carboprost

Therapeutic Classification: abortifacients

Pharmacologic Classification: oxytocics, prostaglandins

Indications ⬆ ⬇

REMS

Induction of mid-trimester abortion.
Treatment of postpartum hemorrhage that has not responded to conventional therapy.

Action ⬆ ⬇

Causes uterine contractions by directly stimulating the myometrium.

Therapeutic effects:

Expulsion of fetus.
Control of postpartum bleeding.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following IM administration.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(peak noted as mean abortion time)

ROUTE	ONSET	PEAK	DURATION
IM	unknown	16 hr	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Acute pelvic inflammatory disease;
Active pulmonary, renal, or hepatic disease.

Use Cautiously in:

Uterine scarring;
Asthma;
Hypotension;
Hypertension;
Cardiac disease;
Adrenal disease;
Anemia;
Jaundice;
Diabetes mellitus;
Seizure disorders.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: flushing

GI: diarrhea, nausea, vomiting, abdominal pain, cramps

GU: UTERINE RUPTURE

Neuro: dizziness, headache

Resp: wheezing

Misc: fever, chills, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA), shivering

Interactions ⬆ ⬇

Drug-drug:

Augments the effects of other oxytocic agents.

Route/Dosage ⬆ ⬇

Test Dose

IM (Adults ): 100 mcg.

Abortifacient

IM (Adults ): 250 mcg every 1.5–3.5 hr depending upon uterine response; may be ↑ to 500 mcg if several doses of 250 mcg produce inadequate response (not to exceed 2 days of continuous therapy or total dose of 12 mg).

Refractory Postpartum Uterine Bleeding

IM (Adults ): 250 mcg; may be repeated every 15–90 min (total dose not to exceed 2 mg).

Availability ⬆ ⬇

(Generic available)

Solution for injection: 250 mcg/mL

Assessment ⬆ ⬇

Monitor frequency, duration, and force of contractions and uterine resting tone. Notify health care professional if contractions are absent or last more than 1 min.
Monitor temperature, pulse, and BP periodically throughout course of therapy. Large dose may cause hypertension. Temperature elevation beginning 1 to 16 hr after initiation of therapy and lasting for several hours is not unusual.
Monitor for signs and symptoms of anaphylaxis (wheezing, chest tightness, dyspnea, rash, pruritus, swelling of face, lips, or throat). Provide supportive care if symptoms occur.
Assess for nausea, vomiting, and diarrhea. Vomiting and diarrhea occur in approximately two-thirds of patients. Premedication with antiemetic and antidiarrheal is recommended.
Monitor amount and type of vaginal discharge. Notify health care professional immediately if symptoms of hemorrhage (increased bleeding, hypotension, pallor, tachycardia) occur.

Implementation ⬆ ⬇

Avoid contact with skin. Thoroughly wash skin immediately after spillage.
- Opioid analgesic may be given for uterine cramping.
- Store in refrigerator.
IM: Administer deep IM. Dose may be repeated every 1.5–3.5 hr. Rotate sites.

Patient/Family Teaching ⬆ ⬇

Explain purpose of vaginal examinations (to assess for trauma to cervix).
- Instruct patient to notify health care professional immediately if fever and chills, foul-smelling vaginal discharge, lower abdominal pain, or increased bleeding occurs.

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Pronunciation ⬇

Classifications ⬆ ⬇