NAME OF DRUG

carboprost tromethamine

CLASSIFICATION

Prostaglandin-Abortifacient

ALTERNATE NAMES

HEMABATE

INDICATIONS

• termination of pregnancy in the second trimester
• control of severe bleeding postpartum or following therapeutic abortion
• treatment of hemorrhagic cystitis in stem cell transplant recipients

RECONSTITUTION AND STABILITY

• stable in refrigerator
• diluted solutions in NS should be administered within 60 minutes of preparation

COMPATIBILITY

• compatible with NS ONLY
• do not mix with other drugs

ROUTES OF ADMINISTRATION

• IM
• bladder instillation - dilute dose in 50mL NS

VH & HSC ADMINISTRATION POLICY

C - Parenteral administration by physician only

DOSAGE

Termination of pregnancy:

• IM: 250 mcg; additional injections of 250 mcg may be administered at intervals of 1.5-3.5 hours, depending on uterine response; may increase dose to 500 mcg if contractility is inadequate after several 250 mcg doses
• total IM dose should not exceed 2 mg

Control of hemorrhage:

• IM: 250 mcg; additional doses may be administered between 15 and 90 minutes apart if needed
• total dose should not exceed 2 mg

Hemorrhagic Cystitis:

• 400-500mcg diluted in 50mL NS and instilled into the bladder; clamp catheter and allow solution to dwell for 60 minutes; repeat every 6 hours until response
• patient should change positions every 15 minutes while carboprost is in bladder

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• increased blood pressure, tachycardia
• bronchoconstriction, pulmonary hypertension
• allergic reactions, fever, chills
• erythema at injection
• bladder spasm with bladder instillation

IMPORTANT IMPLICATIONS

• following IM injection, carboprost usually produces abortion in approximately 16 hours
• adverse events include nausea, vomiting, diarrhea, abdominal pain, myalgia, flushing, headache, dyspnea, sweating, and leukocytosis
• nausea, vomiting and diarrhea are common and can be controlled with concomitant administration of antiemetics and antidiarrheals
• contraindicated in patients with known cardiac, pulmonary, renal, or hepatic disease, or pelvic inflammatory disease
• uterine rupture following administration of IM carboprost and IV oxytocin has been reported
• it is recommended that breast feeding not occur for at least 6 hours after administration
• severe bladder spasms may require symptomatic relief with oxybutinin or belladonna and opium (B&O) suppositories