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Created January 3, 2016, last updated over 3 years ago.
Collection: 68, Score: 3346, Trend score: 0, Read count: 3681, Articles count: 21, Created: 2016-01-03 07:42:36 UTC. Updated: 2021-02-09 00:05:30 UTC.Notes
Carbetocin is a long-acting synthetic oxytocin analog. Although a 100 mcg dose is currently recommended, there is still some question as to the ideal dose. Dosing as low as 20 mcg may possibly be equally effective.
Carbetocin is currently only recommended for use during elective cesarean delivery, obviating the need for a post-operative oxytocin infusion currently practiced in many countries. In some countries it is also used after vaginal delivery.
It is at least as efficacious as intravenous oxytocin, and may possibly be superior at reducing postpartum haemorrhage.
Due to it's comparatively high cost compared with oxytocin however, the economic benefit of avoiding post-operative oxytocin infusions has not been demonstrated.
In the scenario of emergency cesarean section after labor augmentation with oxytocin, a much larger dose is likely required and carbetocin cannot be recommended.
One study has suggested a post-operative analgesic benefit of carbetocin vs oxytocin, although the evidence base for this is far from conclusive.
Daniel Jolley
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Collected Articles
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Comparative Study Controlled Clinical Trial
Carbetocin at elective Cesarean delivery: a sequential allocation trial to determine the minimum effective dose.
The ED90 of carbetocin is approximately 15 mcg after elective cesarean section.
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Randomized Controlled Trial
Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose.
The primary objective of our study was to determine the minimum intravenous dose of carbetocin required to produce adequate uterine contraction in 95% of women (effective dose [ED](95)) undergoing elective Cesarean delivery (CD). ⋯ In women at low risk for PPH undergoing elective CD, carbetocin doses of 80-120 μg are similarly effective. There is a high incidence of hypotension associated with carbetocin in these doses, and further studies with doses lower than 80 μg are warranted to assess the balance of efficacy and side effects. This trial was registered at www.clinicaltrials.gov (NCT01262742).
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Randomized Controlled Trial Comparative Study
Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose, part 2.
The aim of this study was to determine the intravenous dose of carbetocin required to produce effective uterine contraction in 95% of women (ED95) undergoing elective Cesarean delivery under spinal anesthesia. ⋯ In women at low risk for PPH undergoing elective Cesarean delivery under spinal anesthesia, carbetocin is similarly effective in doses of 20-100 μg. There is a high incidence of hypotension associated with carbetocin in these doses. Further dose-finding studies are warranted, including doses lower than 20 μg. This trial was registered at www.clinicaltrials.gov (NCT01428817).
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Randomized Controlled Trial
Carbetocin at Cesarean delivery for labour arrest: a sequential allocation trial to determine the effective dose.
The aim of this study was to estimate the effective dose 90% (ED90) of carbetocin to provide adequate uterine tone at Cesarean delivery (CD) for labour arrest. ⋯ The ED90 of carbetocin at CD for labour arrest, as determined in our study, should be interpreted with caution since it may be underestimated. This dose is higher than the currently recommended dose of 100 µg at elective CD and should not be used routinely given the uncertainty regarding its efficacy and the high incidence of arrhythmias at higher doses. This trial was registered at ClinicalTrials.gov, number: NCT01725243.
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Randomized Controlled Trial Comparative Study
Changes in Blood Pressure and Cardiac Output during Cesarean Delivery: The Effects of Oxytocin and Carbetocin Compared with Placebo.
Little is known about maternal hemodynamics after Cesarean delivery. Uterine contractions may increase cardiac output. Oxytocin is the first-line treatment for uterine atony, although the effects of the long-acting oxytocin analogue carbetocin are comparable with that of oxytocin. The authors analyzed the effects of i.v. oxytocin 5 U, carbetocin 100 µg, and placebo on hemodynamics, uterine tone, adverse events, and blood loss after Cesarean delivery. ⋯ The hemodynamic side effects of oxytocin 5 U and carbetocin 100 µg were comparable. The lack of an increase in stroke volume in the placebo group challenges the theory that uterine contraction causes autotransfusion of uterine blood, leading to an increase in preload.
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Case Reports
[Acute coronary syndrome following a 100 µg carbetocin injection during an emergency Cesarean delivery.]
Postpartum hemorrhage affects 5% of parturients. Its prevention relies mainly on the administration of oxytocin derivatives. Carbetocin is a newly available analogue of oxytocin but has a considerable incidence of side effects. ⋯ A 2012 retrospective analysis of the use of carbetocin in our institution revealed an incidence rate for coronary events of 1/245 (0.34%), a rate similar to the ones reported in previous studies. We discuss the management of patients with angina during a Cesarean delivery as well as the plans to care for these patients in the future.
