Carbitocin dosage
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carbetocin dosage clinical use obstetrics
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carbetocin 100mcg IV IM dosage postpartum hemorrhage prevention mechanism contraindications
Carbetocin (Duratocin / Pabal) — Dosage & Clinical Summary
What It Is
Carbetocin is a long-acting synthetic oxytocin analogue (1-deamino-1-monocarba-2-tyrosine[O-methyl]-oxytocin) used to prevent postpartum haemorrhage (PPH) and uterine atony after delivery.
- Half-life: ~40 minutes (vs. ~3–5 min for oxytocin)
- Single dose provides sustained uterotonic effect for ~1 hour
- WHO Essential Medicine (added to the 23rd EML, 2023)
Standard Dosage
| Route | Dose | Timing |
|---|---|---|
| IV (slow bolus) | 100 mcg over 1 minute | Immediately after delivery of the infant |
| IM | 100 mcg | Immediately after delivery of the infant |
- Single dose only — no repeat dosing is recommended
- Administer after delivery of the baby (not before)
Indications
- Prevention of uterine atony and PPH following:
- Caesarean section (primary indication in most guidelines)
- Vaginal delivery (where oxytocin is unavailable or as an alternative)
The Society of Obstetricians and Gynaecologists of Canada (SOGC) recommends a single IV bolus of 100 mcg for PPH prevention at caesarean section.
Route Notes
- IV route is preferred in caesarean section under spinal/epidural anaesthesia
- IM route is an option where IV access is not available — particularly relevant for the heat-stable formulation (approved by WHO, 2021), which does not require cold-chain storage and is designed for resource-limited settings
Contraindications
- During pregnancy (do not use before delivery)
- Induction of labour (not approved for this purpose)
- Serious cardiovascular disease
- Hepatic or renal impairment (use with caution / avoid)
- Eclampsia or severe pre-eclampsia (use with caution)
- Known hypersensitivity to oxytocin or carbetocin
Key Adverse Effects
- Flushing, nausea, hypotension (less pronounced than with rapid oxytocin bolus)
- Headache, tremor, abdominal pain
- Tachycardia
Comparison with Oxytocin
| Feature | Carbetocin | Oxytocin |
|---|---|---|
| Duration of action | ~60 min | ~3–5 min |
| Dosing | Single dose | Infusion required |
| Storage (heat-stable form) | Room temperature | Cold chain needed |
| PPH prevention efficacy | Comparable or superior | Standard reference |
Bottom line: The standard clinical dose is 100 mcg IV or IM as a single bolus, given immediately after delivery. It is not repeated. — Miller's Anesthesia (WHO EML reference); SOGC Guidelines via ScienceDirect; NCBI NBK546425
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