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Dr. Grey AI

Peptide

Atosiban

Atosiban is a nonapeptide oxytocin/vasopressin receptor antagonist for preterm labor. EMA-approved 2000, used in 68+ countries (NOT FDA-approved in US). A-GRADE evidence: Significantly more patients undelivered at 48h and 7 days vs placebo (P≤0.008) at ≥28 weeks gestation. Similar efficacy to beta-agonists but dramatically better tolerated (7.9% vs 70.8% adverse events vs ritodrine). Cochrane review: No superiority vs placebo or other tocolytics for NEONATAL outcomes - delays delivery but doesn't improve baby outcomes. CAUTION at <28 weeks (one trial noted increased fetal deaths). PRESCRIPTION ONLY.

Research notice. This page is for education and research. Peptides may not be FDA-approved for human use and may only be legally available for research. Talk to a qualified clinician before considering any peptide.

Best evidence
Grade A
Conditions studied
1
Outcomes
9
Graded outcomes
5112

Evidence by condition

  • Strong
  • Moderate
  • Limited
  • Very limited

1 condition, plus general outcomes

Preterm Labor

Preterm Labor: outcomes studied for Atosiban
GradeOutcomeEffectSizeStudiesPeopleStudies list
Tocolytic Efficacy vs Beta-Agonists

vs Salbutamol: 48h efficacy 93.3% vs 95.0% (P=0.67). vs Terbutaline: 48h efficacy 86.1% vs 85.3% (P=0.78). Comparable tocolytic effectiveness with better safety profile. Some trials suggest slightly lower initial success rate.

NoneNo effect18 studies

Studies that measured tocolytic efficacy vs beta-agonists

and 8 more in the citations list

Pregnancy Prolongation (48h-7 days)

Romero Phase 3 (n=501): Significantly more undelivered at 24h, 48h, and 7 days vs placebo (all P≤0.008) at ≥28 weeks. Allows time for corticosteroid administration. Less effective at <28 weeks gestational age.

Improves (the measure goes up)Moderate effect17 studies

Studies that measured pregnancy prolongation (48h-7 days)

and 7 more in the citations list

Maternal Tolerability vs Beta-Agonists

vs Ritodrine: Adverse events 7.9% vs 70.8%, early termination 0% vs 20%. vs Salbutamol: Better tolerated with comparable efficacy. vs Terbutaline: Fewer clinically important adverse events. No cardiovascular side effects seen with beta-agonists.

Improves (the measure goes up)Large effect14 studies

Studies that measured maternal tolerability vs beta-agonists

and 4 more in the citations list

Neonatal Outcomes

Cochrane 2014: No superiority vs placebo, beta-agonists, or CCBs for neonatal outcomes. Similar neonatal morbidity across comparators. One trial noted increased fetal deaths at <24 weeks - use caution at early gestational ages.

NoneNo effect14 studies

Studies that measured neonatal outcomes

and 4 more in the citations list

Maternal Side Effects

Most common: Nausea (mild). No tachycardia, hypotension, or hyperglycemia seen with beta-agonists. No pulmonary edema risk. Fewer treatment discontinuations. Generally well-tolerated by mother and fetus.

Improves (the measure goes down)Large effect14 studies

Studies that measured maternal side effects

and 4 more in the citations list

General

General: outcomes studied for Atosiban
GradeOutcomeEffectSizeStudiesPeopleStudies list
Reproductive Outcomes

8 human trials and systematic reviews support this finding. Evidence includes systematic reviews/meta-analyses. Human clinical trial data available.

Improves (the measure goes up)Moderate effect15 studies

Studies that measured reproductive outcomes

and 5 more in the citations list

Pulmonary Function

4 preclinical studies support this finding. Primarily preclinical evidence.

Improves (the measure goes up)Small effect11 studies

Studies that measured pulmonary function

and 1 more in the citations list

Safety/Tolerability

2 systematic reviews and preclinical studies support this finding. Evidence includes systematic reviews/meta-analyses. Primarily preclinical evidence.

Improves (the measure goes up)Small effect9 studies

Studies that measured safety/tolerability

Pain

2 preclinical studies support this finding. Primarily preclinical evidence.

Improves (the measure goes down)Small effect9 studies

Studies that measured pain

Key findings

  • Tocolytic Efficacy vs Beta-AgonistsPreterm Labor
  • Pregnancy Prolongation (48h-7 days)Preterm LaborImproves (the measure goes up)
  • Maternal Tolerability vs Beta-AgonistsPreterm LaborImproves (the measure goes up)

Safety notes in the studies

  • vs Ritodrine: Adverse events 7.9% vs 70.8%, early termination 0% vs 20%.
  • vs Terbutaline: Fewer clinically important adverse events.
  • One trial noted increased fetal deaths at <24 weeks - use caution at early gestational ages.

