Oxytocin Analogue (Long-Acting Uterotonic)
Pregnancy: Used at delivery/CS — not during pregnancy
Carbetocin
Brand names: Pabal
Adult dose
Dose: 100 mcg IV single slow injection over 1 minute at delivery of anterior shoulder (elective CS) or after placental delivery (elective CS/VD)
Route: IV slow injection
Frequency: Single dose
Max: 100 mcg single dose
CHAMPION trial (Lancet 2018): heat-stable carbetocin (100 mcg) as effective as oxytocin for prevention of PPH at CS. WHO recommends as alternative to oxytocin in hot climates/low-income settings (heat-stable formulation). Acts for 2h vs 30 min for oxytocin.
Paediatric dose
Route: N/A
Frequency: N/A
Max: Not applicable
Concentration: 100 mcg/mL N/A/ml
Not applicable in paediatric patients
Dose adjustments
Renal
Caution in renal impairment
Hepatic
Caution in hepatic impairment
Clinical pearls
- CHAMPION trial established heat-stable carbetocin as equivalent to oxytocin for PPH prevention at CS
- Longer duration than oxytocin — no need for oxytocin infusion post-CS when carbetocin given
- NOT for induction of labour or pre-delivery administration
- Hypotension: similar risk to oxytocin; have IV fluid ready before administration
Contraindications
- Induction of labour or augmentation of labour
- Before delivery of infant
- Cardiovascular disease (caution — hypotension)
- Hypersensitivity to oxytocin or carbetocin
Side effects
- Hypotension (transient)
- Nausea
- Flushing
- Headache
- Tremor
- Tachycardia
Interactions
- Other uterotonics — additive uterotonic effects
- Inhalational anaesthetics — may attenuate uterotonic effect
Monitoring
- Blood pressure (continuous during/after injection)
- Uterine tone
- Blood loss estimation
Reference: BNFc; BNF; CHAMPION Trial (Widmer et al, Lancet 2018); WHO PPH Guidelines 2022. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.