Carbetocin
Also known as: 1-butanoic acid-2-(O-methyl-L-tyrosine)-1-carbaoxytocin, Carbetocin, Carbetocin RTS, Duratocin, Oxytocin analogue, Pabal, RO 12-1685
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Summary
Carbetocin is a synthetic oxytocin analogue approved as a prescription uterotonic. It is given by intramuscular or intravenous injection to stimulate uterine contraction and prevent or treat postpartum haemorrhage (PPH). Because it has a longer duration of action than oxytocin, it can replace the need for a continuous infusion after delivery and is listed among first‑line agents for third‑stage labour care.
Mechanism of Action
Carbetocin binds to the oxytocin receptor on uterine smooth‑muscle cells, activating the same G‑protein‑coupled signalling pathway as oxytocin and inducing rapid uterine contraction. Structural modifications (butanoic‑acid side chain and O‑methyl‑L‑tyrosine) give it a slower clearance, prolonging receptor activation and uterine tone without markedly increasing receptor desensitisation compared with oxytocin.
What the Research Shows
A 2024 clinical update describes carbetocin as a first‑line uterotonic acting on the oxytocin receptor and notes that lower doses can achieve adequate uterine tone. A 2025 Cochrane network meta‑analysis of 122 trials found carbetocin’s effectiveness in preventing PPH ≥500 mL to be comparable to oxytocin (high‑certainty evidence) and similarly effective for PPH ≥1000 mL (moderate certainty). The same review reported a modest reduction in the need for additional uterotonics (RR 0.74, low certainty). An international consensus statement (2019) highlighted that equipotent doses of carbetocin avoid the requirement for a continuous infusion and reduce additional uterotonic use, while a 2022 third‑stage‑care review listed carbetocin among the most effective single‑agent regimens after vaginal delivery and as a preferred bolus after Caesarean section.
Reported Benefits
Evidence indicates carbetocin prevents postpartum haemorrhage as effectively as oxytocin, with a longer half‑life that eliminates the need for a post‑delivery infusion. This simplifies dosing and may lessen the requirement for rescue uterotonics. Its side‑effect profile appears similar to oxytocin, and it is included in guideline‑recommended regimens for both vaginal and Caesarean deliveries.
Limitations of the Evidence
Direct superiority over oxytocin has not been demonstrated; most comparative data show equivalence. Some outcomes, such as reduction in additional uterotonic use, are supported by low‑certainty evidence. Carbetocin is not yet available in all countries (e.g., United States), and dose adjustments may be needed for intrapartum Caesarean sections. Cost and accessibility may limit routine use.
Safety Considerations
The Cochrane review reported that, unlike other uterotonics, carbetocin did not show an increased incidence of side effects compared with oxytocin. No specific adverse events were identified in the cited abstracts, but, as with all uterotonics, caution is advised in women with cardiac disease or severe hypertension because uterine contraction can affect haemodynamics. Standard contraindications for oxytocin (e.g., hypersensitivity) are presumed to apply.
How It Is Administered
Carbetocin is supplied as a sterile injectable solution for intramuscular or intravenous administration. In clinical practice it is given as a single bolus dose immediately after delivery of the fetus, providing prolonged uterine tone without the need for a subsequent infusion. Formulations are prescription‑only.
Routes of Administration
Goals & Uses
- Uterine atony managementObstetricsModerate
- Reduction of uterine atonyUterotonicHigh
- Prevention of postpartum hemorrhage after vaginal deliveryObstetric / HemostasisModerate
- Prevention of postpartum hemorrhageObstetricsHigh
- Non-pneumonic management of PPH in resource-limited settingsGlobal HealthModerate
- Prevention of postpartum hemorrhage after cesarean sectionObstetric / HemostasisHigh
Contraindications
- Severe cardiovascular disease (e.g., uncontrolled hypertension)CardiovascularModerate
- Known hypersensitivity to carbetocin or oxytocinAllergyHigh
- Use before delivery of the infantObstetricHigh
- Cardiovascular disease (severe)CardiovascularHigh
- Induction or augmentation of laborObstetricHigh
- Hypersensitivity to carbetocin or oxytocinAllergicHigh
- Hepatic or renal impairmentOrgan ImpairmentModerate
Adverse Effects
- HypertensionCardiovascularCommonHigh blood pressure
- HeadacheNeurologicCommonPain in the head or upper neck
- HypotensionCardiovascularCommonLow blood pressure
- Nausea/vomitingGastrointestinalCommon
- Tremor / chillsMusculoskeletal / SystemicUncommon
- FlushingVascularUncommonWarmth and redness of the skin
- TachycardiaCardiovascularUncommonAbnormally fast heart rate
- NauseaGastrointestinalCommonFeeling of sickness or urge to vomit
Drug Interactions
- Other uterotonics (e.g., oxytocin, misoprostol)Moderate
- Ergot alkaloids (e.g., methylergonovine)Moderate
- Vasopressors (e.g., epinephrine)Moderate
- Prostaglandins (e.g., misoprostol, dinoprostone)Moderate
- General anesthetics (halogenated agents)Moderate
Population Constraints
- Postpartum womenReproductiveAbsolute
- Renal impairmentOrgan ImpairmentRelative
- Pediatric patientsAgeAbsolute
- Women with severe cardiac diseaseCardiovascularRelative
- Severe cardiovascular diseaseCardiovascularRelative
- Pregnancy (before fetal delivery)ObstetricAbsolute
Regulatory Status
- European UnionApprovedApproved: Prevention of postpartum hemorrhage
- United StatesUnapprovedNot FDA‑approved; available only via clinical trial or compassionate use.
