Drugs List

Therapeutic Indications

Uses

Postpartum haemorrhage following vaginal delivery: Prevention
Prevention of uterine atony after Caesarean section

Administration

Vaginal Delivery
Intramuscular injection or by slow intravenous injection over 1 minute.

Caesarean Section under spinal anaesthesia or epidural
Slow intravenous injection over 1 minute.

Contraindications

Epileptic disorder
Hepatic impairment
Labour
Long QT syndrome
Pregnancy
Renal impairment
Severe cardiovascular disorder
Torsade de pointes

Precautions and Warnings

Family history of long QT syndrome
Asthma
Cardiovascular disorder
Eclampsia
Electrolyte imbalance
History of torsade de pointes
Migraine
Pre-eclampsia

Correct electrolyte disorders before treatment
Not all routes are licensed for all indications
Treatment to be initiated and supervised by a specialist
For intravenous or intramuscular administration only
Consider monitoring ECG in patients at risk of QT prolongation
If uterine atony persists after single dose, consider alternative treatment
If uterine bleeding persists after administration, investigate cause
May cause hyponatraemia
Monitor serum electrolytes
Consider hyponatraemia in all patients with drowsiness/confusion/seizures

If uterine bleeding persists after administration, the cause must be determined. Retained placental fragments, inadequate emptying or repair of the uterus, perineal, vaginal or cervix lacerations or impaired blood coagulation may be causative factors.

Carbetocin is for use on a single occasion. If uterine hypotonia or atony persists additional therapy should be considered with another uterotonic.

Animal studies have demonstrated that carbetocin has some antidiuretic activity, which may lead to hyponatraemia. This effect is more likely in patients receiving large volumes of intravenous fluids. Early signs of drowsiness, listlessness and headache should be recognised in order to prevent convulsions and coma.

Use with caution in patients with migraine, asthma, cardiovascular disorders or any other condition in which a rapid addition to extracellular water may put the patient at risk. These patients should only be treated after careful consideration of the benefits and risks of treatment.

Carbetocin administration to patients with gestational diabetes has not been studied.

Pregnancy and Lactation

Pregnancy

Carbetocin is contraindicated during pregnancy.

Use of carbetocin during pregnancy is contraindicated by the manufacturer. At the time of writing there is limited published information regarding the use of carbetocin during pregnancy. Potential risks are unknown.

Lactation

Carbetocin is considered safe for use during breastfeeding.

The manufacturer states that carbetocin may be used safely when breastfeeding. Carbetocin has been shown to pass from plasma into breast milk in small amounts, and is assumed to be broken down in the gut of the neonate. No significant effects on milk let down have been reported during clinical trials.

Side Effects

Abdominal pain
Anaemia
Arrhythmias
Back pain
Bradycardia
Chest pain
Chills
Dizziness
Dyspnoea
Flushing
Headache
Hypotension
Metallic taste
Myocardial ischaemia
Nausea
Pain - generalised
Prolongation of QT interval
Pruritus
Sensation of warmth
Sweating
Tachycardia
Tremor
Vomiting

Presentation

Injection of carbetocin.

Drugs List

Therapeutic Indications

Uses

Postpartum haemorrhage following vaginal delivery: Prevention
Prevention of uterine atony after Caesarean section

Dosage

Adults

Administration

Vaginal Delivery
Intramuscular injection or by slow intravenous injection over 1 minute.

Caesarean Section under spinal anaesthesia or epidural
Slow intravenous injection over 1 minute.

Contraindications

Epileptic disorder
Hepatic impairment
Labour
Long QT syndrome
Pregnancy
Renal impairment
Severe cardiovascular disorder
Torsade de pointes

Precautions and Warnings

Family history of long QT syndrome
Asthma
Cardiovascular disorder
Eclampsia
Electrolyte imbalance
History of torsade de pointes
Migraine
Pre-eclampsia

Correct electrolyte disorders before treatment
Not all routes are licensed for all indications
Treatment to be initiated and supervised by a specialist
For intravenous or intramuscular administration only
Consider monitoring ECG in patients at risk of QT prolongation
If uterine atony persists after single dose, consider alternative treatment
If uterine bleeding persists after administration, investigate cause
May cause hyponatraemia
Monitor serum electrolytes
Consider hyponatraemia in all patients with drowsiness/confusion/seizures

If uterine bleeding persists after administration, the cause must be determined. Retained placental fragments, inadequate emptying or repair of the uterus, perineal, vaginal or cervix lacerations or impaired blood coagulation may be causative factors.

Carbetocin is for use on a single occasion. If uterine hypotonia or atony persists additional therapy should be considered with another uterotonic.

Animal studies have demonstrated that carbetocin has some antidiuretic activity, which may lead to hyponatraemia. This effect is more likely in patients receiving large volumes of intravenous fluids. Early signs of drowsiness, listlessness and headache should be recognised in order to prevent convulsions and coma.

Use with caution in patients with migraine, asthma, cardiovascular disorders or any other condition in which a rapid addition to extracellular water may put the patient at risk. These patients should only be treated after careful consideration of the benefits and risks of treatment.

Carbetocin administration to patients with gestational diabetes has not been studied.

Pregnancy and Lactation

Pregnancy

Carbetocin is contraindicated during pregnancy.

Use of carbetocin during pregnancy is contraindicated by the manufacturer. At the time of writing there is limited published information regarding the use of carbetocin during pregnancy. Potential risks are unknown.

Lactation

Carbetocin is considered safe for use during breastfeeding.

The manufacturer states that carbetocin may be used safely when breastfeeding. Carbetocin has been shown to pass from plasma into breast milk in small amounts, and is assumed to be broken down in the gut of the neonate. No significant effects on milk let down have been reported during clinical trials.

Side Effects

Abdominal pain
Anaemia
Arrhythmias
Back pain
Bradycardia
Chest pain
Chills
Dizziness
Dyspnoea
Flushing
Headache
Hypotension
Metallic taste
Myocardial ischaemia
Nausea
Pain - generalised
Prolongation of QT interval
Pruritus
Sensation of warmth
Sweating
Tachycardia
Tremor
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: July 2022

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Summary of Product Characteristics: Pabal 100 micrograms in 1ml solution for injection. Ferring Pharmaceuticals Ltd. Revised December 2019.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 27 July 2022