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Comment and Controversy

How soon can oxytocin follow misoprostol?

November 2006 · Vol. 18, No. 11

“Is this induction necessary?” by Judith Chung, MD, and Deborah A. Wing, MD

In their useful discussion, Dr. Judith Chung and Dr. Deborah A. Wing wrote: “Uterine hyperstimulation and meconium-stained amniotic fluid appear to be more common with misoprostol, although these risks can be minimized by using a dose of 25 μg (1/4 of a 100-μg tablet) at an interval of 3 to 6 hours, with oxytocin given no later than 4 hours after the last dose of misoprostol.” They probably intended the phrase to be: “with oxytocin given no earlier than 4 hours after the last dose of misoprostol” (emphasis mine). A review of published reports and MedWatch, the US Food and Drug Administration medical products reporting program, indicates that the vast majority of adverse maternal and fetal outcomes associated with misoprostol therapy resulted from the use of doses exceeding 25 μg, dosing intervals more frequent than 3 to 6 hours, addition of oxytocin less than 4 hours after the last misoprostol dose, or use of the drug in women with prior cesarean delivery or major uterine surgery.

Jeffrey Greenspoon, MD
Beverly Hills, Calif

Drs. Chung and Wing respond: Dosing interval was incorrect

We appreciate Dr. Greenspoon’s careful perusal of our article. He is correct that our intention was to emphasize the recommendation that oxytocin should not be administered at an interval less than 4 hours after the last dose of misoprostol, to minimize the risk of uterine hyperstimulation and meconium-stained fluid. We sincerely apologize for this oversight.

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