised as not known. Adverse drug reactions are listed according to system organ classes in MedDRA. Within each system organ class, ADRs are presented in order of decreasing seriousness.

Table 1 Adverse drug reactions in mother

Table 2 Adverse drug reactions in foetus/neonate

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.

4.9 Overdose

The fatal dose of Oxytocin has not been established. Oxytocin is subject to inactivation by proteolytic enzymes of the alimentary tract. Hence it is not absorbed from the intestine and is not likely to have toxic effects when ingested.

The symptoms and consequences of overdosage are those mentioned under sections 4.4 “Special warnings and precautions for use” and 4.8 “Undesirable effects”. In addition, as a result of uterine overstimulation, placental abruption and/or amniotic fluid embolism have been reported.

Treatment: When signs or symptoms of overdosage occur during continuous i.v. administration of Oxytocin, the infusion must be discontinued at once and oxygen should be given to the mother. In cases of water intoxication it is essential to restrict fluid intake, promote diuresis, correct electrolyte imbalance, and control convulsions that may eventually occur. In the case of coma, a free airway should be maintained with routine measures normally employed in the nursing of the unconscious patient.

5. Pharmacological properties

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Posterior pituitary lobe hormones

Mechanism of action

Oxytocin is a cyclic nonapeptide that is obtained by chemical synthesis. This synthetic form is identical to the natural hormone that is stored in the posterior pituitary and released into the systemic circulation in response to suckling and labour.

Oxytocin stimulates the smooth muscle of the uterus, more powerfully towards the end of pregnancy, during labour, and immediately postpartum. At these times, the oxytocin receptors in the myometrium are increased.

The oxytocin receptors are G-proteins coupled receptors. Activation of receptor by oxytocin triggers release of calcium from intracellular stores and thus leads to myometrial contraction.

Oxytocin elicits rhythmic contractions in upper segment of uterus, similar in frequency, force and duration to those observed during labour.

Being synthetic, oxytocin in Oxytocin does not contain vasopressin, but even in its pure form oxytocin possesses some weak intrinsic vasopressin-like antidiuretic activity.

Based on in vitro studies, prolonged exposure of oxytocin had been reported to cause desensitisation of oxytocin receptors probably due to down-regulation of oxytocin-binding sites, destabilisation of oxytocin receptors mRNA and internalisation of oxytocin receptors.

Plasma levels and onset/duration of effect

Intravenous infusion. When Oxytocin is given by continuous i.v. infusion at doses appropriate for induction or enhancement of labour, the uterine response sets in gradually and usually reaches a steady state within 20 to 40 minutes. The corresponding plasma levels of oxytocin are comparable to those measured during spontaneous first-stage labour. For example, oxytocin plasma levels in 10 pregnant women at term receiving a 4 milliunits per minute intravenous infusion were 2 to 5 microunits/mL. Upon discontinuation of the infusion, or following a substantial reduction in the infusion rate, e.g. in the event of overstimulation, uterine activity declines rapidly but may continue at an adequate lower level.

5.2 Pharmacokinetic properties

Absorption

Plasma levels of oxytocin following intravenous infusion at 4 milliunits per minute in pregnant women at term were 2 to 5 microunits/mL.

Distribution

The steady-state volume of distribution determined in 6 healthy men after i.v. injection is 12.2 L or 0.17 L/kg. Plasma protein binding is negligible for oxytocin. It crosses the placenta in both directions. Oxytocin may be found in small quantities in mother’s breast milk.

Biotransformation/Metabolism

Oxytocinase is a glycoprotein aminopeptidase that is produced during pregnancy and appears in the plasma. It is capable of degrading oxytocin. It is produced from both the mother and the foetus. Liver and kidney plays a major role in metabolising and clearing oxytocin from the plasma. Thus, liver, kidney and systemic circulation contribute to the biotransformation of oxytocin.

Elimination

Plasma half-life of oxytocin ranges from 3 to 20 min. The metabolites are excreted in urine whereas less than 1% of the oxytocin is excreted unchanged in urine. The metabolic clearance rate amounts to 20 mL/kg/ min in the pregnant woman.

Renal impairment

No studies have been performed in renally impaired patients. However, considering the excretion of oxytocin and its reduced urinary excretion because of anti-diuretic properties, the possible accumulation of oxytocin can result in prolonged action.

Hepatic impairment

No studies have been performed in hepatically impaired patients. Pharmacokinetic alteration in patients with impaired hepatic function is unlikely since metabolising enzyme, oxytocinase, is not confined to liver alone and the oxytocinase levels in placenta during the term has significantly increased. Therefore, biotransformation of oxytocin in impaired hepatic function may not result in substantial changes in metabolic clearance of oxytocin.

5.3 Preclinical safety data

Pre-clinical data for oxytocin reveal no special hazard for humans based on conventional studies of single dose acute toxicity, genotoxicity, and mutagenicity.

6. Pharmaceutical particulars

6.1 List of excipients

Sodium acetate tri-hydrate, acetic acid, chlorobutanol, ethanol and water for injections.

6.2 Incompatibilities

Oxytocin should not be infused via the same apparatus as blood or plasma, because the peptide linkages are rapidly inactivated by oxytocin-inactivating enzymes. Oxytocin is incompatible with solutions containing sodium metabisulphite as a stabiliser.

6.3 Shelf life

Five years

6.4 Special precautions for storage

Store between 2°C and 8°C. May be stored up to 30°C for 3 months, but must then be discarded.

6.5 Nature and contents of container

Clear glass 1 ml ampoules. Boxes of 5 ampoules.

