Carbetocin

Duratocin, Pabal, Lonactene, Carbetocin Ferring (heat-stable), 1-deamino-1-carba-2-tyrosine(O-methyl)-oxytocin

Sexual health, hormones & signalling

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Note on this profile. Carbetocin is an approved hospital medicine in the EU, UK, Canada, Australia and many other countries (not the US), given once by injection immediately after birth. It is not a research-only compound and has no outpatient or self-directed use. This page explains the published science.

Summary

Class: Synthetic long-acting octapeptide analogue of oxytocin; the disulphide bridge is replaced by a carba (methylene) link and the tyrosine is O-methylated
Mechanism: Activates uterine oxytocin receptors like oxytocin but resists breakdown, so a single dose keeps the uterus contracted for an hour or more after delivery
Routes studied: Intravenous (slow bolus) and intramuscular
Half-life: ~40 minutes (vs ~3–10 minutes for oxytocin); uterine contraction within 2 minutes, sustained ~60 minutes or longer
Storage: Standard formulation: refrigerate 2–8 °C. Heat-stable formulation: room temperature up to 30 °C for its shelf life (the point of the product)
Regulatory status: Approved in EU states, UK, Canada, Australia, many low- and middle-income countries; not FDA-approved

Doses are as reported in studies or by the community — never recommendations.

1What it is

Carbetocin is a modified copy of oxytocin (#48), the hormone that contracts the uterus in labour and after birth. Two chemical changes make it long-acting: the sulphur–sulphur ring bond is replaced by a carbon bridge and one tyrosine is methylated, both of which protect it from the enzymes that destroy oxytocin within minutes. Ferring brought it to market in the 1990s as Duratocin for preventing uterine atony — the failure of the womb to contract — after caesarean section.

Its public-health significance grew when a heat-stable formulation, needing no refrigeration, was developed with WHO. Postpartum haemorrhage remains the leading cause of maternal death worldwide, and oxytocin loses potency when the cold chain fails. The 2018 CHAMPION trial showed heat-stable carbetocin matched oxytocin for preventing bleeding, and WHO added it to the Essential Medicines List in 2019.

2How it's thought to work

Carbetocin binds the oxytocin receptor on uterine smooth muscle, raising intracellular calcium and triggering rhythmic then tonic contractions that clamp the spiral arteries at the placental site. Its longer replaces the infusion that oxytocin usually requires. Like oxytocin it also has weak vasopressin-receptor activity, which explains some blood-pressure effects, and it may act on mammary myoepithelial cells, though milk let-down is not a clinical use.

A longer-acting oxytocin analogue at the oxytocin receptor on uterine muscle. The uterus contracts and bleeding after delivery is reduced; its resistance to breakdown is what allows a single injection where oxytocin itself needs an infusion.Schematic — not to scale

3What the research shows

Prevention of postpartum haemorrhage after vaginal birth (CHAMPION)

A WHO-coordinated, double-blind, non-inferiority trial randomised 29,645 women in 10 countries to 100 µg heat-stable carbetocin IM or 10 IU oxytocin IM after vaginal delivery. Blood loss ≥500 mL or additional uterotonic use occurred in 14.5% vs 14.4% (non-inferior); for blood loss ≥1,000 mL the rates were 1.51% vs 1.45%, and non-inferiority for that stricter outcome was not demonstrated because of the small number of events (Widmer 2018, NEJM). Adverse effects were similar. [1]

Caesarean section

Multiple randomised trials and meta-analyses compare carbetocin with oxytocin at caesarean, mostly finding less need for additional uterotonics and similar blood loss, with no consistent difference in haemodynamic side effects (Su 2012, Cochrane Database Syst Rev; Kalafat 2021, Am J Obstet Gynecol MFM †). A network meta-analysis of all uterotonics ranked ergometrine–oxytocin and carbetocin among the most effective for preventing bleeding ≥500 mL, with moderate certainty (Gallos 2018, Cochrane Database Syst Rev). [2][3]

Graded A (small)

Low-dose regimens

Dose-finding studies in elective and intrapartum caesarean found the effective dose for 90% of women (ED90) to be well below 100 µg — roughly 15–20 µg in elective and higher in labouring women (Khan 2014; Nguyen-Lu 2015, Can J Anaesth †). This has prompted calls to reduce the licensed dose.

