Grace asked about use of oxytocin nasal spray:
It sounds like this mother is the perfect candidate for oxytocin nasal
spray. I've prescribed it several times in similar circumstances with
excellent results.
I got my guidelines from Ruth Lawrence's text:
I prescribe
Oxytocin Nasal Spray 40 units/ml (Some docs use 10 units/ml, but Dr. L's
says 40)
disp. 5cc
Sig Use one spray each nostril 2-3 minutes before feeding or pumping.
refill: one
This amount lasts about 2 weeks, and by then mom's own reflex is usually
working.
I've never had anybody actually need the refill, but they know it's there
if they do.
Contraindications are allergy to the med, and pregnancy.
Side effects include increased intensity of afterpains (actually an
indication that it's working!), and theoretically, overactive MER.
Regarding it's "not being approved for this use": this is exactly the same
as the Syntocinon Nasal Spray that Wyeth (?) used to market, approved for
exactly this use. The reason that Wyeth took it off the market in 1996 was
that they were losing money on it, because it doesn't have a very long
shelf life. It had nothing to do with any reports of problems that I'm
aware of.
Since it only has a half-life of about 90 seconds, no significant amount
comes through in the milk, or lingers in mom's system, for that matter.
Regarding legal issues, I have a handout that I give moms explaining what
the MER is, how it works, and why theirs may not be working properly. It
goes on to explain how the nasal spray may help, etc. It also talks
about how this is the same med they were given by IV after their placenta
delivered, just made into a nose spray for this use, "like they used to
sell." As long as mothers give informed consent (in the true sense of the
phrase), and you document they you discussed all this with them and they
agreed, you should be ok. It's still their choice whether to get the
script filled, after all.
Hope this is helpful,
Becky Saenz, MD, IBCLC
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