Carbetocin – first line uterotonic

Introduction 

Carbetocin 100mcg by slow intravenous injection has now been recommended by NICE as first-line uterotonic agent after all caesarean deliveries. It has now additionally been approved by the East region formulary and is now stocked by Pharmacy and Theatres in NHS Borders. 

Standard practice has previously been to administer 5iu Syntocinon via slow intravenous injection with an optional further 5iu upon surgical request, and an optional slow infusion of 40iu over 4 hours as either prophylaxis or treatment of postpartum haemorrhage.   

Cochrane review has demonstrated that there is a statistically significant reduction in the need for additional uterotonics, and economic analysis has suggested that while the list price for Carbetocin is greater than that of, overall use of Carbetocin for caesarean delivery is associated with reduced healthcare costs. 

Risks and benefits of Carbetocin 

 Side effects of Carbetocin are similar to those of Syntocinon although studies have suggested that the risk of nausea and vomiting may be lower with Carbetocin. 

Benefits are largely reduction in use of additional uterotonics with reduction in associated side effects and reduction in costs as detailed above. 

Eligibility for Carbetocin 

All patients having caesarean delivery (CD) should receive Carbetocin unless contraindicated. 

The only contraindication listed in the BNF for Carbetocin is epilepsy.  Anecdotally it is already widely used across the UK for patients with stable epilepsy however should currently be used as first line for patients with epilepsy in the absence of specific safety recommendations. 

Procedure 

Carbetocin should be administered after cord clamping as a slow intravenous injection of 100 micrograms.  This may be before or after placental detachment. 

Additional Syntocinon should not be given within 4 hours of administration of Carbetocin – alternative uterotonics should be used within this timeframe. 

References  

1. Intrapartum care.  NICE guideline (2023) 
2. Su LL, Chong YS, Samuel M. Carbetocin for preventing postpartum haemorrhage. Cochrane Database Syst Rev 2012;(4):CD005457 
3. Matthijsse S, Andersson FL, Gargano M, Yum LYS.  Cost-effectiveness analysis of Carbetocin versus oxytocin for the prevention of postpartum hemorrhage following vaginal birth in the United Kingdom.  J Med Econ 2022; 25(1): 129-137 
4. Ai W, Zeng Y, Ma Y, Liu L, Fan D, Wu S, Zhang Y. Side-effects of Carbetocin to prevent postpartum hemorrhage: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res Perspect. 2021 Apr;9(2): e00745.