Carbetocin
Carbetocin: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Drug interactions
- 14. Analogs
- 15. Terms and conditions of storage
- 16. Terms of dispensing from pharmacies
- 17. Reviews
- 18. Price in pharmacies
Latin name: Carbetocin
ATX code: H01BB03
Active ingredient: carbetocin (Carbetocin)
Manufacturer: CJSC Obninsk Chemical-Pharmaceutical Company (Russia); LLC Firm "Ferment" (Russia)
Description and photo update: 2020-28-07
Carbetocin is a long-acting oxytocin agonist; a drug that increases the contractile activity and tone of the myometrium.
Release form and composition
The drug is produced in the form of a solution for intravenous (i / v) administration: a clear, colorless liquid (1 ml each in neutral glass vials, hermetically sealed with rubber stoppers with crimp caps like "Flip Off", in a cardboard box 1 vial and instructions for the use of Carbetocin; 5 vials in blisters, in a cardboard box 1, 2 or 3 packages; for hospitals - 200, 500 or 1000 vials in a cardboard box).
1 ml of solution contains:
- active substance: carbetocin - 100 mcg;
- auxiliary components: anhydrous acetic acid, sodium chloride, water for injection.
Pharmacological properties
Pharmacodynamics
Carbetocin is a drug designed to increase the tone and contractile activity of the myometrium. Its active substance is a polypeptide analogue of the hormone of the posterior lobe of the pituitary gland, a selective agonist of long-acting oxytocin receptors.
The selective effect of the drug on the membranes of the myocytes of the uterus increases their permeability to calcium ions, decreases resting potential and increases their excitability. Similar to the action of oxytocin, carbetocin increases the tone of the uterine muscles, increases the frequency of existing contractions and stimulates rhythmic contractions of the uterus.
After delivery, a single injection of the drug at a dose of 100 mcg within 2 minutes increases the frequency of uterine contractions and causes sharp spontaneous uterine contractions. This dose is sufficient for the prevention of postpartum uterine atony and heavy bleeding.
The uterotonic activity of carbetocin is more potent and prolonged than that of oxytocin.
Pharmacokinetics
After intravenous administration, carbetocin is rapidly distributed in the body, its maximum concentration (C max) in blood plasma is reached after 15 minutes and within 60 minutes averages 1035 pg / ml.
An insignificant amount of the drug penetrates into breast milk, where after 120 minutes its concentration reaches a maximum, which is 56 times lower than the level in blood plasma.
Metabolized by hydrolysis by proteinases.
The half-life (T 1/2) is approximately 40 minutes. Carbetocin is characterized by two-phase elimination with low renal clearance of its unchanged form. Less than 1% of the administered dose is excreted unchanged through the kidneys.
Indications for use
The use of Carbetocin is indicated as a prophylaxis of uterine atony after removal of the child during delivery by caesarean section under spinal or epidural anesthesia.
Contraindications
Absolute:
- liver or kidney disease;
- pronounced pathologies of the cardiovascular system;
- preeclampsia, eclampsia;
- epilepsy;
- use as a labor inducer;
- the period of pregnancy and delivery (before the baby is removed from the womb);
- age up to 18 years;
- hypersensitivity to oxytocin, carbetocin or auxiliary components in the solution.
The drug should be used with caution in cardiovascular diseases, migraine, bronchial asthma, simultaneous administration of large volumes of infusion solutions, or in conditions for which a rapid increase in the volume of extracellular fluid is associated with the risk of complications due to hyperhydration.
Carbetocin, instructions for use: method and dosage
Carbetocin solution is used by slow (within 1 minute) intravenous injection under the supervision of a physician in specialized inpatient obstetric departments.
Before opening, the contents of the bottle must be visually examined. If the solution has changed color or insoluble particles are found in it, it cannot be used.
The bottle is opened immediately before the administration of the solution, immediately after the child is removed by operative delivery, mainly before the separation and removal of the placenta.
Recommended dosage: 100 μg (1 ml) once.
Mixing carbetocin in the same syringe with other drugs is contraindicated.
