Oxytocin Analogue (Long-Acting Uterotonic) Pregnancy: Contraindicated during pregnancy; must not be used for induction of labour. Breast-feeding does not need to be restricted after use of carbetocin.

Carbetocin

Brand names: Pabal

Carbetocin is a long-acting synthetic oxytocin analogue used as a uterotonic for prevention of postpartum haemorrhage, particularly after caesarean section and increasingly after vaginal birth.

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) carbetocin as a single dose

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

Frequency: Single use only — no further doses of carbetocin should be administered

Administer only 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 use only at well-equipped specialist obstetrics units under adequate medical supervision in a hospital.

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, vomiting
Headache, tremor, dizziness
Tachycardia, bradycardia (which can lead to cardiac arrest), arrhythmia
Hypotension, flushing
Pruritus

Interactions

No drug interactions identified during clinical trials; specific interaction studies not undertaken
As carbetocin is closely related in structure to oxytocin, interactions known with oxytocin cannot be excluded
Severe hypertension reported when oxytocin given 3–4 hours after prophylactic administration of a vasoconstrictor with caudal-block anaesthesia
In combination 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 that reduces bleeding from the placental site.

Prescribing in practice

It is intended as a single dose for prophylaxis and should not be used to induce or augment labour, nor given before delivery of the baby.
Like oxytocin it can cause hypotension, tachycardia, flushing and headache, so caution is needed in significant cardiovascular disease and it should be given as directed by route.
A heat-stable formulation widens its use where cold-chain storage is difficult, but standard product storage conditions must still be followed.

Monitoring

Monitor uterine tone, blood loss, blood pressure and heart rate in the immediate postpartum period.

Counselling the patient

Explain to the mother that this single injection is given after birth to help the womb contract and reduce bleeding.
Staff should watch for ongoing bleeding and ensure the uterus stays well contracted.
Report flushing, headache or feeling faint after administration.

Evidence & guidelines

Carbetocin is supported by WHO and trial evidence as an effective uterotonic for preventing postpartum haemorrhage, with a heat-stable form extending access.

Reference: CHAMPION Trial (Widmer et al, Lancet 2018); WHO PPH Guidelines 2022; 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