Reference — Maternal-Newborn
Uterotonic Medications Reference
The atony drugs in working order — and the two contraindication pairings every nurse and every exam expects you to know cold: methylergonovine–hypertension and carboprost–asthma.
Educational use only. Doses, sequences, and repeat intervals follow your hemorrhage protocol and provider orders — this reference covers agent characteristics for learning. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Agents at a Glance
| Drug | Route | Key Contraindication | Side Effects | Nursing Notes |
|---|---|---|---|---|
| Oxytocin (Pitocin) | IV infusion (diluted) or IM | None absolute in hemorrhage — first-line | Water intoxication/hyponatremia with prolonged high-dose infusions; hypotension with rapid IV push (avoid undiluted push) | Routine active-management dose after every birth; rate titrated to tone |
| Methylergonovine (Methergine) | IM (typical) | Hypertension / preeclampsia | Hypertension, vasoconstriction, nausea | Check the blood pressure before giving — the classic exam pairing |
| Carboprost (Hemabate) | IM, repeatable per protocol | Asthma | Bronchospasm, significant diarrhea, nausea, fever | Prostaglandin F2α — the asthma pairing; premedicate for GI effects per order |
| Misoprostol (Cytotec) | Rectal, sublingual, or oral per protocol | No major hemorrhage-setting contraindication | Fever, shivering, GI upset | Prostaglandin E1 — useful when IV access or refrigeration is limited |
| Tranexamic acid (TXA) | IV | Active thromboembolic disease (caution) | Generally well tolerated; thrombosis concern | Antifibrinolytic, not a uterotonic — given early (commonly within 3 hours of onset) alongside the agents above |
Sequence Logic
Fundal massage happens with, not instead of, medications. Oxytocin runs first and continuously; the second-line choice between methylergonovine and carboprost is usually decided by the patient’s history — hypertensive patients get carboprost, asthmatic patients get methylergonovine, and patients with both push the team to misoprostol and escalation.
While drugs cycle, the rest of the response advances in parallel: second IV, labs and crossmatch, quantified loss, and the provider’s next rung (bimanual compression, balloon tamponade, OR).
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with American College of Obstetricians and Gynecologists (ACOG) · AWHONN · American Academy of Pediatrics (AAP) — newborn. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →