Carbetocin

Summary

Carbetocin is a long-acting synthetic oxytocin analogue used to prevent postpartum hemorrhage (PPH) after cesarean delivery and, in some jurisdictions, after vaginal delivery. It binds oxytocin receptors to produce sustained uterine tone, reducing the need for additional uterotonics. A heat-stable formulation (Ferring's Carbetocin RTS) has expanded its use to low-resource settings.

Mechanism of Action

Selective agonist at oxytocin receptors in uterine smooth muscle, causing sustained uterine contractions and reducing postpartum hemorrhage; longer half-life than oxytocin due to resistance to enzymatic degradation.

Routes of Administration

Goals & Uses

• Reduction of uterine atonyUterotonicHigh
• Prevention of postpartum hemorrhage after vaginal deliveryObstetric / HemostasisModerate
• Non-pneumonic management of PPH in resource-limited settingsGlobal HealthModerate
• Prevention of postpartum hemorrhage after cesarean sectionObstetric / HemostasisHigh

Contraindications

• Use before delivery of the infantObstetricHigh
• Cardiovascular disease (severe)CardiovascularHigh
• Induction or augmentation of laborObstetricHigh
• Hypersensitivity to carbetocin or oxytocinAllergicHigh
• Hepatic or renal impairmentOrgan ImpairmentModerate

Adverse Effects

• HeadacheNeurologicCommonPain in the head or upper neck
• HypotensionCardiovascularCommonLow blood pressure
• Tremor / chillsMusculoskeletal / SystemicUncommon
• FlushingVascularCommonWarmth and redness of the skin
• TachycardiaCardiovascularUncommonAbnormally fast heart rate
• NauseaGastrointestinalCommonFeeling of sickness or urge to vomit

Drug Interactions

• Ergot alkaloids (e.g., methylergonovine)Moderate
• Prostaglandins (e.g., misoprostol, dinoprostone)Moderate
• General anesthetics (halogenated agents)Moderate

Population Constraints

• Renal impairmentOrgan ImpairmentRelative
• Pediatric patientsAgeAbsolute
• Severe cardiovascular diseaseCardiovascularRelative
• Pregnancy (before fetal delivery)ObstetricAbsolute

Regulatory Status

• European UnionApprovedApproved: Prevention of uterine atony and excessive bleeding following cesarean sectionApproved as Pabal (Ferring); heat-stable formulation also available.
• United StatesUnapprovedNot FDA-approved as of 2024; available only through investigational channels. FDA has reviewed NDA submissions but approval has not been granted.
• United KingdomApprovedApproved: Prevention of postpartum hemorrhage after cesarean deliveryApproved by MHRA; available as Pabal.

Approved in Canada, EU, UK, and many other countries for prevention of uterine atony and PPH. Not FDA-approved in the United States as of 2024; under review/investigational status in the US. WHO added heat-stable carbetocin to the Essential Medicines List in 2019.

Evidence & Sources

No sources recorded yet.