At a Glance
Carboprost tromethamine intramuscular injection is FDA‑approved for the treatment of postpartum hemorrhage due to uterine atony and for inducing abortion in the second trimester in adults.
Generic/Biosimilar name: Carboprost tromethamine.
Active ingredient: Carboprost Tromethamine.
Administration route: Intramuscular.
Typical intramuscular dosing is 250 micrograms repeated every 15–90 minutes as needed, up to a usual maximum total dose of 2 mg (8 doses), administered only by trained clinicians in a monitored setting.
How It Works
- Carboprost tromethamine is a synthetic form of prostaglandin F2α, a natural hormone-like substance in the body.
- It causes the muscles of the uterus to contract strongly, which helps stop bleeding and empty the uterus.
- These uterine contractions also tighten blood vessels in the uterus, reducing blood loss after childbirth or during an induced abortion.
Treatment and Efficacy
Approved indications
Carboprost tromethamine intramuscular injection is approved to treat postpartum hemorrhage due to uterine atony that does not respond adequately to oxytocin and other measures, and to induce abortion in the second trimester (including in cases of missed abortion or intrauterine fetal death).
Off-label uses and evidence
Clinicians may occasionally use carboprost as part of broader protocols for severe obstetric bleeding or for evacuation of retained products of conception outside labeled gestational limits, based on small studies and clinical experience rather than large randomized trials.
Efficacy expectations
Uterine contractions and reduction in bleeding typically begin within minutes of intramuscular injection, and many cases of postpartum hemorrhage are controlled after one or a few doses; in second‑trimester abortion regimens, repeated doses over several hours help achieve uterine evacuation in most patients. Compared with other uterotonics such as oxytocin and methylergonovine, carboprost is often reserved as a second‑ or third‑line option because it is potent and effective but has more gastrointestinal and respiratory side effects.
Dosage and Administration
Typical dosing and administration
For postpartum hemorrhage due to uterine atony, the usual dose is 250 micrograms given as a deep intramuscular injection, repeated every 15–90 minutes as needed up to a total of 2 mg (8 doses), in a monitored hospital setting. For second‑trimester abortion, 250 micrograms intramuscularly is given at intervals (often every 1.5–3.5 hours) according to protocol until uterine evacuation occurs or a maximum cumulative dose is reached. It is not taken by mouth and is not self‑administered; timing relative to food is not relevant.
Special dosing instructions
Doses may be adjusted or limited in patients with cardiovascular, pulmonary, renal, or hepatic disease, and the drug must be administered only by trained clinicians with access to resuscitation equipment and continuous monitoring of vital signs and uterine status.
Missed dose and overdose
Because carboprost is given in a hospital according to clinical response, patients do not manage missed doses; clinicians decide whether and when to give another injection. Overdose or overly frequent dosing can cause severe uterine hyperstimulation, hemorrhage, bronchospasm, or cardiovascular instability; management is supportive and may include stopping the drug, treating bronchospasm and blood pressure changes, and managing uterine or bleeding complications.
Safety and Side Effects
Common side effects
Common reactions include nausea, vomiting, diarrhea, abdominal cramping, flushing, fever or chills, and increased uterine pain, often starting soon after injection and usually resolving as the drug wears off. These effects are generally short‑lived but can be uncomfortable and may require supportive treatment (for example, anti‑nausea medicine or fluids).
Serious or rare adverse effects
Serious reactions can include bronchospasm or asthma attacks, shortness of breath, chest tightness, severe hypertension, excessive uterine contractions with uterine rupture, heavy or persistent bleeding, anaphylactoid reactions, and, rarely, cardiovascular events. Any trouble breathing, chest pain, severe abdominal pain, sudden heavy bleeding, or signs of shock during or after dosing requires immediate emergency evaluation.
Warnings and precautions
Carboprost is contraindicated in people with active asthma or significant pulmonary disease, and used cautiously in those with a history of asthma, heart disease, high blood pressure, kidney or liver impairment, or glaucoma. It is used only in pregnancy for its obstetric indications and is not a routine medication outside those settings; breastfeeding considerations are limited because dosing is short‑term in a hospital, but infants should be monitored if exposure is possible. Elderly and pediatric patients outside reproductive age are not typical candidates for this drug.
Safety compared with similar drugs
Compared with oxytocin, carboprost has more gastrointestinal and respiratory side effects, so it is usually used after first‑line agents fail; compared with other prostaglandins, its main additional concern is bronchospasm in patients with asthma.
Reporting and safety information
Side effects can be reported to the manufacturer or to the FDA’s MedWatch program, and updated safety information is available through FDA drug safety communications and professional prescribing resources.
Interactions and Precautions
Drug and other interactions
Carboprost is usually given with other uterotonics (such as oxytocin or methylergonovine) and anesthetic or analgesic agents; combined use increases the need for close monitoring of blood pressure, uterine tone, and bleeding. Concurrent use with other prostaglandins or drugs that constrict airways may raise the risk of bronchospasm, especially in patients with asthma. There are no major food interactions, and alcohol use is not relevant because administration occurs in a hospital setting.
Precautions and conditions making use unsafe
Carboprost is contraindicated or used with extreme caution in patients with active asthma or significant pulmonary disease, severe cardiovascular disease, uncontrolled hypertension, significant kidney or liver impairment, or glaucoma, and in situations where strong uterine contractions pose added risk (such as uterine scarring or suspected uterine rupture). It should not be used in viable pregnancies except when termination is intended and clinically appropriate.
Monitoring needs
During treatment, clinicians closely monitor blood pressure, heart rate, respiratory status, oxygen saturation, uterine contractions, and vaginal bleeding; additional tests such as hemoglobin/hematocrit, coagulation studies, or blood gases may be ordered depending on the severity of hemorrhage or the patient’s underlying conditions.
Common Questions and Answers
Q: What is carboprost tromethamine used for?
A: It is an injectable medicine given in hospitals to control severe bleeding after childbirth due to a soft uterus (uterine atony) and to help induce abortion in the second trimester when medically indicated.
Q: How quickly does carboprost work to stop postpartum bleeding?
A: Uterine contractions and a decrease in bleeding usually begin within minutes after the intramuscular injection, and clinicians decide whether repeat doses are needed based on response.
Q: Who should not receive carboprost tromethamine?
A: People with active asthma or serious lung disease, and those with significant heart, kidney, liver disease, uncontrolled high blood pressure, or glaucoma are generally poor candidates, and the care team will choose alternatives when possible.
Q: Can carboprost be used at home or in an outpatient clinic?
A: No, carboprost is intended only for use in hospitals or similar facilities where continuous monitoring and emergency treatment are available.
Q: Will I still be able to breastfeed after receiving carboprost?
A: The drug is given as short‑term treatment around delivery, so significant long‑term exposure to the baby is unlikely; your care team can advise you on when to start or resume breastfeeding based on your overall condition and other medicines you receive.
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Disposal Guidance
Storage
Store carboprost tromethamine vials as directed by the manufacturer, typically refrigerated and protected from light; do not freeze, and keep in the original container until use.
Handling and disposal
This medicine is for use in healthcare facilities only; unused or expired vials should be disposed of by clinic or hospital staff following hazardous pharmaceutical waste procedures, not in household trash or drains.