Treatment (as opposed to prevention) of established haemorrhage

Limited data; not a licensed indication.

4Reported side effects and interactions

Literature-reported

nausea and vomiting, abdominal pain, flushing, headache, tremor, hypotension and tachycardia (dose-related; slow IV injection reduces them), metallic taste, feeling of warmth, sweating; rarely chest pain, dyspnoea, hyponatraemia with fluid overload (water retention is weaker than oxytocin's but not absent). Contraindicated before delivery of the infant (it is not for induction or augmentation), in severe pre-eclampsia or cardiovascular disease, and in children. Because it is long-acting, excessive uterine tone cannot be switched off by stopping an infusion.

Community-reported

essentially none documented.

Theoretical. repeat dosing has not been formally studied and is not recommended.

Interactions. additive hypotension with anaesthetic agents and other vasodilators; additive uterotonic effect with prostaglandins or ergometrine; no cytochrome interactions.

Markers researchers commonly monitor

From obstetric anaesthesia and trial protocols:

Marker	Why it's watched
Estimated or measured blood loss, uterine tone by palpation	the primary outcomes; tone is assessed minutes after the dose.
Blood pressure and heart rate	hypotension and tachycardia around injection, especially with rapid IV push.
Haemoglobin before and after delivery	objective marker of blood loss.
Serum sodium	only when large volumes of fluid have been given; water-retention risk is lower than with oxytocin infusions.
Need for additional uterotonics or surgical intervention	the standard secondary endpoint in trials.

Free for everyone. Safety information is never behind a paywall.

5Reconstitution and handling

Ready-to-use 100 µg/mL ampoules or vials; single dose, no . Standard product is refrigerated; the heat-stable product is stored at room temperature and was designed for settings without reliable refrigeration. Hospital administration only; the calculator is not applicable.

6Commonly studied alongside

Oxytocin (#48, the universal comparator), ergometrine and syntometrine, misoprostol, tranexamic acid (WOMAN trial era), and, pharmacologically, atosiban (#217) as the mirror-image oxytocin antagonist.

Informational cross-links. Not stack recommendations.

7Regulatory status by region

Region	Status (checked —)
United States	Not FDA-approved; not marketed
European Union	Nationally authorised in most member states (Duratocin, Pabal and others) for prevention of uterine atony after caesarean; heat-stable product and vaginal-birth indication approved in several countries †
United Kingdom	MHRA-licensed (Pabal) for prevention of uterine atony following caesarean under epidural or spinal anaesthesia; hospital use
Australia	TGA-registered (Duratocin)
South Africa	SAHPRA-registered †; also supplied through WHO-prequalification channels in sub-Saharan Africa
Sport (WADA)	Not prohibited

8Open questions

Is 100 µg more than needed? Dose-finding data suggest much lower doses are effective at caesarean.
Non-inferiority for severe haemorrhage (≥1,000 mL) was not proven in CHAMPION; a larger trial would be needed.
Cost-effectiveness and real-world performance of the heat-stable product in low-resource settings.

9References

1Widmer M et al. (2018). Heat-stable carbetocin versus oxytocin to prevent hemorrhage after vaginal birth (CHAMPION). NEJM. PubMed · DOI
2Gallos ID et al. (2018). Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. PubMed · DOI
3Su LL, Chong YS, Samuel M (2012). Carbetocin for preventing postpartum haemorrhage. Cochrane Database Syst Rev. PubMed · DOI
4Malm M et al. (2018). Development and stability of a heat-stable formulation of carbetocin for the prevention of postpartum haemorrhage for use in low and middle-income countries. J Pept Sci. PubMed · DOI
5World Health Organization (2018). WHO recommendation on heat-stable carbetocin for the prevention of postpartum haemorrhage; and WHO Model List of Essential Medicines (2019 addition). PubMed
6Pabal / Duratocin Summary of Product Characteristics (current, UK/EU). PubMed

References are being resolved to PubMed/DOI identifiers; links search PubMed for the citation until then.

† Being confirmed by our reviewers against current sources.

10Community

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Self-reported side effects Phase 2

Not enough data yet. 0 of the 50 members needed have logged this compound for 4+ weeks. We don't show anything below 50, so no one can be identified.

11Page history

31 Oct 2026Profile published — awaiting medical review

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