From the Guidelines
Carbetocin is best administered as a single intravenous (IV) dose of 100 micrograms given slowly over 1 minute. This is typically done immediately after delivery of the baby in cesarean section or after delivery of the placenta in vaginal birth. The medication should not be repeated, as it is designed as a single-dose treatment. For patients with renal impairment, dose adjustment may be necessary. Carbetocin should be stored in refrigeration (2-8°C) until ready for use, though it can remain stable at room temperature (below 25°C) for up to 24 hours. This synthetic oxytocin analog has a longer half-life (approximately 40 minutes) than oxytocin, providing sustained uterine contractions to prevent postpartum hemorrhage. The IV route is preferred over intramuscular administration because it provides more immediate onset of action and more predictable drug levels, which is crucial in the management of potential postpartum bleeding.
However, the provided evidence does not directly support the administration of carbetocin, as the studies mentioned are related to different topics, such as non-tuberculous mycobacterial pulmonary disease 1 and epithelial ovarian carcinoma 1. Despite this, the recommended administration of carbetocin is based on its pharmacological properties and clinical use.
Some key points to consider when administering carbetocin include:
- The importance of slow IV administration to minimize adverse effects
- The need for dose adjustment in patients with renal impairment
- The stability of the medication at room temperature for up to 24 hours
- The preference for IV administration over intramuscular administration due to its more immediate onset of action and predictable drug levels.
It is essential to note that the provided evidence does not directly address the administration of carbetocin, and the recommended administration is based on general medical knowledge and the properties of the medication.
From the Research
Methods of Administration for Carbetocin
The administration of carbetocin can be done through various methods, including:
- Intravenous (IV) injection
- Intramuscular (IM) injection
- Short infusion
Efficacy of Different Administration Methods
Studies have shown that:
- Intravenous injection of carbetocin produces a tetanic uterine contraction within 2 minutes, lasting about 6 minutes, followed by rhythmic contractions for a further 60 +/- 18 minutes 2
- Intramuscular injection of carbetocin also produces tetanic contraction in less than 2 minutes, lasting about 11 minutes, and followed by rhythmic contractions for an additional 119 +/- 69 minutes 2
- The prolonged duration of activity after intramuscular compared with the intravenous carbetocin was significant (p = 0.020) 2
- The ED90 of carbetocin was 14.8 μg (95% confidence interval 13.7 to 15.8) when administered intravenously during elective Cesarean delivery 3
- Administration of carbetocin as short infusion does not compromise uterine tone and has similar cardiovascular side-effects as a slow i.v. bolus 4
Safety and Tolerability
- Carbetocin has a safety and tolerability profile similar to oxytocin, with a low incidence of adverse effects such as headache, tremor, hypotension, flushing, nausea, abdominal pain, pruritus, and feeling of warmth 5
- The maximum tolerated dose (MTD) of carbetocin when administered intramuscularly after normal vaginal birth was calculated to be at 200 microg 6
- Serious adverse events, including blood loss > or = 1000 ml, manual placenta removal, additional oxytocics administration, and blood transfusion, were more common in the higher dose groups 6