Last update: Sept. 6, 2021

Oxytocin

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

Oxytocin is an endogenous hormone with a cyclic nonapeptide structure. It is secreted by the hypothalamus and stored in the posterior lobe of the pituitary gland.
It is an essential hormone during childbirth and lactation and it is released during breastfeeding producing a calming and anxiolytic effect on the mother (Niwayama 2017).
It is present in men and women even during the neonatal period and its natural form has been found in breast milk (Lawrence 2016 p77).
Causes uterine contractions and has a mild antidiuretic effect.

The bioavailable synthetic form is used to induce labor, support delivery of the placenta and control postpartum bleeding (Uptodate 2018).
Oxytocin is administered intravenously and intranasally through various dosing protocols (ACOG 2009, Leduc 2013, Wei 2010, Uptodate 2018).

At the date of the last update, we did not find published data on its excretion in breast milk.

Pharmacokinetic data (moderately high molecular weight and acidic pKa) make it unlikely for oxytocin to pass into breast milk in significant quantities (Hale 2017 p741).
Due to its proteinaceous nature it is inactivated in the gastrointestinal tract without being absorbed (oral bioavailability practically nil: De Groot 1995) and this hinders or prevents passage to neonatal and infant plasma from ingested breast milk (Apotex 2018, Alfasigma2018, Hale 2017 p741). Circulating oxytocin in neonatal / infant plasma is endogenously produced (Lawrence 2016 p77).

USE OF OXYTOCIN DURING DELIVERY
The induction of labor with oxytocin is widespread and has known risks (Guerra 2009).
There is controversy about how exogenous oxytocin during labor can affect endogenous secretion and lactation. Even though there is little research with limited methodologies and of very heterogeneous consistencies (Erickson 2017, Buckley 2015), several studies suggest that intravenous oxytocin administered during childbirth can affect breastfeeding altering primitive reflexes and reducing neonatal breastfeeding behaviour responses, delaying or hindering the start or duration of lactation (Marin 2015, Brimdyr 2015, Bell 2013, Abdoulahi 2017, Gomes 2018, García 2014, BBrown 2014, Bell 2013, Olza 2012, Wiklund 2009).
Other research has not found this association (Takahashi 2021, Fernández 2019 and 2017), especially if the administration of oxytocin is not accompanied by epidural analgesia (Takahashi 2021) or when long-term results are measured. The possible adverse effects of synthetic intrapartum oxytocin do not persist beyond the first few days: the administration of intrapartum oxytocin decreases the probability of exclusive breastfeeding on discharge from the maternity, but does not affect the duration or type of breastfeeding at 6 weeks or 9 months postpartum (Takács 2021).

USE OF OXYTOCIN AS GALACTOGOGUE
Oxytocin has been used as a galactogogue (Winterfeld 2012) with very different results. One trial with significant methodological flaws found an important increase in production (Ruis 1981) and in another trial there was no difference in milk production between the two evaluated groups (Fewtrel 2006).
A series of 3 cases of tetraplegic mothers with loss of neuronal connection between breast and hypothalamus reported a favorable effect on milk letdown with the use inhaled oxytocin (Cowley2005).

The chronic use of intranasal oxytocin can lead to dependence, so its use should be limited to the first week postpartum (Hale 2017 p741).

The best galactogogue is a frequent on-demand lactation with correct technique and a mother that retains her self-confidence (Mannion 2012, Forinash 2012, ABM 2011). Do not use as a galactogogue without sanitary control.

Oxytocin does not improve the symptoms of breast engorgement in the immediate puerperium (Mangesi 2016, Ingelman-Sundberg1953).

Alternatives

We do not have alternatives for Oxytocin.

