Carboprost (Hemabate)
Hemabate · 15-methyl PGF2α
Synthetic prostaglandin F2α analog (uterotonic)
15-methylated synthetic analog of prostaglandin F2α. Binds prostaglandin F receptors on uterine smooth muscle → potent contraction. Also constricts pulmonary smooth muscle → BRONCHOSPASM (contraindication in asthma).
Indications
- •Postpartum hemorrhage from uterine atony — third-line after oxytocin + methylergonovine
- •Termination of pregnancy (off-label use in some institutions)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Postpartum hemorrhage | 250 mcg IM (or IM into uterine wall by surgeon) q15 min, max 8 doses (2 mg total) | — |
Pharmacokinetics
Onset 5-15 min IM. Half-life ~3 h. Hepatic + renal metabolism.
Hemodynamic effects
↑BP (modest), ↑PVR (significant — pulmonary vasoconstriction), tachycardia.
Respiratory effects
BRONCHOSPASM — common (~10% incidence) — CONTRAINDICATED in asthma.
Side effects
- !Nausea + vomiting (~50%) — pre-treat with antiemetic
- !Diarrhea (~50%)
- !Bronchospasm — CONTRAINDICATED in asthma (use misoprostol instead)
- !Pulmonary HTN exacerbation
- !Fever, chills
- !Increased intracranial pressure
Contraindications
- ×Asthma (absolute)
- ×Active pulmonary disease
- ×Hypersensitivity
- ×Active cardiac/renal/hepatic disease (relative)
Clinical pearls
- ★PPH stepwise: oxytocin → methylergonovine → CARBOPROST → misoprostol → mechanical/surgical (Bakri balloon, B-Lynch, embolization, hysterectomy).
- ★ASTHMA — major contraindication. Use MISOPROSTOL (PGE1) instead — does not cause bronchospasm.
- ★Pre-treat with ANTIEMETIC (ondansetron 4 mg + dexamethasone 4-8 mg) — N/V universal.
- ★May be given INTRA-MYOMETRIALLY by surgeon (transabdominal injection into uterine wall) — direct effect, less systemic.
- ★Plus TXA 1 g IV (WOMAN trial — reduces death from PPH bleeding).
Other drugs in OB / GYN Related
- Oxytocin
Stimulates uterine smooth muscle contraction (uterine OXTR receptors). ADH-like action at high doses.
- Methylergonovine (Methergine)
Direct uterine smooth muscle stimulant — potent + sustained contraction. Also vasoconstrictor (especially coronary + cerebral arteries) → CONTRAINDICATED in HTN, preeclampsia, CAD.
- Misoprostol (Cytotec)
Synthetic PGE1 analog. Binds prostaglandin E receptors on uterine smooth muscle → contraction. Also: cytoprotective gastric mucosa (original indication for NSAID-induced ulcers); cervical ripening; GI motility.
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