| Medication | Dose | Considerations | Major side effects |
| Oxytocin | IV infusion (preferred): Example regimens*[1]:
or¶
Usual duration: ≥4 hours. Usual maximum cumulative dose: 40 units. IM (alternative where IV access is unavailable): 10 units once. | Standard of care for most patients in the United States with or without other uterotonic medications. | Generally well tolerated. Flushing, gastrointestinal (eg, nausea, vomiting). Risk of hypotension, tachycardia, and myocardial ischemia with rapid IV administration of high doses. Risk of hyponatremia (rare) with large doses given for a prolonged period due to water retention. |
| Misoprostol | Buccal/sublingual: 200 to 400 mcg once. Oral (alternative route where oxytocin is unavailable): 600 mcg once. | May also be administered rectally; however, onset may be delayed relative to buccal/sublingual. | Shivering, fever, gastrointestinal (eg, diarrhea, vomiting), headache. |
Ergot alkaloids
| IM: 0.2 mg once. | Due to vasoconstrictive effects, contraindicated in patients with hypertension (including preeclampsia/eclampsia), history of migraine, or vascular disease (eg, Raynaud phenomenon). | Often not well tolerated due to vasoconstrictive adverse effects. Cardiovascular (eg, elevated blood pressure, myocardial ischemia), headache, increase in postpartum abdominal pain, gastrointestinal (eg, nausea, vomiting). |
| Carbetocin (not available in the United States) | IV or IM: 100 mcg once (administer IV over one minute). | According to manufacturer labeling, use with caution in patients with asthma, epilepsy, migraine, or cardiovascular disease. | Similar to oxytocin. Flushing, cardiovascular (eg, hypotension), headache, abdominal pain, gastrointestinal (eg, nausea). |
| Tranexamic acid | IV: 1 g over 10 to 20 minutes once. Alternative 10 to 15 mg/kg over 10 to 20 minutes once. | Some UpToDate contributors routinely use as adjunct to oxytocin in higher-risk settings (eg, for patients who refuse blood products or those with a significant risk for postpartum hemorrhage). | Generally well tolerated; may increase risk of thrombotic events. |
| Oxytocin-ergometrine (combination not available in the United States) | IM: Oxytocin 5 units and ergometrine 0.5 mg once. | Refer to individual medications. | Refer to individual medications. |
IV: intravenous; NS: normal saline; IM: intramuscular.
* The optimal oxytocin infusion regimen has not been established; doses and durations vary among centers. To reduce risk of harm due to a medication error (eg, incorrect rate), UpToDate contributors recommend that centers have available an institutionally approved protocol for oxytocin infusion that includes steps on how to prepare and administer the infusion by programmable infusion pump using standard concentration(s). Commonly used concentrations are 10 to 40 units in 500 to 1000 mL of 0.9% saline.
¶ This oxytocin regimen is used at the UpToDate contributor's center.