Carboprost

Uses

Terminating pregnancy between the 13th and 20th weeks of gestationIn the following conditions related to second trimester abortion:

1. Failure of expulsion of the fetus during the course of treatment by another method;

2. Premature rupture of membranes in intrauterine methods with loss of drug and insufficient or absent uterine activity;

3. Requirement of a repeat intrauterine instillation of drug for expulsion of the fetus;

4. Inadvertent or spontaneous rupture of membranes in the presence of a previable fetus and absence of adequate activity for expulsion.

Treatment of postpartum hemorrhage due to the uterus failing to return to its normal size and who have not responded to conventional treatments.

Carboprost is also used to associated treatment for these conditions: Refractory postpartum uterine hemorrhage, Medically induced abortion

How Carboprost works

Carboprost is a synthetic prostaglandin. It binds the prostaglandin E2 receptor, causing myometrial contractions, casuing the induction of labour or the expulsion of the placenta. Prostaglandins occur naturally in the body and act at several sites in the body including the womb (uterus). They act on the muscles of the womb, causing them to contract.

Dosage

Carboprost dosage

1. Abortion and Indications 1–4An initial dose of 1 ml of Carbestop (containing the equivalent of 250 mcg of Carboprost) is to be administered intramuscularly. Subsequent doses of 250 mcg should be administered at 1½ to 3½ hour intervals depending on uterine response. An optional test dose of 100 mcg (0.4 ml) may be administered initially. The dose may be increased to 500 micrograms (2 ml) if uterine contractility is judged to be inadequate after several doses of 250 mcg (1 ml). The total dose administered of Carbestop should not exceed 12 mg and continuous administration of the drug for more than 2 days is not recommended.

2. For Refractory Postpartum Uterine Bleeding:An initial dose of 250 mcg of Carbestop (1 ml) is to be given deep, intramuscularly (IM). If needed the dose of 1 ml may be repeated between 15 to 90 minutes. The total dose of Carbestop should not exceed 2 mg (8 doses).

Side Effects

The most frequent adverse reactions observed are related to its contractile effect on smooth muscle, especially gastrointestinal effects like vomiting, nausea, diarrhea and pyrexia. Endometritis, retained placental fragments, and excessive uterine bleeding occurred as the most common complications after abortion with Carboprost.

Toxicity

Symptoms of overdose include irritation, nausea, vomiting, diarrhea, coughing, dyspnea, asthma, hypertension, flushing, and pyrexia.

Precaution

• Use Carboprost by medically trained personnel in a hospital which can provide immediate intensive care and acute surgical facilities.

• Use Carboprost cautiously in patients with a history of asthma, hypo- or hypertension, cardiovascular, renal or hepatic disease, anemia, jaundice, diabetes or epilepsy and compromised (scarred) uteri.

• In few patients with chorioamnionitis, uterus may not respond to Carboprost.

• Cervix should always be carefully examined immediately post-abortion.

Interaction

Carboprost may augment the activity of other oxytocic agents. Concomitant use with other oxytocic agents is not recommended.

Food Interaction

Pregnancy & Breastfeeding use

Pregnancy category C. Animal studies do not indicate that Carboprost is teratogenic, however, it has been shown to be embryotoxic in rats and rabbits and any dose which produces increased uterine tone could put the embryo or fetus at risk.

Contraindication

• Hypersensitivity (including anaphylaxis and angioedema) to Carboprost Sterile Solution
• Acute pelvic inflammatory disease
• Patients with active cardiac, pulmonary, renal or hepatic disease

Storage Condition

Store at 2-8°C. Do not freeze. Keep away from light. Once the ampoule has been opened, the product should be used immediately.

Innovators Monograph

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