Postpartum hemorrhage, prevention:
Following vaginal delivery: IV, IM: 100 mcg (single dose only).
Following cesarean section: IV: 100 mcg (single dose only).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Injection:
Duratocin: 100 mcg/mL (1 mL)
Solution, Intravenous:
Duratocin: 100 mcg/mL ([DSC])
Generic: 100 mcg/mL (1 mL)
Not available in the US
IV: Administer undiluted as bolus IV injection over 1 minute. Following vaginal delivery, administer as soon as possible after delivery of the infant, preferably before delivery of the placenta. Following cesarean section, administer only after delivery of infant has been completed by cesarean section; may administer before or after delivery of placenta.
IM: IM administration may also be used following vaginal delivery only (Leduc 2018; WHO 2018).
Note: Not approved in the US.
Postpartum hemorrhage, prevention: Prevention of postpartum hemorrhage by controlling uterine atony.
The Institute for Safe Medication Practices (ISMP) includes oxytocin (carbetocin analog) among its list of drugs which have a heightened risk of causing significant patient harm when used in error.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Cardiovascular: Flushing (2% to 25%), hypotension (2% to 21%)
Gastrointestinal: Abdominal pain (40%), nausea (3% to 27%)
Hematologic: Anemia (23%)
Nervous system: Headache (13% to 26%), localized warm feeling (19%)
Neuromuscular & skeletal: Tremor (1% to 12%)
1% to 10%:
Cardiovascular: Chest pain (4%), tachycardia (1%)
Dermatologic: Diaphoresis (1%), pruritus (10%)
Gastrointestinal: Metallic taste (1% to 6%), vomiting (3% to 8%)
Nervous system: Anxiety, chills, dizziness (1% to 4%), pain (4%)
Neuromuscular & skeletal: Back pain (4%)
Respiratory: Dyspnea (1% to 10%)
Miscellaneous: Fever (9%)
Hypersensitivity to carbetocin, oxytocin, or any component of the formulation; administration prior to delivery of infant for any reason (including elective or medical induction of labor); serious cardiovascular disorders; use in children
Concerns related to adverse effects:
• Antidiuretic effect: May produce antidiuretic effect; risk of water intoxication cannot be excluded.
• Bleeding: Persistent bleeding warrants further evaluation to rule out coagulopathy, genital tract trauma, or the presence of retained placental fragments.
Disease-related concerns:
• Asthma: Use with caution in patients with asthma.
• Cardiovascular disease: Use has not been studied in patients with a history of hypertension or known coagulopathy; use with extreme caution in patients with cardiovascular disease (contraindicated in serious cardiovascular disorders), especially coronary artery disease.
• Epilepsy: Use with caution in patients with epilepsy.
• Migraines: Use with caution in patients with migraines.
Other warnings/precautions:
• Appropriate use: Carbetocin induced contractions are of a longer duration than those observed with oxytocin and are not stopped by discontinuation of therapy. Improper use during pregnancy may produce symptoms similar to those observed with oxytocin overdosage (eg, hyperstimulation of uterus with strong or prolonged contractions, tumultuous labor, uterine rupture, cervical and vaginal lacerations, postpartum hemorrhage, utero-placental hypoperfusion and variable deceleration of fetal heart rate, fetal hypoxia, hypercapnia, or death). Therapy should not be repeated if response to initial dose is inadequate; aggressive therapy with alternative agents (eg, oxytocin, ergonovine) should be utilized. Monitor patients with eclampsia and pre-eclampsia closely.
None known.
Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification
Amisulpride (Oral): May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination
Carboprost Tromethamine: May enhance the adverse/toxic effect of Oxytocic Agents. Specifically, oxytocic effects may be enhanced. Risk X: Avoid combination
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Dinoprostone: May enhance the adverse/toxic effect of Carbetocin. Specifically, Carbetocin oxytocic effects may be enhanced. Risk X: Avoid combination
DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy
Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Levodopa-Containing Products: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. Risk C: Monitor therapy
Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
MiSOPROStol: May enhance the adverse/toxic effect of Carbetocin. Specifically, Carbetocin oxytocic effects may be enhanced. Risk X: Avoid combination
Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy
Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Use in pregnancy prior to delivery is contraindicated.
Carbetocin induced contractions are of a longer duration than those observed with oxytocin and are not stopped by discontinuation of therapy. Improper use during pregnancy may produce symptoms similar to those observed with oxytocin overdosage (eg, hyperstimulation of uterus, uterine rupture).
Carbetocin is present in breast milk.
Carbetocin was detected in the breast milk of 5 healthy nursing women approximately 7 to 14 weeks postpartum though peak levels observed were 50 times lower than in plasma (Silcox 1993). Exposure to the breastfeeding infant is expected to be minimal and not expected to pose significant health risks as carbetocin in breast milk is rapidly degraded in the GI tract of a breastfeeding infant. Milk let-down was found to occur normally in 5 breastfeeding women after receiving a carbetocin 70 mcg dose by the intramuscular route.
Persistent postpartum bleeding; blood pressure
Binds oxytocin receptors located in uterine smooth muscle producing rhythmic uterine contractions characteristic to deliver, as well as increasing both the frequency of existing contractions and uterine tone. Enhances uterine involution early in postpartum.
Onset of action: IV: 1.2 ± 0.5 minutes.
Distribution: Vd: 22 L.
Bioavailability: IM: 77%.
Duration: IV: ~60 minutes; IM: ~120 minutes (Sweeney 1990; WHO 2018).
Half-life elimination: Terminal: IV: 33 minutes; IM: 55 minutes.
Time to peak: IM: 30 minutes (median).
Excretion: IV: Urine (<1%, as unchanged drug).
