Carbitocin dose
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carbetocin dose postpartum hemorrhage prevention
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carbetocin dose route IM IV WHO heat-stable formulation indication
Carbetocin (Carbitocin) — Dosing Summary
Carbetocin is a long-acting synthetic oxytocin analogue used for prevention of postpartum hemorrhage (PPH).
Standard Dose
| Setting | Dose | Route | Timing |
|---|---|---|---|
| Caesarean section | 100 mcg IV (slow bolus over 1 min) | Intravenous | After delivery of the baby, before or after placental delivery |
| Vaginal delivery (heat-stable formulation) | 100 mcg IM | Intramuscular | Immediately after delivery |
Key Points
- Single dose only — not repeated. If uterine tone is inadequate, follow additional uterotonic protocols.
- IV route: Preferred after caesarean section; gives faster onset.
- IM route: Used with the heat-stable formulation (Pabal/Duratocin), suitable for vaginal delivery and low-resource settings.
- Half-life: ~40 minutes — significantly longer than oxytocin (~5 min), providing sustained uterine tone.
Formulations
| Formulation | Storage | Use |
|---|---|---|
| Standard (refrigerated) | 2–8°C | Mostly caesarean delivery |
| Heat-stable (e.g., Pabal/Ferring) | Room temperature up to 30°C | All deliveries, especially LMICs |
The heat-stable formulation (100 mcg/mL) is on the WHO Essential Medicines List and is recommended by WHO for prevention of PPH in all birth settings.
Contraindications / Cautions
- Not for use before delivery of the baby (risk of fetal distress)
- Caution in cardiovascular disease (can cause hypotension, flushing)
- Not recommended in pre-eclampsia/eclampsia or hepatic/renal impairment (limited data)
Source: WHO EML 2023; SOGC guidelines; Ferring prescribing information
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