Demoxytocin
Also known as: 1-deamino-oxytocin, Deamino-oxytocin, Demoxytocin, Desaminooxytocin, Moxytocin, Sandopart
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Summary
Demoxytocin is a synthetic oxytocin analogue that is approved for prescription use to induce or augment labour. It is most commonly given as buccal tablets (resoriblets) but can also be administered intramuscularly, intravenously, nasally, subcutaneously or sublingually. Clinical trials have compared demoxytocin with prostaglandin E2 for induction in overdue pregnancies, unripe cervix, and premature rupture of membranes, showing it can achieve labour in a majority of cases with a generally mild side‑effect profile.
Mechanism of Action
Demoxytocin mimics oxytocin by binding to oxytocin receptors on uterine smooth muscle. Receptor activation triggers the phosphatidyl‑inositol‑calcium signalling cascade, raising intracellular calcium and promoting myometrial contraction. The molecule lacks the N‑terminal amino acid of native oxytocin, which modestly alters its pharmacokinetics but retains sufficient affinity to stimulate uterine activity needed for labour induction or augmentation.
What the Research Shows
Randomised studies from the late 1970s to early 1980s compared buccal demoxytocin with oral prostaglandin E2. In overdue pregnancies, labour was induced in 92 % of demoxytocin recipients versus 96 % with prostaglandin E2, though operative delivery was slightly higher with demoxytocin. In women with an unfavourable cervix (Bishop ≤5), success rates were lower for demoxytocin (≈62 %) than for prostaglandin E2 (≈82 %). When primary amniotomy was performed, prostaglandin E2 achieved higher success (82 % vs 63 %). In cases of premature rupture of membranes, demoxytocin’s success (77 %) was not significantly different from prostaglandin E2 (86 %). Across trials, demoxytocin showed no hypertonic uterine contractions and a lower incidence of gastrointestinal side effects than prostaglandin E2. Neonatal jaundice rates were not significantly influenced by the choice of oxytocic.
Reported Benefits
Demoxytocin reliably induces labour in most women, including those with overdue pregnancies, and can be administered via the buccal route, avoiding injection. Compared with prostaglandin E2, it is associated with fewer gastrointestinal adverse effects and no reported hypertonic uterine contractions. The drug’s oral‑mucosal delivery simplifies administration in outpatient settings.
Limitations of the Evidence
Evidence indicates demoxytocin is less effective than prostaglandin E2 for cervical ripening in women with an unfavourable Bishop score, with lower success rates and a higher operative‑delivery proportion. All published data are from older trials; no recent head‑to‑head comparisons with modern intravenous oxytocin protocols are available. Sample sizes are modest, and the studies focus on specific obstetric scenarios, limiting generalisability.
Safety Considerations
Across the cited trials, demoxytocin was well tolerated. No hypertonic uterine contractions or serious maternal complications were reported. Mild side effects such as nausea or vomiting occurred in about 1–2 % of patients, considerably lower than with prostaglandin E2. Neonatal jaundice incidence did not differ significantly between demoxytocin and other oxytocics, suggesting no major neonatal safety concerns.
How It Is Administered
Demoxytocin is formulated as buccal tablets (resoriblets) that dissolve in the mouth for systemic absorption. It may also be given intramuscularly, intravenously, nasally, subcutaneously or sublingually, although the published obstetric studies primarily used the buccal route. Dosing regimens in the literature involved repeated doses (e.g., 50 IU every 30 minutes) until labour commenced.
Routes of Administration
Goals & Uses
- Induction of laborObstetricsModerate
- Augmentation of laborObstetricsModerate
- Promotion of lactation / milk ejectionLactationModerate
- Third stage of labor managementObstetricsLow
- Labor inductionObstetricsModerate
- Postpartum hemorrhage prophylaxisObstetricsModerate
- Control of postpartum hemorrhageObstetricsModerate
Contraindications
- Cephalopelvic disproportionObstetricHigh
- Placenta praeviaObstetricHigh
- Hypersensitivity to demoxytocin or oxytocinAllergyHigh
- Fetal malpresentation requiring cesareanObstetricHigh
- Placenta previaObstetricHigh
- Hypertonic uterine contractionsObstetricHigh
- Vasa praeviaObstetricHigh
- Fetal distressObstetricHigh
Adverse Effects
- Allergic reactionsImmunologicalRare
- Uterine hyperstimulationUterineCommon
- HypotensionCardiovascularUncommonLow blood pressure
- Water intoxicationRenalRare
- Nausea and vomitingGastrointestinalCommon
- Water retention / hyponatremiaMetabolicUncommon
- Fetal bradycardiaNeonatalUncommon
Drug Interactions
- Prostaglandin analogsModerate
- General anesthetics (e.g., halothane)Moderate
- Prostaglandins (e.g., dinoprostone, misoprostol)High
- OxytocinModerate
- Vasoconstrictors (sympathomimetics)Moderate
- Ergot alkaloids (e.g., ergometrine)Moderate
Population Constraints
- Grand multiparous womenObstetricRelative
- Women with cardiovascular diseaseCardiovascularRelative
- Women with prior uterine surgery or cesarean sectionObstetric HistoryRelative
- Elderly patientsAgeRelative
- Pregnant women (non-obstetric use)PregnancyAbsolute
- Pregnant women (≥37 weeks gestation)ObstetricAbsolute
- NeonatesPediatricRelative
Regulatory Status
- European UnionApprovedApproved: Labor induction, Postpartum hemorrhageApproved in several EU member states.
