Uterotonic (Prostaglandin) Pregnancy: Teratogenic effects: animal studies do not indicate that carboprost tromethamine is teratogenic, however it has been shown to be embryotoxic in rats and rabbits, and any dose which produces increased uterine tone could put the embryo or fetus at risk.

Carboprost

Brand names: Hemabate

Carboprost is a synthetic prostaglandin F2-alpha analogue used to treat postpartum haemorrhage due to uterine atony when first-line uterotonics have failed.

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: 250 micrograms (1 mL of carboprost tromethamine injection) as the initial dose — the same initial dose is stated for both labelled indications

Route: Deep intramuscular injection (administer with a tuberculin syringe)

Frequency: Refractory postpartum uterine bleeding: repeat at intervals of 15 to 90 minutes if required — the need for additional injections and the interval can be determined only by the attending physician as dictated by the clinical course. Abortion and indications 1–4: subsequent 250 microgram doses at 1½ to 3½ hour intervals depending on uterine response

Max: Refractory postpartum uterine bleeding: total dose should not exceed 2 milligrams (8 doses). Abortion and indications 1–4: total dose should not exceed 12 milligrams, and continuous administration for more than two days is not recommended.

NO UK SPC WAS AVAILABLE IN THE SOURCE BUNDLE — this draft is taken from the US FDA prescribing information for CARBOPROST TROMETHAMINE (Dr. Reddy's Laboratories, label date 2024-12-19); verify against the UK SPC before publication. Two distinct labelled regimens exist and must not be conflated. (1) REFRACTORY POSTPARTUM UTERINE BLEEDING: initial 250 micrograms (1 mL) deep intramuscularly; in clinical trials the majority of successful cases (73%) responded to single injections, but in selected cases multiple dosing at 15 to 90 minute intervals was carried out successfully; total must not exceed 2 mg (8 doses). (2) ABORTION AND INDICATIONS 1–4: initial 1 mL (250 micrograms) deep in the muscle via tuberculin syringe; an optional test dose of 100 micrograms (0.4 mL) may be given initially; subsequent 250 microgram doses at 1½ to 3½ hour intervals depending on uterine response; the dose may be increased to 500 micrograms (2 mL) if uterine contractility is judged inadequate after several 250 microgram doses; total must not exceed 12 mg with no continuous administration beyond two days. Carboprost should be used only with strict adherence to recommended dosages, by medically trained personnel in a hospital that can provide immediate intensive care and acute surgical facilities. Not indicated if the fetus in utero has reached the stage of viability, and should not be considered a feticidal agent; any pregnancy termination that fails should be completed by some other means. The product contains benzyl alcohol. Inspect parenteral products visually for particulate matter and discoloration before administration. Paediatric: safety and effectiveness in paediatric patients have not been established.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity (including anaphylaxis and angioedema) to carboprost tromethamine injection
Acute pelvic inflammatory disease
Patients with active cardiac, pulmonary, renal or hepatic disease

Side effects

Vomiting and diarrhoea (approximately two-thirds of patients studied)
Nausea (approximately one-third of patients)
Temperature increase greater than 2 degrees F (approximately one-eighth of patients); a minority had a clinical diagnosis of endometritis, with the remainder returning to normal within several hours of the last injection
Flushing or hot flashes (approximately one-fourteenth of patients); chills or shivering
Headache, nervousness, sleep disorders
Dyspnoea, tightness in chest, coughing, wheezing

Interactions

Other oxytocic agents — carboprost may augment their activity; concomitant use is not recommended

Clinical monograph

How it works

It stimulates prostaglandin receptors on the myometrium to produce strong, sustained uterine contractions that compress bleeding vessels.

Prescribing in practice

It is contraindicated in asthma because it can cause bronchospasm, and should be used with caution where there is cardiac, pulmonary, hepatic, or renal disease.
It is a second-line agent for atonic postpartum haemorrhage, given by deep intramuscular injection (or directly into the myometrium) and repeated at intervals if needed up to a maximum number of doses.
Common adverse effects include nausea, vomiting, diarrhoea, flushing, and pyrexia.

Monitoring

Monitor uterine tone, blood loss, blood pressure, temperature, and respiratory status during use.

Counselling the patient

Explain that this injection is given to help control heavy bleeding after birth when other medicines have not worked.
Side effects such as nausea, diarrhoea, flushing, and a raised temperature are common and usually short-lived.
It is administered and monitored by the maternity team.

Evidence & guidelines

Prostaglandin uterotonics such as carboprost are recognised in NICE guidance as an option for refractory atonic postpartum haemorrhage.

Reference: RCOG PPH Green-top Guideline; WOMAN trial; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). 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

Bishop Score · Labour & Delivery

Pathways