Cytotec for Inductions - page 3

My hospital will soon be using Cytotec for labor induction. I wondered if anyone out there has used this drug for inductions before, and what your opinions were on that. The literature seems to... Read More

  1. by   CEG
    Quote from L&D.RN
    We use it, and it works well. Sometimes it really moves things along quicker than we're used to with our good ol' cervidil. It's great with a cervix that isn't ready for pit. We give 100mcg q 4-6 hours, but there are stipulations such as if they're contracting >2 in 10 min with some pain, we hold off. There is also a list of contraindications that would restrict our use in certain patients. Some of the nurses don't love it, but I like it a lot better than cervidil, and it's much easier to administer!
    This is a really high dose. The high doses are what is associated with poor outcomes- I believe no more than 50 mcg Q 4 H is what is recommended so it may be prudent to look into that. Most of our docs use cytotec, we only have one who uses cervidil. We are about 50/50 who goes into labor just from the cytotec and those who still need pit.
  2. by   HeartsOpenWide
    Quote from SteelTownRN
    Thanks for responding. Can you elaborate on what the contraindications are? The only ones I'm aware of are: low Bishop score (obviously), and having 5 or more past pregnancies. Are there more? Thanks in advance.
    Ummm....pregnancy!!!!

    First, in reality, using Cytotec for induction is not "off-label" at all--it is "on-label contraindicated." On the Cytotec label it is explicitly written that this drug is contraindicated for use on pregnant women. Contraindication would not be on the label unless data exist suggesting possible serious risks from such use. "On-label contraindicated" is a whole different level of risk-taking than a use that is not mentioned one way or the other on the label.
    http://www.midwiferytoday.com/articles/cytotec.asp

    I just did a preceptorship in L&D at a hospital that uses cytotec but they give it PO instead of vaginally...the nurses said its ok to give it PO...but has anyone else heard if giving PO is safe and does not cause the uterine ruptures that can happen with vaginally? (I am still skeptical)
  3. by   CEG
    Quote from HeartsOpenWide
    Ummm....pregnancy!!!!


    http://www.midwiferytoday.com/articles/cytotec.asp

    I just did a preceptorship in L&D at a hospital that uses cytotec but they give it PO instead of vaginally...the nurses said its ok to give it PO...but has anyone else heard if giving PO is safe and does not cause the uterine ruptures that can happen with vaginally? (I am still skeptical)
    It is equally effective as vaginally without the discomfort of insertion. It still causes the same adverse effects. Many OBs argue that if it is given PO it cannot be retrieved but good luck pulling 25 mcg of cytotec out of the vagina. I think PO is a much more woman-friendly method of insertion.

    Keep in mind that many drugs are used off-label in OB. Including terbutaline. There are many limitations to getting a drug approved for use in OB including the difficulty in studying the effects, the costs, and the ethical questions. There is no benefit for the manufacturers of cytotec or terbutaline to get FDA approval when the drug is cheap, already in use and proven. Although there are adverse outcomes associated with cytotec this is true of any drug and any unnecessary intervention which most cases of cytotec use are. More prudent would be limiting inductions of any type to the medically necessary.
  4. by   HeartsOpenWide
    Quote from CEG
    Keep in mind that many drugs are used off-label in OB. Including terbutaline.
    Where does a nurse stand legally if she is the one that administors an off-label/against label drug such as cytotec and then the pt sues when somthing goes wrong?

    Quote from CEG
    More prudent would be limiting inductions of any type to the medically necessary.
    :yeahthat:
  5. by   CEG
    Quote from HeartsOpenWide
    Where does a nurse stand legally if she is the one that administors an off-label/against label drug such as cytotec and then the pt sues when somthing goes wrong?
    I don't really know but I have been told "local practice standard" trumps everything, including medical evidence, in court. The example I was given is continuous fetal monitoring. Science says it is bad, but if I don't do it and baby dies, then in court I get nailed because "local practice standard" says that it should be done (i.e. hospital policy or all the other docs are doing it). Same with using terb or cytotec. If I use it and bad outcome but "everyone else is doing it" I may have some degree of protection. Also, whatever ACOG says about it can be helpful/harmful. But I don't know any of this for fact Maybe you could just hide behine "doctor's orders." I would love to see what would happened if I start refusing to administer cytotec to patients-- I can guess it would involve me and the unemployment line.

close