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Oxytocin is also known as


Oxytocin in other languages or writings:

Group

Oxytocin belongs to this group or family:

Tradenames

Main tradenames from several countries containing Oxytocin in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 0,078 %
Molecular weight 1.007 daltons
Protein Binding 30 %
VD 0,17 l/Kg
pKa 6,56 -
Tmax 0,17 - 0,88 hours
T1/2 0,05 - 0,33 hours

References

  1. Fernández-Cañadas Morillo A, Durán Duque M, Hernández López AB, Muriel Miguel C, Pérez Riveiro P, Salcedo Mariña A, Royuela Vicente A, Casillas Santana ML, Marín Gabriel MA. Cessation of breastfeeding in association with oxytocin administration and type of birth. A prospective cohort study. Women Birth. 2019 Feb;32(1):e43-e48. Abstract
  2. Alfasigma. Oxitocina (Syntocinon). Ficha técnica. 2018 Full text (in our servers)
  3. Apotex. Oxytocin. Drug Summary. 2018 Full text (in our servers)
  4. Gomes M, Trocado V, Carlos-Alves M, Arteiro D, Pinheiro P. Intrapartum synthetic oxytocin and breastfeeding: a retrospective cohort study. J Obstet Gynaecol. 2018 Aug;38(6):745-749. Abstract
  5. Hemati Z, Abdollahi M, Broumand S, Delaram M, Namnabati M, Kiani D. Association between Newborns' Breastfeeding Behaviors in the First Two Hours After Birth and Drugs Used For Their Mothers in Labor. Iran J Child Neurol. 2018 Spring;12(2):33-40. Abstract
  6. Erickson EN, Emeis CL. Breastfeeding Outcomes After Oxytocin Use During Childbirth: An Integrative Review. J Midwifery Womens Health. 2017 Jul;62(4):397-417. Abstract
  7. Niwayama R, Nishitani S, Takamura T, Shinohara K, Honda S, Miyamura T, Nakao Y, Oishi K, Araki-Nagahashi M. Oxytocin Mediates a Calming Effect on Postpartum Mood in Primiparous Mothers. Breastfeed Med. 2017 Mar;12:103-109. Abstract
  8. Fernández-Cañadas Morillo A, Marín Gabriel MA, Olza Fernández I, Martínez Rodríguez B, Durán Duque M, Malalana Martínez AM, Gonzalez Armengod C, Pérez Riveiro P, García Murillo L. The Relationship of the Administration of Intrapartum Synthetic Oxytocin and Breastfeeding Initiation and Duration Rates. Breastfeed Med. 2017 Mar;12:98-102. Abstract
  9. Mangesi L, Zakarija-Grkovic I. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev. 2016 Jun 28;(6):CD006946. Abstract
  10. [No authors listed] Guidelines for oxytocin administration after birth: AWHONN practice brief number 2. J Obstet Gynecol Neonatal Nurs. 2015 Jan-Feb;44(1):161-163. Abstract
  11. Marín Gabriel MA, Olza Fernández I, Malalana Martínez AM, González Armengod C, Costarelli V, Millán Santos I, Fernández-Cañadas Morillo A, Pérez Riveiro P, López Sánchez F, García Murillo L. Intrapartum synthetic oxytocin reduce the expression of primitive reflexes associated with breastfeeding. Breastfeed Med. 2015 May;10(4):209-13. Abstract
  12. Brown A, Jordan S. Active management of the third stage of labor may reduce breastfeeding duration due to pain and physical complications. Breastfeed Med. 2014 Dec;9(10):494-502. Abstract
  13. García-Fortea P, González-Mesa E, Blasco M, Cazorla O, Delgado-Ríos M, González-Valenzuela MJ. Oxytocin administered during labor and breast-feeding: a retrospective cohort study. J Matern Fetal Neonatal Med. 2014 Oct;27(15):1598-603. Abstract
  14. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  15. Bell AF, White-Traut R, Rankin K. Fetal exposure to synthetic oxytocin and the relationship with prefeeding cues within one hour postbirth. Early Hum Dev. 2013 Mar;89(3):137-43. Abstract
