Induxin

Pharmacotherapeutic group: Posterior pituitary lobe hormones

ATC code: H01B B02

Mechanism of action

Induxin is a cyclic nonapeptide that is obtained by chemical synthesis. This synthetic form is identical to the natural hormone that is stored in the posterior pituitary and released into the systemic circulation in response to suckling and labour.

Induxin stimulates the smooth muscle of the uterus, more powerfully towards the end of pregnancy, during labour, and immediately postpartum. At these times, the Induxin receptors in the myometrium are increased.

The Induxin receptors are G-proteins coupled receptors. Activation of receptor by Induxin triggers release of calcium from intracellular stores and thus leads to myometrial contraction.

Induxin elicits rhythmic contractions in upper segment of uterus, similar in frequency, force and duration to those observed during labour.

Being synthetic, Induxin in Induxin does not contain vasopressin, but even in its pure form Induxin possesses some weak intrinsic vasopressin-like antidiuretic activity.

Based on in vitro studies, prolonged exposure of Induxin had been reported to cause desensitisation of Induxin receptors probably due to down-regulation of Induxin-binding sites, destabilisation of Induxin receptors mRNA and internalisation of Induxin receptors.

Plasma levels and onset/duration of effect

Intravenous infusion. When Induxin is given by continuous IV infusion at doses appropriate for induction or enhancement of labour, the uterine response sets in gradually and usually reaches a steady state within 20 to 40 minutes. The corresponding plasma levels of Induxin are comparable to those measured during spontaneous first-stage labour. For example, Induxin plasma levels in 10 pregnant women at term receiving a 4 milliunits per minute intravenous infusion were 2 to 5 microunits/mL. Upon discontinuation of the infusion, or following a substantial reduction in the infusion rate, e.g. in the event of overstimulation, uterine activity declines rapidly but may continue at an adequate lower level.

Pharmacotherapeutic group: Posterior pituitary lobe hormones

ATC code: H01B B02

Mechanism of action

Oxytocin is a cyclic nonapeptide that is obtained by chemical synthesis. This synthetic form is identical to the natural hormone that is stored in the posterior pituitary and released into the systemic circulation in response to suckling and labour.

Oxytocin stimulates the smooth muscle of the uterus, more powerfully towards the end of pregnancy, during labour, and immediately postpartum. At these times, the oxytocin receptors in the myometrium are increased.

The oxytocin receptors are G-proteins coupled receptors. Activation of receptor by oxytocin triggers release of calcium from intracellular stores and thus leads to myometrial contraction.

Oxytocin elicits rhythmic contractions in upper segment of uterus, similar in frequency, force and duration to those observed during labour.

Being synthetic, oxytocin in Induxin does not contain vasopressin, but even in its pure form oxytocin possesses some weak intrinsic vasopressin-like antidiuretic activity.

Based on in vitro studies, prolonged exposure of oxytocin had been reported to cause desensitisation of oxytocin receptors probably due to down-regulation of oxytocin-binding sites, destabilisation of oxytocin receptors mRNA and internalisation of oxytocin receptors.

Plasma levels and onset/duration of effect

Intravenous infusion. When Induxin is given by continuous i.v. infusion at doses appropriate for induction or enhancement of labour, the uterine response sets in gradually and usually reaches a steady state within 20 to 40 minutes. The corresponding plasma levels of oxytocin are comparable to those measured during spontaneous first-stage labour. For example, oxytocin plasma levels in 10 pregnant women at term receiving a 4 milliunits per minute intravenous infusion were 2 to 5 microunits/mL. Upon discontinuation of the infusion, or following a substantial reduction in the infusion rate, e.g. in the event of overstimulation, uterine activity declines rapidly but may continue at an adequate lower level.

Absorption

Plasma levels of Induxin following intravenous infusion at 4 milliunits per minute in pregnant women at term were 2 to 5 microunits/mL.

Distribution

The steady-state volume of distribution determined in 6 healthy men after IV injection is 12.2 L or 0.17 L/kg. Plasma protein binding is negligible for Induxin. It crosses the placenta in both directions. Induxin may be found in small quantities in mother's breast milk.

