Long-acting oxytocin analogue (uterotonic) Pregnancy: Contraindicated during pregnancy and must not be used for the induction of labour. Breastfeeding does not need to be restricted after use; only small amounts pass into colostrum/breast milk and are assumed to be degraded in the infant gut.

Carbetocin

Brand names: Pabal, Duratocin

Carbetocin is a long-acting synthetic analogue of oxytocin used to prevent uterine atony and postpartum haemorrhage following delivery.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 100 micrograms (1 ml) as a single dose

Route: intravenous (caesarean section under epidural/spinal anaesthesia); intravenous or intramuscular (vaginal delivery)

Frequency: single administration only - no further doses should be given

Must only be administered after delivery of the infant, and as soon as possible after delivery, preferably before delivery of the placenta. For intravenous administration, give slowly over 1 minute. Intended for single use only; no data on additional doses. In case of persisting uterine hypotonia/atonia and consequent excessive bleeding, additional therapy with another uterotonic should be considered. Administer only in well-equipped specialist obstetrics units with experienced and qualified staff.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

During pregnancy and labour before delivery of the infant
Must not be used for the induction of labour
Hypersensitivity to carbetocin, oxytocin or to any of the excipients
Hepatic or renal disease
Serious cardiovascular disorders
Epilepsy

Side effects

Nausea, abdominal pain (very common); vomiting, metallic taste (common) - IV administration
Headache, tremor (very common); dizziness (common)
Hypotension, flushing
Pruritus
Feeling of warmth, chills, pain

Interactions

No drug interactions identified during clinical trials with analgesics, spasmolytics and agents used for epidural or spinal anaesthesia; specific interaction studies not undertaken
As carbetocin is closely related to oxytocin, oxytocin-associated interactions cannot be excluded: severe hypertension reported when oxytocin given 3-4 hours after prophylactic vasoconstrictor with caudal-block anaesthesia
With ergot-alkaloids (e.g. methylergometrine), oxytocin and carbetocin may enhance the blood pressure raising effect

Clinical monograph

How it works

It binds oxytocin receptors on uterine smooth muscle, producing sustained uterine contraction and tone to reduce postpartum bleeding.

Prescribing in practice

It is given as a single dose for prevention of postpartum haemorrhage and must not be used to induce or augment labour or before delivery of the baby.
It should be used with caution in women with cardiovascular disease, pre-eclampsia, or eclampsia, and is not recommended in significant hepatic or renal impairment.
Because of its long duration of action, the effect cannot be stopped once administered, unlike a titratable oxytocin infusion.

Monitoring

Monitor uterine tone, blood pressure, and vaginal blood loss after administration.

Counselling the patient

Explain that this single injection helps the womb contract after birth to reduce the risk of heavy bleeding.
Report any feeling of faintness, palpitations, or excessive bleeding to the maternity team.
It is given by a healthcare professional immediately after delivery.

Evidence & guidelines

Uterotonics for active management of the third stage of labour are recommended by NICE to reduce the risk of postpartum haemorrhage.

Reference: RCOG GTG 52; NICE NG235; WHO PPH; SmPC; Confirm identity and dosing against the manufacturer SPC (eMC) and NICE. Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways