carbetocin

Carbetocin is a synthetic analogue of oxytocin used as a uterotonic to prevent postpartum hemorrhage (PPH) after delivery of the placenta. It is a selective oxytocin receptor agonist with a chemical modification—a thioether linkage—that makes it more resistant to enzymatic breakdown and results in a longer duration of action than natural oxytocin.

Medical uses include prevention of PPH after vaginal or cesarean delivery, particularly in women at high risk of PPH. A typical regimen is a single 100 microgram intramuscular dose given immediately after delivery; in some settings intravenous administration is used. It is generally considered an alternative to oxytocin when a longer-acting uterotonic is desirable.

Adverse effects are similar to other uterotonics and can include nausea, vomiting, headache, flushing, and abdominal pain. More concerning are cardiovascular effects such as tachycardia and hypotension, and there is a risk of uterine hypertonus or arrhythmias in susceptible patients. Contraindications include known hypersensitivity to carbetocin or any components; use with caution in women with cardiovascular disease, severe hypertension, or a history suggesting risk of uterine rupture.

Regulatory status varies by country, but carbetocin is approved in many regions for PPH prophylaxis. It is typically administered by obstetric teams and considered alongside oxytocin and other uterotonics in clinical guidelines. Its longer duration can offer a more stable prophylactic effect compared with oxytocin, though cost and availability influence its use.