Drugs List

Administration

For deep intramuscular injection only.

Other routes contra-indicated.

Contraindications

Renal impairment
Cardiac impairment
Respiratory disease
Hepatic impairment
Acute pelvic inflammatory disease

Precautions and Warnings

The preparations should only be used in hospitals or clinics with specialised obstetric units.

It must not be used for induction of labour.

Cardiovascular collapse has been reported rarely following the use of prostaglandins. This should be considered when using carboprost.

Excessive doses may cause uterine rupture.

Use with caution in patients with the following conditions:
Asthma
History of asthma
Epilepsy
History of epilepsy
History of glaucoma
Glaucoma
Raised intraocular pressure
Cardiovascular disease
Hypertension
Hypotension
Anaemia
Jaundice
Diabetes mellitus
Compromised (scarred) uterus

Decreases in maternal arterial oxygen have been reported following carboprost treatment, although a causal relationship with this drug has not been established. Patients with pre-existing cardio-pulmonary impairment should be monitored during therapy and given extra oxygen if required.

Transient pyrexia that may be due to hypothalamic thermoregulation has been observed after intramuscular carboprost. Temperature elevations have been observed in some patients. The temperature elevation will usually return to normal within several hours of the last injection.

Pregnancy and Lactation

Pregnancy

For treating refractory post-partum haemorrhage only.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

No adverse effects on the infant would be expected if the mother was receiving carboprost whilst breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Nausea
Vomiting
Diarrhoea
Headache
Chills
Dizziness
Pain on injection
Dyspnoea
Bronchospasm
Flushing
Pulmonary oedema
Erythema at injection site
Hyperthermia
Diaphoresis
Wheezing
Increased blood pressure
Cardiovascular collapse
Septic shock
Urinary tract infections
Thyrotoxicosis
Sleep disturbances
Anxiety
Nervousness
Dystonia
Paraesthesia
Somnolence
Dysgeusia
Syncope
Blurred vision
Eye pain
Vertigo
Tinnitus
Tachycardia
Palpitations
Hot flushes
Asthma
Cough
Respiratory distress
Hyperventilation
Hiccups
Uterine haemorrhage
Pharyngeal oedema
Choking sensation
Epistaxis
Dry throat
Upper respiratory tract infection
Haematemesis
Upper abdominal pain
Dry mouth
Retching
Hyperhidrosis
Rash
Torticollis
Back pain
Myalgia
Muscle spasm
Blepharospasm
Retained placenta
Endometriosis
Uterine rupture
Pelvic pain
Breast tenderness
Lethargy
Chest discomfort
Chest pain
Asthenia
Thirst
Rise in body temperature

Presentation

Solution for injection containing carboprost tromethamine equivalent to carboprost 250 micrograms/ml.

Drugs List

Dosage

Adults

Elderly

Children

Patients with Renal Impairment

Patients with Hepatic Impairment

Additional Dosage Information

Administration

For deep intramuscular injection only.

Other routes contra-indicated.

Contraindications

Renal impairment
Cardiac impairment
Respiratory disease
Hepatic impairment
Acute pelvic inflammatory disease

Precautions and Warnings

The preparations should only be used in hospitals or clinics with specialised obstetric units.

It must not be used for induction of labour.

Cardiovascular collapse has been reported rarely following the use of prostaglandins. This should be considered when using carboprost.

Excessive doses may cause uterine rupture.

Use with caution in patients with the following conditions:
Asthma
History of asthma
Epilepsy
History of epilepsy
History of glaucoma
Glaucoma
Raised intraocular pressure
Cardiovascular disease
Hypertension
Hypotension
Anaemia
Jaundice
Diabetes mellitus
Compromised (scarred) uterus

Decreases in maternal arterial oxygen have been reported following carboprost treatment, although a causal relationship with this drug has not been established. Patients with pre-existing cardio-pulmonary impairment should be monitored during therapy and given extra oxygen if required.

Transient pyrexia that may be due to hypothalamic thermoregulation has been observed after intramuscular carboprost. Temperature elevations have been observed in some patients. The temperature elevation will usually return to normal within several hours of the last injection.

Pregnancy and Lactation

Pregnancy

For treating refractory post-partum haemorrhage only.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

No adverse effects on the infant would be expected if the mother was receiving carboprost whilst breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Nausea
Vomiting
Diarrhoea
Headache
Chills
Dizziness
Pain on injection
Dyspnoea
Bronchospasm
Flushing
Pulmonary oedema
Erythema at injection site
Hyperthermia
Diaphoresis
Wheezing
Increased blood pressure
Cardiovascular collapse
Septic shock
Urinary tract infections
Thyrotoxicosis
Sleep disturbances
Anxiety
Nervousness
Dystonia
Paraesthesia
Somnolence
Dysgeusia
Syncope
Blurred vision
Eye pain
Vertigo
Tinnitus
Tachycardia
Palpitations
Hot flushes
Asthma
Cough
Respiratory distress
Hyperventilation
Hiccups
Uterine haemorrhage
Pharyngeal oedema
Choking sensation
Epistaxis
Dry throat
Upper respiratory tract infection
Haematemesis
Upper abdominal pain
Dry mouth
Retching
Hyperhidrosis
Rash
Torticollis
Back pain
Myalgia
Muscle spasm
Blepharospasm
Retained placenta
Endometriosis
Uterine rupture
Pelvic pain
Breast tenderness
Lethargy
Chest discomfort
Chest pain
Asthenia
Thirst
Rise in body temperature

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 ).

Shelf Life and Storage

Store in a refrigerator at 2 to 8 degrees C

Reference Sources

British National Formulary, 64th Edition (2012) Pharmaceutical Press, London.

Summary of Product Characteristics: Hemabate Sterile Solution. Pharmacia Ltd. Revised January 2012.