Carboprost Alembic
Carboprost tromethamine – Prostaglandin for Postpartum Hemorrhage
Carboprost Alembic contains carboprost tromethamine (15-methyl-prostaglandin F2-alpha), a powerful synthetic prostaglandin used primarily for the treatment of severe postpartum hemorrhage that does not respond to conventional uterotonic therapy. Administered as an intramuscular injection exclusively in hospital settings, it causes strong uterine contractions that help control life-threatening bleeding after childbirth. This medication is used only under direct specialist supervision and is never self-administered.
Quick Facts
Key Takeaways
- Carboprost Alembic is a prescription-only prostaglandin used to treat severe postpartum hemorrhage (PPH) when oxytocin and other first-line agents fail.
- It is administered as a deep intramuscular injection of 0.25 mg, which may be repeated every 15 minutes up to a maximum total dose of 2 mg (8 doses).
- The most common side effects include nausea, vomiting, diarrhea, and transient fever, occurring in up to 60% of patients.
- Carboprost is contraindicated in patients with active cardiac, pulmonary, renal, or hepatic disease, and must never be given intravenously.
- This medication is used exclusively in hospital settings under specialist obstetric supervision and is listed in WHO guidelines for PPH management.
What Is Carboprost Alembic and What Is It Used For?
Carboprost tromethamine, the active ingredient in Carboprost Alembic, belongs to a class of medications known as prostaglandins. Prostaglandins are naturally occurring hormone-like substances that play a critical role in numerous physiological processes, including the regulation of smooth muscle contraction. In obstetric medicine, carboprost is valued for its ability to stimulate powerful, sustained contractions of the uterine myometrium (the muscular wall of the uterus), which is essential for achieving hemostasis after delivery.
Postpartum hemorrhage remains one of the leading causes of maternal mortality worldwide, accounting for approximately 25% of all maternal deaths according to the World Health Organization (WHO). The condition is defined as blood loss of 500 ml or more within 24 hours after birth (or 1,000 ml or more following cesarean section). When primary uterotonic agents such as oxytocin fail to control the bleeding—a scenario known as refractory PPH—second-line agents like carboprost become critically important in preventing catastrophic outcomes.
Carboprost acts by binding to prostaglandin receptors on the smooth muscle cells of the myometrium, triggering a cascade of intracellular events that result in sustained uterine contractions. Unlike naturally occurring prostaglandin F2-alpha, the 15-methyl modification in carboprost confers significantly enhanced potency (approximately 20 times more potent) and a longer duration of action, as the methyl group at the C-15 position makes the molecule more resistant to enzymatic degradation by 15-hydroxyprostaglandin dehydrogenase.
In clinical practice, Carboprost Alembic is indicated for the following situations: treatment of postpartum hemorrhage due to uterine atony that has not responded to conventional management including oxytocin infusion, uterine massage, and ergometrine; termination of pregnancy between 13 and 20 weeks of gestation; and in some institutional protocols, as an adjunctive agent during cesarean section in patients at high risk for uterine atony. Its use is restricted to hospital settings where appropriate monitoring and resuscitation facilities are available.
The medication is supplied as a sterile solution for injection containing 0.25 mg/ml of carboprost tromethamine, equivalent to approximately 0.19 mg of carboprost free acid. Each ampoule contains 1 ml of solution, providing a single dose of 0.25 mg. The formulation includes tromethamine (trometamol) as a salt form to improve aqueous solubility and stability. The product must be stored under refrigeration (2–8°C) and protected from light.
What Should You Know Before Receiving Carboprost Alembic?
Contraindications
Carboprost Alembic is strictly contraindicated in several clinical scenarios. The prescribing physician must conduct a thorough review of the patient's medical history before administration. Absolute contraindications include active cardiac disease (including angina, valvular disease, or cardiac arrhythmias), active pulmonary disease (particularly asthma or chronic obstructive pulmonary disease), active renal disease with impaired renal function, active hepatic disease, and acute pelvic inflammatory disease.
The medication must not be administered to patients with known hypersensitivity to carboprost tromethamine, any other prostaglandin, or any of the excipients in the formulation. Patients who have demonstrated bronchospastic reactions to any prostaglandin should not receive this medication, as severe and potentially life-threatening bronchospasm can occur.
Carboprost Alembic must NEVER be administered intravenously. Intravenous injection can cause severe bronchospasm, cardiovascular collapse, and potentially fatal outcomes. The medication is intended for deep intramuscular injection only, or in specific surgical situations, direct intramyometrial injection.
