Carbetocin

Section 1.1

Midwives may independently prescribe, order and administer this drug.

Carbetocin is a uterotonic used for the prevention of uterine atony and postpartum hemorrhage (PPH). It is a long-acting, synthetic nonapeptide analogue of oxytocin and is available in both heat stable and non-heat stable formulations.

Indications and Clinical Use:

Carbetocin may be administered for the prevention (but not typically the treatment) of PPH following vaginal birth in those with one or more risk factors for PPH. In its heat-stable formulation and in the absence of oxytocin, it may also be used in place of oxytocin for active management of third stage. Carbetocin may be ordered and administered by midwives based on its availability, the overall clinical scenario, and in accordance with local, provincial and/or national PPH algorithms.

Contraindications:

Carbetocin is contraindicated in pregnancy, in those with a hypersensitivity to oxytocin or carbetocin, in those with serious cardiovascular disease and in those under 18 years of age.

Warnings and Precautions:

May have antidiuretic effects; use with extreme caution in those with cardiovascular disease. Use cautiously in the presence of asthma.

Pregnancy:

Category B- Limited data

Lactation:

Category L3 – Limited Data – Probably Compatible

Adverse Reactions:

Headache, hypotension, flushing, nausea, vomiting, pruritus, chills, tachycardia.

Dosage and Administration:

For prevention of PPH in those with one or more risk factors for PPH who deliver vaginally: A single dose of 100 mcg IM or IV immediately following birth

For prevention of PPH where oxytocin is not available for active management of the third stage: A single dose of 100mcg IM or IV immediately following birth

Onset of Action:

Rapid

Half-life:

40 minutes

Elimination:

Non-renal