Biotransformation/Metabolism

Induxinase is a glycoprotein aminopeptidase that is produced during pregnancy and appears in the plasma. It is capable of degrading Induxin. It is produced from both the mother and the foetus. Liver and kidney plays a major role in metabolising and clearing Induxin from the plasma. Thus, liver, kidney and systemic circulation contribute to the biotransformation of Induxin.

Elimination

Plasma half-life of Induxin ranges from 3 to 20 min. The metabolites are excreted in urine whereas less than 1% of the Induxin is excreted unchanged in urine. The metabolic clearance rate amounts to 20 mL/kg/ min in the pregnant woman.

Renal impairment

No studies have been performed in renally impaired patients. However, considering the excretion of Induxin and its reduced urinary excretion because of anti-diuretic properties, the possible accumulation of Induxin can result in prolonged action.

Hepatic impairment

No studies have been performed in hepatically impaired patients. Pharmacokinetic alteration in patients with impaired hepatic function is unlikely since metabolising enzyme, Induxinase, is not confined to liver alone and the Induxinase levels in placenta during the term has significantly increased. Therefore, biotransformation of Induxin in impaired hepatic function may not result in substantial changes in metabolic clearance of Induxin.

Absorption

Plasma levels of oxytocin following intravenous infusion at 4 milliunits per minute in pregnant women at term were 2 to 5 microunits/mL.

Distribution

The steady-state volume of distribution determined in 6 healthy men after i.v. injection is 12.2 L or 0.17 L/kg. Plasma protein binding is negligible for oxytocin. It crosses the placenta in both directions. Oxytocin may be found in small quantities in mother's breast milk.

Biotransformation/Metabolism

Oxytocinase is a glycoprotein aminopeptidase that is produced during pregnancy and appears in the plasma. It is capable of degrading oxytocin. It is produced from both the mother and the foetus. Liver and kidney plays a major role in metabolising and clearing oxytocin from the plasma. Thus, liver, kidney and systemic circulation contribute to the biotransformation of oxytocin.

Elimination

Plasma half-life of oxytocin ranges from 3 to 20 min. The metabolites are excreted in urine whereas less than 1% of the oxytocin is excreted unchanged in urine. The metabolic clearance rate amounts to 20 mL/kg/ min in the pregnant woman.

Renal impairment

No studies have been performed in renally impaired patients. However, considering the excretion of oxytocin and its reduced urinary excretion because of anti-diuretic properties, the possible accumulation of oxytocin can result in prolonged action.

Hepatic impairment

No studies have been performed in hepatically impaired patients. Pharmacokinetic alteration in patients with impaired hepatic function is unlikely since metabolising enzyme, oxytocinase, is not confined to liver alone and the oxytocinase levels in placenta during the term has significantly increased. Therefore, biotransformation of oxytocin in impaired hepatic function may not result in substantial changes in metabolic clearance of oxytocin.

Pre-clinical data for Induxin reveal no special hazard for humans based on conventional studies of single dose acute toxicity, genotoxicity, and mutagenicity.

Pre-clinical data for oxytocin reveal no special hazard for humans based on conventional studies of single dose acute toxicity, genotoxicity, and mutagenicity.

Induxin should not be infused via the same apparatus as blood or plasma, because the peptide linkages are rapidly inactivated by Induxin-inactivating enzymes. Induxin is incompatible with solutions containing sodium metabisulphite as a stabiliser.

Induxin should not be infused via the same apparatus as blood or plasma, because the peptide linkages are rapidly inactivated by oxytocin-inactivating enzymes. Induxin is incompatible with solutions containing sodium metabisulphite as a stabiliser.

Snap ampoules: no file required.

Induxin is compatible with the following infusion fluids: sodium chloride 0.9 %, dextrose 5 %, Ringer's solution, acetated Ringer's solution.

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.

Snap ampoules: no file required.

Induxin is compatible with the following infusion fluids, but due attention should be paid to the advisability of using electrolyte fluids in individual patients: sodium/potassium chloride (103mmol Na⁺ and 51mmol K⁺), sodium bicarbonate 1.39%, sodium chloride 0.9%, sodium lactate 1.72%, dextrose 5%, laevulose 20%, macrodex 6%, rheomacrodex 10%, Ringer's solution.