Carbetocin

Registered South African indications:

• Postpartum uterine atony

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Hypersensitivity to oxytocin
• Pregnancy
• Renal impairment
• Hepatic impairment
• Induction of labour
• Pre-eclampsia 
• Eclampsia
• Serious cardiovascular disorders
• Epilepsy

Cautions

• Breastfeeding
• Use before delivery of infant
• Patients also receiving large volumes of intravenous fluids
• Migraine
• Asthma 
• Cardiovascular disease 
• Gestational diabetes mellitus
• Vaginal delivery

Forms avail. in SA and covered in this monograph: inj

Postpartum uterine atony
- Post caesarean section

• IV: 100μg, given over 1min, immediately after baby delivered

It should be given as soon as possible after delivery, preferably before removal of the placenta

Not established for use in children

Pregnancy

• Contraindicated
• Carbetocin is contraindicated during pregnancy and must not be used for the induction of labour 

Breastfeeding

• Caution
• No significant effects on milk let-down have been reported during clinical trials. Small amounts of carbetocin have been shown to pass from plasma into breast milk of breastfeeding women. The small amounts transferred into colostrum or breast milk after a single injection of carbetocin, and subsequently ingested by the infant are assumed to be degraded by enzymes in the gut

Renal Impairment

• No dose adjustment recommended (single-dose use)
• Document renal function (CrCl/eGFR) prior to use

Hepatic Impairment

• No dose adjustment is recommended (single-dose use)

Elderly    

• Not indicated for use in geriatric patients

Porphyria Information

• Not yet classified (NC)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Headache
• Tremor
• Dizziness

Cardiovascular Disorders

• Hypotension
• Flushing

Respiratory Disorders

• Chest pain
• Dyspnoea

Gastrointestinal Disorders

• Nausea and vomiting
• Abdominal pain
• Metallic taste

Musculoskeletal Disorders

• Back pain

Skin and Subcutaneous Tissue Disorders

• Pruritus

Immune, Blood and Lymphatic System Disorders

• Anaemia
• Chills

Others

• Feeling of warmth

• Vasoconstrictors
• Ergot-alkaloids
• Prostaglandins
• Halothane 
• Cyclopropane

• Blood pressure
• Postpartum bleeding

Carbetocin binds to 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. It enhances uterine involution early in postpartum.

Injection (per ml) 100μg

• Pabal (Ferring) originator