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Int J Obstet Anesth · Feb 2014
Letter Observational StudyQT interval prolongation following carbetocin in prevention of post-cesarean delivery hemorrhage.
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Cochrane Db Syst Rev · Jan 2012
Review Meta AnalysisCarbetocin for preventing postpartum haemorrhage.
Postpartum haemorrhage (PPH) is one of the major contributors to maternal mortality and morbidity worldwide. Active management of the third stage of labour has been proven to be effective in the prevention of PPH. Syntometrine is more effective than oxytocin but is associated with more side effects. Carbetocin, a long-acting oxytocin agonist, appears to be a promising agent for the prevention of PPH. ⋯ There is evidence to suggest that 100 µg of intravenous carbetocin is more effective than oxytocin for preventing PPH in women undergoing caesarean deliveries, but more studies are needed to validate this finding. Carbetocin is associated with less blood loss compared to syntometrine in the prevention of PPH for women who have vaginal deliveries and is associated with significantly fewer adverse effects. Further research is needed to analyse the cost-effectiveness of carbetocin as a uterotonic agent.
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Randomized Controlled Trial Comparative Study
Haemodynamic effects of carbetocin and oxytocin given as intravenous bolus on women undergoing caesarean delivery: a randomised trial.
This study compares the maternal heart rate effects of carbetocin and oxytocin during elective caesarean delivery. ⋯ Both oxytocins have comparable haemodynamic effects and are uterotonic drugs with an acceptable safety profile for prophylactic use. Minimal differences in the recovery phase beyond 70 seconds are in keeping with the fact that carbetocin has an extended half-life compared with oxytocin.
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To obtain quantitative data on uterine contractility postpartum and compare the response of intramuscular oxytocin to carbetocin. ⋯ IUPT monitoring generated quantitative data on postpartum uterine activity. When compared to high-dose oxytocin, a low dose of carbetocin has a more prolonged effect on uterine activity both in terms of a higher amplitude and frequency of contractions.
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J Obstet Gynaecol Can · Nov 2011
Randomized Controlled Trial Comparative StudyCarbetocin versus oxytocin for prevention of postpartum hemorrhage in patients with severe preeclampsia: a double-blind randomized controlled trial.
In patients with severe preeclampsia there is an increased risk of postpartum hemorrhage, but the hemodynamic changes associated with severe preeclampsia make the management of any kind of bleeding particularly troublesome. There are many pharmacological options for the management of postpartum hemorrhage, oxytocin being the first line of treatment. There is as yet no evidence about the safety and efficacy of using carbetocin, an oxytocin agonist, in these patients. We aimed to compare oxytocin with carbetocin for the routine prevention of postpartum hemorrhage in patients with severe preeclampsia. ⋯ Carbetocin is an appropriate alternative to oxytocin for the prevention of postpartum hemorrhage in women with severe preeclampsia. Considering that it appears not to have a major hemodynamic effect in women with severe preeclampsia and that it uses a lower volume per dose than oxytocin, it should be considered a valid option in the management of the third stage of labour in women with hypertensive disorders of pregnancy.
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Arch. Gynecol. Obstet. · Nov 2009
Randomized Controlled Trial Comparative StudyUtilization of carbetocin for prevention of postpartum hemorrhage after cesarean section: a randomized clinical trial.
A randomized study involving pregnant women was conducted to compare the effectiveness of a single intravenous (IV) injection of carbetocin with that of a standard 2-h oxytocin IV infusion with respect to intraoperative blood loss in the prevention of uterine atony after cesarean section (CS). The two treatments also were compared for safety and ability to maintain adequate uterine tone and to reduce the incidence and severity of postpartum hemorrhage (PPH) in women at risk for this condition. ⋯ Carbetocin makes possible to obtain, with a single IV injection, results equivalent to those of oxytocin on the maintenance of uterine tonicity and the limitation of blood losses, in the peri- and in the post-operative period, during a delivery by CS. It has in addition a comparable tolerance. Even in our series adverse events are practically of the same type and similar frequency in both study groups. Thus, the effectiveness of carbetocin consists, thanks to its long half-life, on an unique injection, whereas oxytocin requires repeated injections or a perfusion of several hours, with a variability of the administered doses.
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Randomized Controlled Trial Comparative Study
Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial.
To compare the effectiveness of carbetocin and oxytocin when they are administered after caesarean section for prevention of postpartum haemorrhage (PPH). ⋯ Carbetocin is associated with a reduced use of additional oxytocics. It is unclear whether this may reduce rates of PPH and blood transfusions.
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Am. J. Obstet. Gynecol. · Mar 1999
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialDouble-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section.
The goal of this study was to compare carbetocin, a long-acting oxytocin analog, with oxytocin in the prevention of uterine atony after cesarean section. ⋯ Carbetocin, a new drug for the prevention of uterine atony, appears to be more effective than a continuous infusion of oxytocin and has a similar safety profile.