  16. Leduc D, Biringer A, Lee L, Dy J; CLINICAL PRACTICE OBSTETRICS COMMITTEE.; SPECIAL CONTRIBUTORS.. Induction of labour. J Obstet Gynaecol Can. 2013 Sep;35(9):840-857. Abstract
  17. Winterfeld U, Meyer Y, Panchaud A, Einarson A. Management of deficient lactation in Switzerland and Canada: a survey of midwives' current practices. Breastfeed Med. 2012 Aug;7:317-8. Abstract
  18. Forinash AB, Yancey AM, Barnes KN, Myles TD. The use of galactogogues in the breastfeeding mother. Ann Pharmacother. 2012 Oct;46(10):1392-404. Abstract
  19. Mannion C, Mansell D. Breastfeeding self-efficacy and the use of prescription medication: a pilot study. Obstet Gynecol Int. 2012;2012:562704. Abstract Full text (link to original source) Full text (in our servers)
  20. Olza Fernández I, Marín Gabriel M, Malalana Martínez A, Fernández-Cañadas Morillo A, López Sánchez F, Costarelli V. Newborn feeding behaviour depressed by intrapartum oxytocin: a pilot study. Acta Paediatr. 2012 Jul;101(7):749-54. Abstract
  21. Zuppa AA, Sindico P, Orchi C, Carducci C, Cardiello V, Romagnoli C. Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production. J Pharm Pharm Sci. 2010;13(2):162-74. Abstract Full text (link to original source) Full text (in our servers)
  22. Wei SQ, Luo ZC, Qi HP, Xu H, Fraser WD. High-dose vs low-dose oxytocin for labor augmentation: a systematic review. Am J Obstet Gynecol. 2010 Oct;203(4):296-304. Abstract
  23. Guerra GV, Cecatti JG, Souza JP, Faúndes A, Morais SS, Gülmezoglu AM, Parpinelli MA, Passini R Jr, Carroli G; World Health Organisation 2005 Global Survey on Maternal and Perinatal Health Research Group. Factors and outcomes associated with the induction of labour in Latin America. BJOG. 2009 Dec;116(13):1762-72. Abstract Full text (link to original source) Full text (in our servers)
  24. Wiklund I, Norman M, Uvnäs-Moberg K, Ransjö-Arvidson AB, Andolf E. Epidural analgesia: breast-feeding success and related factors. Midwifery. 2009 Apr;25(2):e31-8. Epub 2007 Nov 5. Abstract
  25. Cowley KC. Psychogenic and pharmacologic induction of the let-down reflex can facilitate breastfeeding by tetraplegic women: a report of 3 cases. Arch Phys Med Rehabil. 2005 Jun;86(6):1261-4. Abstract
  26. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  27. Gabay MP. Galactogogues: medications that induce lactation. J Hum Lact. 2002 Aug;18(3):274-9. Abstract
  28. De Groot AN, Vree TB, Hekster YA, Pesman GJ, Sweep FC, Van Dongen PJ, Van Roosmalen J. Bioavailability and pharmacokinetics of sublingual oxytocin in male volunteers. J Pharm Pharmacol. 1995 Jul;47(7):571-5. Abstract
  29. Takeda S, Kuwabara Y, Mizuno M. Concentrations and origin of oxytocin in breast milk. Endocrinol Jpn. 1986 Dec;33(6):821-6. Abstract
  30. Ylikorkala O, Kauppila A, Kivinen S, Viinikka L. Treatment of inadequate lactation with oral sulpiride and buccal oxytocin. Obstet Gynecol. 1984 Jan;63(1):57-60. Abstract
  31. Ruis H, Rolland R, Doesburg W, Broeders G, Corbey R. Oxytocin enhances onset of lactation among mothers delivering prematurely. Br Med J (Clin Res Ed). 1981 Aug 1;283(6287):340-2. Abstract
  32. INGELMAN-SUNDBERG A. Early puerpereal breast engorgement. Acta Obstet Gynecol Scand. 1953;32(4):399-402. Abstract

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