Oxytocin Shortage

Last updated October 21, 2022

Yes, but the shortage is affecting hospitals and regions differently. The FDA Drug Shortage Program requires notification of shortages of medically necessary products that could have a significant impact on public health. Two major manufacturers and several small compounding pharmacies currently supply oxytocin in the United States. On September 23, 2022, one of the major manufacturers reported a manufacturing delay of certain-size vials of oxytocin¹. Some hospitals and regions have noticed a shortage already whereas other areas have not experienced a shortage.

Last updated October 21, 2022

When medication supply backorders occur, the FDA notifies end users of products of pending shortage delays. While categories are listed by the FDA for reasons for a drug shortage, the specific explanation is not delineated. This could be due to factors such as requirements related to complying with good manufacturing practices, regulatory delay, a shortage of an active ingredient, shortage of an inactive ingredient component, discontinuation of the manufacture of the drug, delay in shipping of the drug, or a demand increase for the drug.

Last updated January 12, 2023 at 9:30 a.m. ET

The FDA webpage indicates lack of availability from one manufacturer with the next expected release in January 2023, and limited availability from another manufacturer¹.

Last updated October 21, 2022

Oxytocin is utilized for a variety of purposes during labor; alternative medications are available for many of these situations. With thoughtful planning, risks to individual patients should be minimized. As processes and outcomes of care are known to vary by patient population and institutional resources, applying equitable solutions will be important to avoid widening of existing disparities.

Last updated October 21, 2022

Until the oxytocin supply shortage has been resolved, each facility may need to establish a cross-departmental team (pharmacy, obstetric and anesthesia care professionals, nursing leadership, etc.) and an action plan to optimize the use of oxytocin. Examples of interventions could include the following:

Antepartum

• Develop a hierarchy of scheduled and unscheduled inductions as needed and create ongoing processes of review.
• Consider specific indications and contraindications to uterotonics during stratification of individual risk for postpartum hemorrhage based on historical factors.

Intrapartum

• Consider delineating admission criteria for active labor, for example, minimal cervical dilation of 4 cm.
• Use cervical ripening agents for inductions of labor when the Bishop score is not favorable to maximize the Bishop score prior to initiating oxytocin to reduce overall usage. For example, consider use of a balloon with misoprostol for cervical ripening rather than concomitant use with oxytocin.
• Enhance active management of labor, inclusive of amniotomy, to minimize need for pharmacologic augmentation, shorten time to delivery, and minimize hemorrhage risk.
• Stratify and update individual risk for postpartum hemorrhage, with anticipatory planning for management. An example of an approach to stratifying risk is found in ACOG Practice Bulletin No 183, Table 2².
• Limit wasting of the labor oxytocin infusion bag after delivery by using the same infusion bag for the same patient for postpartum hemorrhage prophylaxis, as needed.

Postpartum

• Consider 10 U, IM, oxytocin postpartum for hemorrhage prophylaxis.
• Alternatively, consider replacing oxytocin infusion with one-time doses of alternative uterotonics such as methylergonovine, 15-methyl prostaglandin F2α, or misoprostol, depending on patient risk factors. An example of medication options is found in ACOG Practice Bulletin No 183, Table 3².
• When postpartum hemorrhage has occurred, consider using two doses of uterotonics (either methylergonovine, 15-methl prostaglandin F2α, or misoprostol), advancing to oxytocin infusion only after these therapies are deployed. When initial medical therapy fails, tranexamic acid should be considered.

Additional Potential Actions to Implement

• Avoid routine use of oxytocin for first trimester dilation and curettage.
• Develop mechanisms for daily oversight and accountability to ensure tighter control of current inventory (anesthesia carts, main OR, ED, etc.).