Carbetocin is indicated for the prevention of uterine atony and postpartum hemorrhage (excessive bleeding) following delivery by elective cesarean section under epidural or spinal anesthesia.

Carbetocin is a long-acting uterotonic agent used to prevent postpartum bleeding. It is a synthetic analogue of oxytocin and produces similar effects by stimulating uterine contractions. It binds to oxytocin receptors in the smooth muscles of the uterus, causing rhythmic contractions, increasing contraction frequency, and enhancing uterine tone. Oxytocin receptor levels are low in the non-pregnant uterus but increase during pregnancy and peak at the time of delivery.

A single intravenous dose of 100 mcg of carbetocin injection is administered by bolus injection, slowly over 1 minute, only when infant delivery has been completed by caesarean section under epidural or spinal anaesthesia. carbetocin is to be used as a single dose only.

No clinically significant drug interactions have been reported with carbetocin.

Due to its prolonged action, uterine contractions caused by carbetocin cannot be quickly reversed by stopping the drug. Therefore, it should not be administered before delivery or for induction of labor. Use during pregnancy is contraindicated as it may cause excessive uterine stimulation, leading to complications such as uterine rupture, fetal distress, or severe hemorrhage. Carbetocin is contraindicated in patients with hypersensitivity to oxytocin or carbetocin. It should also be avoided in patients with cardiovascular diseases including coronary artery disease, valvular heart disease, cardiomyopathy, and heart failure. It is not recommended for use in children.

Common side effects (10–40%) include nausea, vomiting, abdominal pain, itching, fever, tremor, and weakness. Less common effects (1–5%) include back pain, dizziness, metallic taste, anemia, sweating, chest pain, shortness of breath, chills, tachycardia, and anxiety.

Carbetocin injection is contraindicated during pregnancy. Small amounts may pass into breast milk; however, the amount ingested by the infant is minimal and is not expected to cause significant harm.

• If adequate uterine contraction is not achieved with a single dose, additional uterotonic agents (e.g., oxytocin or ergometrine) may be required.
• Hyponatremia may occur due to its similarity to oxytocin.
• Use with caution in patients with epilepsy, migraine, asthma, or conditions prone to fluid overload.
• Monitor blood pressure in patients with eclampsia or pre-eclampsia.
• Not recommended for use in elderly patients.

Overdose may lead to excessive uterine activity and pain. Management is supportive and symptomatic.

Drugs acting on the uterus

Store at 2–8°C. Do not freeze. Protect from light. Use immediately after opening the ampoule.