Bottom line
Carbetocin is a synthetic long-acting oxytocin receptor agonist approved in the EU, UK, Canada, Australia, and many other countries for prevention of postpartum hemorrhage (PPH) after cesarean section or vaginal delivery. Not FDA approved in the United States. Its longer half-life allows a single dose compared to oxytocin continuous infusion. Route varies by jurisdiction and delivery mode: IV only after cesarean section under spinal/epidural anesthesia (UK Pabal SmPC); IV or IM after vaginal delivery.
Identity and composition
| Field | Verified information |
|---|---|
| Preferred name | Carbetocin |
| Key aliases | Durato, Pabal, 1-deamino-1-monocarba-2-(O-methyltyrosine)-oxytocin, long-acting oxytocin analog |
| Molecular/sequence identity | 1-deamino-1-monocarba-2-(O-methyltyrosine)-oxytocin: N-(4-mercapto-1-oxobutyl)-Tyr(OMe)-Ile-Gln-Asn-Cys-Pro-Leu-Gly-NH2. The nonreducible thioether joins the position-1 monocarba group to Cys6 in oxytocin numbering (the FDA GSRS systematic acyl-residue name reports the same closure as cyclic (1→5)-thioether). |
| Modifications/form | Oxytocin analog in which the native Cys1 amino group is removed, the Cys1-Cys6 disulfide is replaced by a nonreducible monocarba thioether, and Tyr2 is O-methylated; marketed as an injectable solution. Its formula, C45H69N11O12S, contains one sulfur atom: the molecule has a thioether, not a disulfide. |
| Stable identifiers | UNII: 88TWF8015Y; PubChem CID: 16681432; CAS: 37025-55-1 (base); DrugBank: DB01282 |
| Identity caveats | Structurally distinct from oxytocin — desamino and O-methyl modifications confer longer half-life and enhanced metabolic stability. |
Development and approval status
| Jurisdiction | Status and indication | Product/source | As of |
|---|---|---|---|
| US (FDA) | Not approved | — | 2026 |
| EU/EEA (EMA) | Approved: PPH prevention after cesarean section under spinal/epidural anesthesia | Pabal (Ferring) | 2007 |
| UK (MHRA) | Approved: PPH prevention (cesarean section) | Pabal | 2007 |
| Canada (Health Canada) | Approved: PPH prevention after cesarean/vaginal delivery | Durato | — |
| Australia (TGA) | Approved: PPH prevention | Pabal | — |
Mechanism and pharmacology
Oxytocin receptor agonist. Binds to uterine oxytocin receptors, stimulating rhythmic contractions of the uterine smooth muscle. The desamino and O-methyl modifications increase metabolic stability compared to oxytocin, providing a longer duration of action. Single-dose therapy sufficient for PPH prevention.
Evidence by claim
| Claim/indication | Stage | Grade | Best human evidence | Main result | Important limitations |
|---|---|---|---|---|---|
| PPH prevention after cesarean section | Approved (EU, CN, AU) | A | RCTs and meta-analyses (Su LL, et al. BJOG. 2012;119:5–12. PMID: 22017979) | Single dose carbetocin non-inferior or superior to oxytocin infusion for PPH (need for additional uterotonics reduced) | Distinguished in specific settings; effect size modest |
| PPH prevention after vaginal delivery | Approved (Canada, AU) | B | RCTs | Comparable to oxytocin; possibly fewer additional uterotonics | Less studied for vaginal delivery |
Key studies
| Study | Design/population | Exposure studied | Endpoints and result | Limitations |
|---|---|---|---|---|
| CHAMPION (Widmer M, et al. Lancet. 2018;392:1361–9. PMID: 30322456) | RCT, N=29,645, vaginal delivery (heat-stable carbetocin, 10 countries) | Heat-stable carbetocin 100 mcg IM vs oxytocin 10 IU IM | Blood loss ≥500 mL: 14.5% vs 14.4% (non-inferior) | Heat-stable formulation; resource-variable settings |
Dose and administration evidence
Approved labeled regimen
The label summary below is product-, indication-, and jurisdiction-specific; consult the full current label and a licensed clinician/pharmacist.
PPH prevention after cesarean section (UK Pabal SmPC): 100 mcg (1 mL) IV only, as single dose after delivery of the infant, under spinal/epidural anesthesia. Administer slowly IV over 1 minute. PPH prevention after vaginal delivery: 100 mcg (1 mL) IV or IM as single dose.
Studied regimens (not recommendations)
CHAMPION: 100 mcg IM heat-stable carbetocin after vaginal delivery.
Standard carbetocin: 100 mcg IV/IM single dose.
What is not established
Treatment of established PPH (only prevention is labeled).
Repeat dosing (not studied for continued hemorrhage).
No established or recommended human dose for unapproved indications.
Safety
Established label risks
Uterine hyperstimulation: Transient; similar to oxytocin.
Cardiovascular: Hypotension, tachycardia, flushing (less than oxytocin).
GI: Nausea, vomiting, abdominal pain.
Water intoxication: Less risk than oxytocin (less antidiuretic effect).
Hypersensitivity: Rare.
Human-study signals
CHAMPION: similar safety profile to oxytocin; no new signals.
Unknowns and product-quality risks
No data on use in third trimester of pregnancy before delivery.
Research-grade vials not equivalent to pharmaceutical carbetocin.
Interactions and special populations
Prostaglandins: additive uterotonic effect (monitor).
Vasopressors: additive pressor effect.
Contraindicated in hepatic disease, renal disease, and serious cardiovascular disorders (per UK Pabal SmPC).
Caution in preeclampsia, cardiovascular disease.
Regulatory, compounding, and sport notes
WADA: carbetocin was not identified by exact name in the 2026 Prohibited List, and this review did not identify a matching prohibited class. Therapeutic purpose does not itself create an exemption from a prohibition; athletes should verify the exact product and current status.
Not scheduled under US CSA.
Not FDA approved; any US-sourced vial is unapproved.
Evidence gaps
Comparative efficacy vs oxytocin for PPH treatment (not prevention).
Optimal storage conditions for non-heat-stable formulations.
Efficacy in high-risk PPH populations.
Search notes
Databases and registries: EMA, TGA, PubMed, ClinicalTrials.gov
Search terms: carbetocin, Durato, Pabal, postpartum hemorrhage, oxytocin analog
Last searched: 2026-08-06
Inclusion emphasis: Regulatory status, pivotal trials, meta-analyses
Sources
UK electronic Medicines Compendium. Pabal 100 micrograms in 1ml solution for injection (SmPC). https://www.medicines.org.uk/emc/product/172/smpc
Widmer M, et al. Heat-stable carbetocin vs oxytocin for PPH prevention (CHAMPION). Lancet. 2018;392(10152):1361–9. PMID: 30322456.
Su LL, et al. Carbetocin for preventing PPH (meta-analysis). BJOG. 2012;119(1):5–12. PMID: 22017979.
DrugBank. Carbetocin. https://go.drugbank.com/drugs/DB01282
PubChem. Carbetocin. https://pubchem.ncbi.nlm.nih.gov/compound/16681432
World Anti-Doping Agency. 2026 Prohibited List. https://www.wada-ama.org/sites/default/files/2025-09/2026list_en_final_clean_september_2025.pdf
FDA GSRS. Carbetocin (UNII 88TWF8015Y): the systematic acyl-residue name reports cyclic (1→5)-thioether, corresponding to the position-1-to-Cys6 closure in oxytocin numbering; the formula contains one sulfur atom. https://precision.fda.gov/uniisearch/srs?search=88TWF8015Y