carbetocin: clinical use

Prescribing considerations

• Use only after delivery in a well-equipped specialist obstetric unit.
• Investigate continuing bleeding rather than assuming persistent uterine atony; consider retained placental tissue, genital-tract trauma, uterine repair problems and coagulation disorders.
• Use caution with migraine, asthma, cardiovascular disease, pre-eclampsia, eclampsia or conditions where fluid retention could be hazardous.
• Specific evidence in gestational diabetes and eclampsia is limited.

Contraindications and cautions

• Pregnancy or labour before delivery of the infant, and induction of labour.
• Hypersensitivity to carbetocin, oxytocin or an excipient.
• Hepatic or renal disease.
• Serious cardiovascular disorders.
• Epilepsy.

Monitoring

• Uterine tone and postpartum blood loss.
• Blood pressure, pulse and symptoms of arrhythmia or myocardial ischaemia.
• Fluid balance and early features of hyponatraemia, particularly with substantial intravenous fluid exposure.
• Response to treatment and alternative causes if bleeding continues.

Clinical pharmacology

Carbetocin is a selective, long-acting oxytocin-receptor agonist. It increases postpartum uterine tone and rhythmic contractions; elimination is biphasic, with low renal clearance of unchanged medicine.

Formulation and product differences

• The product is a clear, colourless solution in a single-use vial.
• After caesarean birth under epidural or spinal anaesthesia it is administered intravenously; after vaginal birth it may be administered intravenously or intramuscularly.
• Protect from light, store below 30°C and do not freeze. Do not mix with other medicines where compatibility has not been established.

Injection

Route: Parenteral

Strengths: 100 micrograms/1 mL