- United StatesUnapprovedNot approved by FDA.
- United KingdomApprovedApproved: Labor inductionApproved for obstetric use.
Approved for obstetric use in several European and Asian countries; not approved by the FDA in the United States.
Evidence & Sources
- Journal ArticleModerateUlstein M, Sagen N, Eikhom SN1979-01-01T00:00:00.000000Z
- Journal ArticleModerateSørensen SS, Brocks V, Lenstrup C1985-01-01T00:00:00.000000Z
- Journal ArticleModerateLange AP, et al.1982-01-01T00:00:00.000000Z
- Journal ArticleModerateWestergaard JG, et al.1983-01-01T00:00:00.000000Z
- Journal ArticleModerateWestergaard JG, et al.1983-01-01T00:00:00.000000Z
- Journal ArticleModerateLykkesfeldt G1976-01-01T00:00:00.000000Z
Frequently Asked Questions
How does demoxytocin differ from natural oxytocin?
Demoxytocin is a synthetic analogue that lacks the N‑terminal amino acid of oxytocin. This structural change modestly alters its pharmacokinetics but preserves enough receptor affinity to stimulate uterine contractions similarly to the natural hormone.
Is demoxytocin more effective than prostaglandin E2 for labour induction?
In women with a favourable cervix or after amniotomy, demoxytocin achieves success rates comparable to prostaglandin E2. However, in cases of an unfavourable cervix (Bishop ≤5), prostaglandin E2 consistently shows higher induction success.
What side effects should be expected with demoxytocin?
Reported adverse effects are mild and infrequent, mainly nausea or vomiting in about 1–2 % of patients. No hypertonic uterine contractions or serious maternal complications were observed in the cited studies.
Can demoxytocin be used for cervical ripening?
The available evidence suggests limited efficacy for cervical ripening, especially when the Bishop score is low. Prostaglandin E2 has demonstrated superior ripening properties in the same clinical settings.
Is demoxytocin safe for the newborn?
Neonatal jaundice rates did not differ significantly between demoxytocin and other oxytocics, indicating no clear increase in neonatal risk associated with its use.
What is Demoxytocin?
Demoxytocin is a synthetic oxytocin analogue that is approved for prescription use to induce or augment labour. It is most commonly given as buccal tablets (resoriblets) but can also be administered intramuscularly, intravenously, nasally, subcutaneously or sublingually. Clinical trials have compared demoxytocin with prostaglandin E2 for induction in overdue pregnancies, unripe cervix, and premature rupture of membranes, showing it can achieve labour in a majority of cases with a generally mild side‑effect profile.
What is Demoxytocin used for?
Demoxytocin is educationally associated with: Induction of labor, Augmentation of labor, Promotion of lactation / milk ejection, Third stage of labor management, Labor induction, Postpartum hemorrhage prophylaxis, Control of postpartum hemorrhage. Educational only — not medical advice.
How is Demoxytocin administered?
Recorded routes of administration: Buccal, Intramuscular, Intravenous, Nasal, Subcutaneous, Sublingual.
What are the potential side effects of Demoxytocin?
Reported adverse effects include: Allergic reactions, Uterine hyperstimulation, Hypotension, Water intoxication, Nausea and vomiting, Water retention / hyponatremia, Fetal bradycardia. This list is not exhaustive — consult a qualified clinician.
Who should avoid Demoxytocin?
Recorded contraindications: Cephalopelvic disproportion, Placenta praevia, Hypersensitivity to demoxytocin or oxytocin, Fetal malpresentation requiring cesarean, Placenta previa, Hypertonic uterine contractions, Vasa praevia, Fetal distress. Consult a qualified clinician before use.