- United KingdomApprovedApproved: Prevention of postpartum hemorrhage
Approved in the EU, UK, and many other jurisdictions for postpartum hemorrhage; not FDA‑approved in the United States.
Evidence & Sources
- Journal ArticleModerateOnwochei DN, Desai N, Tsen LC2024-01-01T00:00:00.000000Z
- Journal ArticleHighGallos ID, et al.2025-01-01T00:00:00.000000Z
- Journal ArticleLowHeesen M, et al.2019-01-01T00:00:00.000000Z
- Journal ArticleModerateJones AJ, Federspiel JJ, Eke AC2023-01-01T00:00:00.000000Z
- Journal ArticleModerateHersh AR, et al.2024-01-01T00:00:00.000000Z
Frequently Asked Questions
What clinical situation is carbetocin used for?
Carbetocin is used to prevent or treat postpartum haemorrhage by promoting uterine contraction after the birth of the baby, whether the delivery is vaginal or by Caesarean section.
How does carbetocin differ from oxytocin?
Both drugs activate the oxytocin receptor, but carbetocin’s chemical modifications give it a slower clearance, resulting in a longer duration of uterine contraction and eliminating the need for a continuous infusion after the initial dose.
Is carbetocin more effective than oxytocin for preventing PPH?
Large network meta‑analyses show carbetocin is at least as effective as oxytocin for preventing blood loss of ≥500 mL and ≥1000 mL. It does not appear to be superior, but it may reduce the need for extra uterotonic agents.
Are there any special safety concerns with carbetocin?
Available evidence indicates carbetocin’s side‑effect profile is similar to oxytocin and does not increase adverse events. Nevertheless, standard cautions for uterotonics—such as monitoring cardiovascular status in women with heart disease—still apply.
How is carbetocin administered?
Carbetocin is given by intramuscular or intravenous injection as a single bolus dose immediately after delivery. Its prolonged action means a continuous infusion is not required.
What is Carbetocin?
Carbetocin is a synthetic oxytocin analogue approved as a prescription uterotonic. It is given by intramuscular or intravenous injection to stimulate uterine contraction and prevent or treat postpartum haemorrhage (PPH). Because it has a longer duration of action than oxytocin, it can replace the need for a continuous infusion after delivery and is listed among first‑line agents for third‑stage labour care.
What is Carbetocin used for?
Carbetocin is educationally associated with: Uterine atony management, Reduction of uterine atony, Prevention of postpartum hemorrhage after vaginal delivery, Prevention of postpartum hemorrhage, Non-pneumonic management of PPH in resource-limited settings, Prevention of postpartum hemorrhage after cesarean section. Educational only — not medical advice.
How is Carbetocin administered?
Recorded routes of administration: Intramuscular, Intravenous.
What are the potential side effects of Carbetocin?
Reported adverse effects include: Hypertension, Headache, Hypotension, Nausea/vomiting, Tremor / chills, Flushing, Tachycardia, Nausea. This list is not exhaustive — consult a qualified clinician.
Who should avoid Carbetocin?
Recorded contraindications: Severe cardiovascular disease (e.g., uncontrolled hypertension), Known hypersensitivity to carbetocin or oxytocin, Use before delivery of the infant, Cardiovascular disease (severe), Induction or augmentation of labor, Hypersensitivity to carbetocin or oxytocin, Hepatic or renal impairment. Consult a qualified clinician before use.