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J. Matern. Fetal. Neonatal. Med. · Jan 2016
Randomized Controlled TrialCarbetocin versus oxytocin for prevention of postpartum hemorrhage in obese nulliparous women undergoing emergency cesarean delivery.
To assess and compare the effectiveness and safety of single IV polus dose of carbetocin, versus IV oxytocin infusion in the prevention of PPH in obese nulliparous women undergoing emergency Cesarean Delivery. ⋯ A single 100-µg IV carbetocin is more effective than IV oxytocin infusion for maintaining adequate uterine tone and preventing postpartum bleeding in obese nulliparous women undergoing emergency cesarean delivery, both has similar safety profile and minor hemodynamic effect.
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J. Matern. Fetal. Neonatal. Med. · Jun 2012
Controlled Clinical TrialCarbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage.
To compare the effectiveness of carbetocin with oxytocin with respect to maintain adequate uterine tone and to reduce the incidence and severity of postpartum haemorrhage. Moreover safety, adverse effects and the need of additional medications were evaluated. ⋯ A single carbetocin injection is efficacious and safe on the maintenance of uterine tone and on the limitation of blood losses, in peri- and in postoperative period. In addition, carbetocin was able to reduce pain perception during postoperative days improving quality life of women.
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Arch. Gynecol. Obstet. · May 2013
Comparative StudySystematic use of carbetocin during cesarean delivery of multiple pregnancies: a before-and-after study.
Cesarean deliveries of multiple pregnancies are associated with a high risk of hemorrhage. The aim of this study is to evaluate the efficacy of carbetocin administered systematically during cesarean deliveries of multiple pregnancies. ⋯ In our population of multiple pregnancies delivered by cesarean, carbetocin did not appear more effective than oxytocin in preventing severe postpartum hemorrhage.
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Arch. Gynecol. Obstet. · Dec 2013
Randomized Controlled TrialCarbetocin versus sublingual misoprostol plus oxytocin infusion for prevention of postpartum hemorrhage at cesarean section in patients with risk factors: a randomized, open trail study.
To compare combined sublingual misoprostol plus oxytocin infusion with intravenous carbetocin for prevention of postpartum hemorrhage (PPH) in patients with risk factors during cesarean section (CS). ⋯ Both sublingual misoprostol plus oxytocin infusion and intravenous carbetocin are similarly effective for the prevention of PPH in patients with risk factors during CS.
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Arch. Gynecol. Obstet. · Jun 2013
Comparative StudyCarbetocin in comparison with oxytocin in several dosing regimens for the prevention of uterine atony after elective caesarean section in the Netherlands.
The aim of the study was to compare the prophylactic effects of carbetocin with those of oxytocin for the prevention of uterine atony in patients undergoing elective caesarean section (CS) in the Netherlands. The primary endpoint was the need for additional uterotonic medication. ⋯ Compared with oxytocin, prophylaxis of uterine atony with carbetocin after an elective CS diminished the need for additional uterotonics by more than 50 %.
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Comparative Study
Does carbetocin for prevention of postpartum haemorrhage at caesarean section provide clinical or financial benefit compared with oxytocin?
Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide. A recent Cochrane review of carbetocin (long-acting oxytocin analogue) concluded that its use decreased additional uterotonic requirements, however, no included studies compared its use against intravenous bolus oxytocin. The majority of studies of carbetocin have considered its use in vaginal delivery; no studies have examined the economic implications of its use. ⋯ A range of clinical outcomes were observed including frequency of postpartum haemorrhage, estimated blood loss, transfusion requirements, change in haemoglobin or haemodynamics, use of additional uterotonics and perioperative recovery. Finally, a composite financial analysis was performed. No clinically significant benefit was found, however associated costs increased by £18.52/patient.
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Clin. Pharmacol. Ther. · Jul 1992
Comparative StudyEffect of carbetocin, a long-acting oxytocin analog on the postpartum uterus.
Carbetocin, a long-acting oxytocin analog, was administered by intravenous and intramuscular injection to 40 women 24 to 48 hours postpartum. Intravenous injection of 8 to 30 micrograms produced a tetanic uterine contraction within 2 minutes, lasting about 6 minutes, followed by rhythmic contractions for a further 60 +/- 18 minutes. Intramuscular injection of 10 to 70 micrograms also produced tetanic contraction in less than 2 minutes, lasting about 11 minutes, and followed by rhythmic contractions for an additional 119 +/- 69 minutes. ⋯ Carbetocin produced mild lower abdominal cramping in most patients and severe pain in three patients who received 50 or 100 micrograms intravenously or 70 micrograms intramuscularly. Approximately half of the patients also experienced flushing and warmth. Although carbetocin has not yet been studied immediately postpartum, its prolonged uterine activity suggests that carbetocin may offer advantages over oxytocin in management of the third stage of labor.
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