Warnings and Precautions
Several conditions require extreme caution and careful risk-benefit assessment before administering carboprost. Patients with a history of asthma (even if currently inactive), hypertension, cardiovascular disease, adrenal disease, diabetes mellitus, epilepsy, jaundice, compromised uteri (including previous cesarean section or uterine surgery), cervicitis, infected endocervical lesions, or acute vaginitis should receive carboprost only when the potential benefits clearly outweigh the risks.
Carboprost can cause transient elevations in blood pressure. In patients with pre-eclampsia or pre-existing hypertension, continuous blood pressure monitoring is essential during and after administration. The drug may also cause bronchoconstriction, and pre-treatment with a bronchodilator should be considered in patients with any history of reactive airway disease.
Gastrointestinal side effects, particularly diarrhea and vomiting, are common and may be severe. Prophylactic or concurrent administration of anti-emetic and anti-diarrheal agents should be considered. Temperature elevation is also common, typically self-limiting, and should be differentiated from postpartum endometritis or sepsis.
During and following carboprost administration, the following must be monitored: maternal vital signs (blood pressure, pulse, temperature, respiratory rate) at regular intervals; uterine tone and vaginal bleeding; fluid balance; and signs of adverse reactions including bronchospasm, chest pain, or cardiovascular changes. Oxygen saturation monitoring is recommended.
Pregnancy and Breastfeeding
Carboprost is used specifically in the postpartum period (after delivery) and must not be administered during pregnancy except for the specific indication of pregnancy termination between 13 and 20 weeks of gestation. The powerful uterotonic effects of carboprost can cause uterine hyperstimulation, uterine rupture, and fetal harm if administered during an ongoing pregnancy.
Regarding breastfeeding, prostaglandins are found naturally in breast milk. Limited data exist on the excretion of exogenous carboprost into human breast milk. However, given the short duration of action and the fact that the drug is typically administered as a single course in an acute clinical setting, the impact on breastfeeding is considered minimal. The WHO considers the use of carboprost in emergency postpartum settings compatible with the initiation or continuation of breastfeeding once the patient is clinically stable.
How Does Carboprost Alembic Interact with Other Drugs?
Drug interactions with carboprost are primarily pharmacodynamic in nature, relating to enhanced or opposing effects on smooth muscle contraction, cardiovascular function, and bronchial tone. Since carboprost is administered in controlled hospital settings, interactions are generally managed through careful clinical monitoring and appropriate timing of drug administration.
Major Interactions
The most clinically significant interactions involve other uterotonic agents and prostaglandins. When carboprost is used sequentially with or following oxytocin infusion, the combined uterotonic effect may lead to uterine hyperstimulation, tetanic contractions, or uterine rupture. Careful timing and dose adjustment are essential. If both agents are being used, it is recommended to allow the effects of the previous agent to diminish before initiating the next.
Concurrent use with other prostaglandin preparations (such as misoprostol, dinoprostone, or sulprostone) should be avoided, as the additive pharmacological effects on uterine smooth muscle, gastrointestinal motility, and cardiovascular function can significantly increase the risk of adverse events.
Minor Interactions
Non-steroidal anti-inflammatory drugs (NSAIDs) may theoretically reduce the efficacy of carboprost by inhibiting prostaglandin synthesis, although this interaction is not consistently demonstrated in clinical settings. Beta-adrenergic agonists used as tocolytics (such as terbutaline or ritodrine) may oppose the uterotonic effects of carboprost. General anesthetic agents, particularly halogenated agents, may potentiate the hypotensive effects of carboprost and should be managed with appropriate cardiovascular monitoring.
| Interacting Drug | Type | Effect | Management |
|---|---|---|---|
| Oxytocin (Syntocinon) | Major | Enhanced uterotonic effect; risk of uterine hyperstimulation | Allow interval between doses; monitor uterine tone closely |
| Misoprostol | Major | Additive prostaglandin effects on uterus and GI tract | Avoid concurrent use; use sequentially with monitoring |
| Dinoprostone (PGE2) | Major | Additive uterotonic and cardiovascular effects | Avoid concurrent administration |
| Ergometrine / Methylergometrine | Moderate | Enhanced vasoconstriction and uterotonic effects | Use with caution; monitor blood pressure |
| NSAIDs (e.g., Ibuprofen) | Minor | May theoretically reduce prostaglandin efficacy | Clinical significance uncertain; monitor response |
| Beta-agonists (Terbutaline) | Moderate | Opposing effects on uterine tone (tocolysis vs. contraction) | Discontinue tocolytic before carboprost if possible |
| Halogenated anesthetics | Moderate | Potentiation of hypotensive effects | Cardiovascular monitoring; adjust anesthetic dose |
What Is the Correct Dosage of Carboprost Alembic?
