Carbeshot100 mcg/ml

Carbeshot is a synthetic, long-acting analogue of oxytocin indicated for the prevention of postpartum hemorrhage (PPH) caused by uterine atony following delivery of the baby.

Established/Approved Use

• Prevention of postpartum hemorrhage due to uterine atony following delivery of an infant, particularly after cesarean section performed under regional (spinal or epidural) or general anesthesia, given as a single dose immediately after delivery of the baby and before delivery of the placenta.

Guideline-Supported Use

• Some international guidelines (e.g., WHO) also support use of Carbeshot for prevention of PPH after vaginal delivery in appropriate hospital settings; local labeling and availability vary.

Carbeshot is not indicated for induction or augmentation of labor and must never be given before delivery of the baby.

Each mL of sterile solution for injection contains Carbetocin 100 micrograms (as carbetocin acetate), supplied in single-dose ampoules/vials for intravenous or intramuscular injection.

Carbeshot is a synthetic octapeptide analogue of the natural hormone oxytocin, modified to have a longer duration of action. It is used in obstetric practice as a uterotonic agent to promote sustained uterine contraction and reduce blood loss immediately after childbirth.

Compared with oxytocin, which requires a continuous infusion because of its short half-life, Carbeshot can be given as a single injection because its effect on the uterus lasts considerably longer.

Carbeshot belongs to the class of oxytocic agents (uterotonics) — synthetic oxytocin receptor agonists used to prevent or manage postpartum uterine atony and bleeding.

Carbetocin acts as an agonist at oxytocin receptors located on uterine smooth muscle (myometrium), producing rhythmic contractions similar to those of endogenous oxytocin but with a more sustained tonic contraction.

Onset and Duration

• Onset of uterine contraction: within about 2 minutes of intravenous administration.
• Duration of contractile effect: approximately 1 hour, covering the period of highest postpartum hemorrhage risk.

Pharmacokinetics

• Elimination half-life of roughly 40 minutes after IV administration — substantially longer than the few minutes seen with natural oxytocin.
• Metabolized and eliminated via the liver and kidneys.

Carbeshot is given as a slow intravenous injection over approximately 1 minute, or alternatively by intramuscular injection, using aseptic technique. It should be administered only after delivery of the baby and, in cesarean section, after clamping of the umbilical cord and before delivery of the placenta. It should not be diluted or mixed with other injections unless otherwise directed.

Carbeshot has not been extensively studied for drug interactions; the following are recognized as clinically relevant:

• Other oxytocic/ergot agents (e.g., ergometrine, additional oxytocin): concurrent or sequential use may increase the risk of excessive uterine contraction, hypertension, and cardiovascular effects; combined use should be avoided unless specifically directed by the treating physician.
• Vasoconstrictors and sympathomimetics: concurrent use may potentiate pressor effects when combined with the vasopressor-like actions of Carbeshot.
• Volatile halogenated anesthetics (e.g., halothane): may reduce the uterotonic effect of Carbeshot and increase the risk of uterine relaxation/bleeding.

Adverse effects of Carbeshot are generally transient and related to its oxytocic action.

Common

• Nausea, vomiting, abdominal pain
• Flushing, feeling of warmth
• Headache, dizziness, tremor
• Hypotension, transient tachycardia
• Pruritus (itching), chills
• Metallic taste

Less Common

• Chest pain, palpitations, dyspnea (shortness of breath)
• Anemia
• Back pain

Serious cardiovascular reactions (e.g., significant hypotension, arrhythmia) are uncommon but require prompt medical attention if they occur — see Precautions and Warnings.

Carbeshot is specifically indicated for use in the immediate postpartum period, after the baby has been delivered, and must never be given before delivery of the fetus (see Contraindications).

Lactation: Limited data suggest only small amounts of Carbeshot pass into breast milk, and clinically significant effects on the breastfed infant are not expected when used as a single postpartum dose. However, data are limited, so Carbeshot should be used postpartum only if the potential benefit justifies the potential risk, and a physician should be consulted regarding breastfeeding after its use.

Carbeshot should be administered only by, or under the direct supervision of, a healthcare professional trained in obstetric care, with facilities available for monitoring uterine tone, blood pressure, and heart rate.

• Cardiovascular disease: Use with caution in patients with cardiovascular disorders, as Carbeshot can cause transient hypotension, flushing, and reflex tachycardia; caution is advised in women with significant cardiac disease.
• Hepatic or renal impairment: Specific dosing data are limited; use with caution and appropriate monitoring.
• Not for pre-delivery use: See Contraindications — never administer before the baby is delivered.
• Single-dose use: Repeat dosing of Carbeshot is not recommended; if bleeding continues, alternative uterotonic measures should be used as directed by the physician.

Overdosage with Carbeshot may cause excessive uterine contraction (tetanic contraction) and exaggerated versions of its common side effects, such as marked hypotension, tachycardia, flushing, nausea, and vomiting. There is no specific antidote.

If overdose is suspected, seek immediate medical attention or contact emergency services/a poison control center. Management is supportive, with monitoring of vital signs, uterine tone, and fluid/electrolyte status in a hospital setting.

Store at room temperature (below 30°C), away from light and moisture. Do not freeze. Keep out of reach of children. Use immediately after opening the ampoule/vial; discard any unused portion.

Elderly: Not applicable — Carbeshot is used only in women of reproductive age in the peripartum period.

Hepatic impairment: Limited data; use with caution and appropriate monitoring (see Precautions and Warnings).

Renal impairment: Limited data; use with caution and appropriate monitoring (see Precautions and Warnings).

Cardiovascular disease: Use with caution due to risk of transient hypotension and tachycardia (see Precautions and Warnings).

Carbeshot is given as a single dose only, immediately after delivery of the baby (and, in cesarean section, before delivery of the placenta). It is not intended for repeated or ongoing administration.

Oxytocic agents; synthetic oxytocin analogues; uterotonics.

Carbetocin is a synthetic long-acting agonist of the oxytocin receptor on the myometrium. Receptor binding activates G-protein-coupled signaling pathways that raise intracellular calcium in uterine smooth muscle cells, producing rhythmic and then sustained (tonic) uterine contractions that compress blood vessels at the placental site and reduce postpartum blood loss.

Carbeshot is used exclusively in adult women in the immediate postpartum period; it has no application in the pediatric (infant/child) population. Safety and efficacy of Carbeshot in pregnant adolescents under 18 years of age have not been specifically established, and use in this group should be at the direction of an obstetric specialist.