Studies cited

34 studies from PubMed

  1. Safety and efficacy of atosiban for fetomaternal resuscitation following severe placental abruption in preparation for an emergency cesarean section: a narrative review.Expert opinion on drug safety, 2025 · PMID 41173812
  2. The biased OTR ligands -atosiban and carbetocin- differentially inhibit early or late formalin-induced nociception in rats.Neuropharmacology, 2025 · PMID 40324652
  3. Atosiban as a potential treatment for endometriosis-related pain: results from the ENDOBAN pilot study.Fertility and sterility, 2025 · PMID 41443364
  4. Effect of atosiban on in vitro fertilization pregnancy outcome among women with endometriosis in presence or absence of adenomyosis.Taiwanese journal of obstetrics & gynecology, 2023 · PMID 37407190
  5. A multicenter, retrospective comparison of pregnancy outcomes between groups of preterm labor nulliparous mothers treated with atosiban vs. ritodrine in singleton and multiple pregnancies.Taiwanese journal of obstetrics & gynecology, 2023 · PMID 37678995
  6. Non-Cardiogenic Pulmonary Edema Due to Administration of Atosiban.Cureus, 2023 · PMID 37123811
  7. Atosiban-induced acute pulmonary edema: A rare but severe complication of tocolysis.Heliyon, 2023 · PMID 37305518
  8. Efficacy of atosiban for repeated embryo implantation failure: A systematic review and meta-analysis.Frontiers in endocrinology, 2023 · PMID 37033236
  9. Tocolytics for delaying preterm birth: a network meta-analysisCochrane Database Syst Rev, 2022 · PMID 35947046
  10. Efficacy of atosiban combined with ritodrine in the treatment of threatened preterm labor and related risk factors of different pregnancy outcomes.American journal of translational research, 2022 · PMID 36105038
  11. Tocolysis with nifedipine versus atosiban and perinatal outcome: an individual participant data meta-analysis.BMC pregnancy and childbirth, 2022 · PMID 35840927
  12. Short-Term Outcomes of Atosiban in the Treatment of Preterm Labour at the Sultan Qaboos University Hospital, Muscat, Oman: A tertiary care experienceSultan Qaboos Univ Med J, 2021 · PMID 34221474
  13. Usefulness of atosiban for tocolysis during external cephalic version: Systematic review and meta-analysis.European journal of obstetrics, gynecology, and reproductive biology, 2021 · PMID 33421816
  14. Atosiban Combined with Ritodrine for Late Threatened Abortion or Threatened Premature Labor Patients with No Response to Ritodrine: A Clinical Trial.Medical science monitor : international medical journal of experimental and clinical research, 2021 · PMID 33731666
  15. Atosiban and Pregnancy Outcomes Following In Vitro Fertilization Treatment for Infertile Women Requiring One, Two, or More Embryo Transfer Cycles: A Longitudinal Cohort Study.Reproductive sciences (Thousand Oaks, Calif.), 2020 · PMID 32046434
  16. Effectiveness and safety of atosiban versus conventional treatment in the management of preterm labor.Taiwanese journal of obstetrics & gynecology, 2020 · PMID 32917318
  17. Atosiban improves the outcome of embryo transfer. A systematic review and meta-analysis of randomized and non-randomized trials.JBRA assisted reproduction, 2020 · PMID 32401462
  18. The use of atosiban prolongs pregnancy in patients treated with fetoscopic endotracheal occlusion (FETO).Journal of perinatal medicine, 2019 · PMID 31603859
  19. Systematic review and meta-analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2019 · PMID 30784056
  20. Steroids, atosiban and pulmonary oedema: are or may be a cause?International journal of obstetric anesthesia, 2018 · PMID 29602690
  21. Evaluation of the efficacy of atosiban in pregnant women with threatened preterm labor associated with assisted reproductive technologyJ Matern Fetal Neonatal Med, 2017 · PMID 27212183
  22. The impact of atosiban on pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer: A meta-analysis.PloS one, 2017 · PMID 28422984
  23. A meta-analysis of atosiban supplementation among patients undergoing assisted reproduction.Archives of gynecology and obstetrics, 2017 · PMID 28695395
  24. Oxytocin receptor antagonists for inhibiting preterm labourCochrane Database Syst Rev, 2014 · PMID 24903678
  25. Atosiban improves implantation and pregnancy rates in patients with repeated implantation failure.Reproductive biomedicine online, 2012 · PMID 22818095
  26. Atosiban and non-cardiogenic pulmonary oedema.International journal of obstetric anesthesia, 2012 · PMID 21840202
  27. Use of atosiban in a twin pregnancy with extremely preterm premature rupture in the membrane of one twin: a case report and literature review.Taiwanese journal of obstetrics & gynecology, 2010 · PMID 21199753
  28. Atosiban versus usual care for the management of preterm laborJ Perinat Med, 2006 · PMID 17614750
  29. Effectiveness of nifedipine versus atosiban for tocolysis in preterm labour: a meta-analysis with an indirect comparison of randomised trials.BJOG : an international journal of obstetrics and gynaecology, 2003 · PMID 14664874
  30. Treatment of preterm labor with the oxytocin antagonist atosiban: a double-blind, randomized, controlled comparison with salbutamolEur J Obstet Gynecol Reprod Biol, 2001 · PMID 11574128
  31. The oxytocin antagonist atosiban versus the beta-agonist terbutaline in the treatment of preterm labor. A randomized, double-blind, controlled studyActa Obstet Gynecol Scand, 2001 · PMID 11328217
  32. An oxytocin receptor antagonist (atosiban) in the treatment of preterm labor: a randomized, double-blind, placebo-controlled trial with tocolytic rescueAm J Obstet Gynecol, 2000 · PMID 10819855
  33. Double-blind, randomized, controlled trial of atosiban and ritodrine in the treatment of preterm labor: a multicenter effectiveness and safety studyAm J Obstet Gynecol, 2000 · PMID 10819857
  34. Maintenance treatment of preterm labor with the oxytocin antagonist atosibanAm J Obstet Gynecol, 2000 · PMID 10819856