Side effects
- from the lymphatic system and blood: often - anemia;
- from the side of the vessels: often - hyperemia of the skin of the face, lowering blood pressure (blood pressure);
- from the nervous system: very often - tremor, headache; often - dizziness;
- from the respiratory system, chest and mediastinal organs: often - a feeling of suffocation, shortness of breath, chest pain;
- from the musculoskeletal system: often - back pain;
- from the gastrointestinal tract: very often - abdominal pain, nausea; often - metal taste in the mouth, vomiting;
- general disorders: very often - a feeling of heat; often - chills;
- from the skin and subcutaneous tissues: often - itching;
- violations at the injection site: often - pain at the injection site;
- others: the frequency has not been established - increased sweating, tachycardia.
Overdose
Symptoms: hypertonicity of the myometrium, postpartum hemorrhage, uterine rupture, hyponatremia, overhydration, more often against the background of intravenous administration during surgical delivery of significant volumes of infusion solutions.
Treatment: the use of symptomatic and supportive therapy. If symptoms of an overdose appear, the patient should be provided with appropriate oxygenation. If overhydration is detected, it is required to stimulate diuresis, limit fluid intake, and take measures to restore the electrolyte balance. It is necessary to ensure careful monitoring of the condition of the woman in labor for clinical signs of hyponatremia: headache, drowsiness, apathy. This will help prevent seizures and coma.
special instructions
The use of carbetocin is prohibited at any stage of the operation before the birth of the child or again.
If, after the administration of the drug, persistent uterine bleeding is observed, when establishing its cause, the specialist must first of all make sure of the integrity of the uterus, the absence of unseparated fragments of the placenta and bleeding disorders.
In case of profuse bleeding with atony or hypotension of the uterus, the use of oxytocin and / or ergometrine is indicated.
The decision to use the drug in patients with signs of hyponatremia (headache, apathy or drowsiness) should be made by the doctor only if the expected clinical effect outweighs the possible risks.
The efficacy and safety of using Carbetocin during vaginal delivery or in women with gestational diabetes mellitus has not been established.
Application during pregnancy and lactation
The use of Carbetocin is contraindicated during gestation and cesarean section until the child is removed.
Pediatric use
Due to the lack of information on the effectiveness and safety, Carbetocin solution is contraindicated in patients under 18 years of age.
With impaired renal function
The use of the drug in patients with kidney disease is contraindicated.
For violations of liver function
The use of the drug in patients with liver diseases is contraindicated.
Drug interactions
No cases of drug interactions have been established with the simultaneous use of Carbetocin with analgesics, antispasmodics, agents for spinal or epidural anesthesia.
With the use of caudal-conduction anesthesia, the administration of carbetocin within the first four hours after prophylactic use of vasoconstrictor drugs increases the risk of a sharp increase in blood pressure.
When combined with methylergometrine (ergot preparations), the effect of carbetocin and an increase in blood pressure may increase.
Joint use with prostaglandins can enhance the effect of the drug, therefore, such combinations are recommended to be avoided, and if necessary, the woman in labor should be monitored constantly.
Inhalation anesthetics such as halothane or cyclopropane can reduce the effects of carbetocin on the uterus and increase the hypotensive effect.
Sequential administration of carbetocin and oxytocin increases the risk of arrhythmias.
The likelihood of cumulative exposure increases if oxytocin or methylergometrine is administered after carbetocin.
Consideration should be given to the possibility of interactions that are characteristic of oxytocin.
Analogs
Carbetocin analogues are Oxytocin, Oxytocin-Vial, Oxytocin-Richter, Oxytocin-MEZ, Pabal, etc.
Terms and conditions of storage
Keep out of the reach of children.
Store at temperatures from 2 to 8 ° C in a dark place, do not freeze.
Shelf life is 2 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Carbetocin
Reviews of Carbetocin from patients are currently absent.
Experts compared the efficacy and tolerability of carbetocin and oxytocin in the prevention of postpartum hemorrhage after vaginal delivery. According to the results of a prospective, double-blind, randomized study, it was found that the use of carbetocin is associated with similar adverse reactions, but accompanied by minimal hemodynamic changes, compared with traditional oxytocin. But women in the carbetocin group experienced more tachycardia than in the oxytocin group.
Price for Carbetocin in pharmacies
The price of Carbetocin, solution for intravenous administration, 100 μg / ml, for a package containing 5 vials of 1 ml, is 8,915 rubles.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