6.6 Special precautions for disposal and other handling

Snap ampoules: no file required.

Oxytocin is compatible with the following infusion fluids, but due attention should be paid to the advisability of using electrolyte fluids in individual patients: sodium/potassium chloride (103mmol Na⁺ and 51mmol K⁺), sodium bicarbonate 1.39%, sodium chloride 0.9%, sodium lactate 1.72%, dextrose 5%, laevulose 20%, macrodex 6%, rheomacrodex 10%, Ringer’s solution.

7. Manufactured in India by:
TAJ PHARMACEUTICALS LTD.
Mumbai, India
Unit No. 214.Old Bake House,
Maharashtra chambers of Commerce Lane,
Fort, Mumbai – 400001
at:Gujarat, INDIA.
Customer Service and Product Inquiries:
1-800-TRY-FIRST (1-800-222-434 & 1-800-222-825)
Monday through Saturday 9:00 a.m. to 7:00 p.m. EST
E-mail: tajgroup@tajpharma.com

Oxytocin Injection USP 5 IU/ml and 10 IU/ml

PATIENT INFORMATION LEAFLET

Oxytocin 5 IU/ml and 10 IU/ml Concentrate for solution for infusion Taj Pharma

oxytocin

Read all of this leaflet carefully before you receive this medicine because it contains important information for you.

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

What is in this leaflet

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

1. What Oxytocin is and what it is used for

Oxytocin contains a manufactured form of oxytocin (a natural hormone). It belongs to a group of medicines called oxytocics that make the muscles of the womb contract.

Oxytocin is used:

• to start or help contractions during childbirth (labour)
• to help in the management of a miscarriage
• to prevent and control bleeding after delivery of your baby
• during a caesarean section.

2. What you need to know before you receive Oxytocin

You must not receive Oxytocin:

• 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

Oxytocin should not be used for prolonged periods if:

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

Warnings and precautions

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 low 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.

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

receive Oxytocin.

Latex allergy

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

Other medicines and 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.

Oxytocin with food and drink

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

Pregnancy and breast-feeding

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.

Driving and using machines

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

Oxytocin contains ethanol

Oxytocin contains small amounts of ethanol (alcohol), less than 100mg per dose.

3. How Oxytocin is given to you

Your doctor or midwife will decide when and how to treat you with Oxytocin. If you think that the effect of Oxytocin is too strong or too weak, tell your doctor or midwife. While you are receiving Oxytocin, both you and your baby will be closely monitored.

Oxytocin is usually diluted before use and given as an intravenous infusion (drip) into one of your veins.

The usual dose is different in the following circumstances:

To start or help contractions during labour

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.

What to do if you receive more Oxytocin than you should

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 leftover 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.

What to do if you miss a dose

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

If you have any further questions on the use of this medicine, ask your doctor or midwife.

4. Possible side effects

Like all medicines, Oxytocin can cause side effects, although not everyone gets them. Your doctor may consider it necessary to treat the side effects of Oxytocin with other medicines.

Some side effects could be serious. If any of the following occur, tell your doctor straight away:

The following side effect may affect between 1 and 10 in every 10,000 patients:

• a severe allergic (anaphylactic/anaphylactoid) reaction with difficulty in breathing, dizziness and lightheadedness, feeling faint, nausea, cold and clammy skin or a fast or weak pulse
• Swelling of the face, lips, tongue, throat, and/or extremities (possible signs of angioedema)

The following side effects have been reported in Oxytocin

Common side effects (more than 1 in 100 patients) of Oxytocin include:

• feeling or being sick
• headache
• fast or slow heartbeat

Uncommon side effects (more than 1 in 1,000 patients) of Oxytocin include:

• an irregular heartbeat.

Rare side effects (more than 1 in 10,000 patients) of Oxytocin include:

• skin rashes

Other side effects

Effects in the mother:

• haemorrhage (bleeding)ss
• 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.

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or midwife. This includes any possible side effects not listed in this leaflet. You can also report side effects directly (see below).

5. How to store Oxytocin

Keep this medicine out of the sight and reach of children.

The hospital pharmacy will store this medicine in a refrigerator between 2º to 8°C and make sure that it is not used after the expiry date on the pack. The expiry date refers to the last day of that month. Oxytocin may be stored at temperatures of up to 30°C for 3 months, but must then be discarded.

If your doctor decides to stop your treatment, return any unused medicine to the pharmacist. Only keep it if your doctor tells you to.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist on how to dispose of medicines no longer required. These measures will help protect the environment.

6. Contents of the pack and other information

What Oxytocin contains

The active substance is oxytocin.

The other ingredients are sodium acetate tri-hydrate, chlorobutanol, ethanol, acetic acid and water for injections.

What Oxytocin looks like and contents of the pack

Oxytocin is a clear, colourless, sterile liquid which comes in a 1ml (millilitre) clear glass ampoule. Oxytocin comes in packs of five ampoules. Each Oxytocin ampoule contains either  5  IU (International Units) or 10 IU oxytocin.

7. Manufactured in India by:
   TAJ PHARMACEUTICALS LTD.
   Mumbai, India
   Unit No. 214.Old Bake House,
   Maharashtra chambers of Commerce Lane,
   Fort, Mumbai – 400001
   at:Gujarat, INDIA.
   Customer Service and Product Inquiries:
   1-800-TRY-FIRST (1-800-222-434 & 1-800-222-825)
   Monday through Saturday 9:00 a.m. to 7:00 p.m. EST
   E-mail: tajgroup@tajpharma.com