Carboprost Alembic dosing is strictly determined by the treating obstetrician or anesthesiologist and is based on the clinical severity of hemorrhage, the patient's response to treatment, and the presence of any comorbidities that may influence drug tolerance. This medication is never self-administered and requires continuous medical supervision during and after each dose.
Adults – Postpartum Hemorrhage
Standard Dosing Protocol
Initial dose: 0.25 mg (1 ml) by deep intramuscular injection into a large muscle (typically the deltoid or gluteal muscle).
Repeat doses: 0.25 mg at intervals of not less than 15 minutes, based on clinical response.
Maximum dose: 2 mg total (8 doses of 0.25 mg). In refractory cases, some clinical protocols permit a single dose of 0.5 mg, though this is not standard.
Alternative route: Direct intramyometrial injection of 0.25 mg may be performed during cesarean section, at the discretion of the operating surgeon.
Adults – Mid-trimester Pregnancy Termination
Pregnancy Termination Protocol (13–20 weeks)
Initial dose: 0.25 mg by deep intramuscular injection.
Subsequent doses: 0.25 mg at 1.5 to 3.5-hour intervals, adjusted based on uterine response and tolerability.
Maximum dose: 12 mg total over the course of treatment. If no response after 2 days of treatment, alternative methods should be considered.
Children
Carboprost Alembic is not indicated for use in children or adolescents. There are no pediatric indications for this medication. Its use is restricted to adult patients in obstetric settings.
Elderly
The obstetric indications for carboprost do not typically apply to elderly patients. No specific dosage adjustments for elderly patients are provided in the prescribing information. In the rare clinical scenario where carboprost might be considered in an older patient (such as postoperative hemorrhage involving the uterus), standard adult dosing would apply with enhanced cardiovascular and respiratory monitoring.
Missed Dose
The concept of a missed dose does not apply to carboprost, as it is administered in acute clinical settings by healthcare professionals based on real-time clinical assessment. Each dose is given in response to ongoing hemorrhage, and the decision to administer subsequent doses is based on the clinical response to previous injections. If bleeding recurs after an interval, additional doses may be given provided the maximum cumulative dose has not been exceeded.
Overdose
Overdose with carboprost may cause severe uterine hyperstimulation leading to uterine rupture, cardiovascular collapse, and death. There is no specific antidote. Treatment is supportive: discontinue the drug immediately, administer intravenous fluids, bronchodilators for bronchospasm, and provide cardiovascular support as needed. Beta-sympathomimetic agents (such as salbutamol) may be used to counteract uterine hyperstimulation.
| Indication | Dose | Interval | Max Dose | Route |
|---|---|---|---|---|
| Postpartum hemorrhage (PPH) | 0.25 mg (1 ml) | ≥15 minutes | 2 mg (8 doses) | Deep IM injection |
| Intramyometrial (cesarean) | 0.25 mg | Single dose | 0.25 mg | Direct injection into myometrium |
| Mid-trimester termination | 0.25 mg | 1.5–3.5 hours | 12 mg total | Deep IM injection |
What Are the Side Effects of Carboprost Alembic?
Carboprost, like all prostaglandin analogues, produces side effects that are largely predictable extensions of its pharmacological activity on smooth muscle throughout the body. While the primary therapeutic target is the uterine myometrium, prostaglandin receptors are widely distributed in the gastrointestinal tract, bronchial smooth muscle, and vascular smooth muscle, leading to effects in these organ systems. The majority of side effects are self-limiting and resolve within hours of the last dose.
Healthcare providers administering carboprost should be prepared to manage these anticipated side effects, and patients should be informed about what to expect. Pre-treatment with anti-emetics (such as ondansetron) and anti-diarrheal agents (such as loperamide) is recommended by some institutions to reduce gastrointestinal side effects. Antipyretics may be given to manage temperature elevation.
Very Common
Affects more than 1 in 10 patients (>10%)
- Nausea (up to 60% of patients)
- Vomiting (up to 50% of patients)
- Diarrhea (up to 60% of patients)
- Fever / temperature elevation (up to 50%; typically transient, <6 hours)
- Flushing and hot flashes
Common
Affects 1 to 10 in 100 patients (1–10%)
- Headache
- Chills and shivering
- Abdominal pain and cramping
- Injection site pain
- Hypertension (transient blood pressure elevation)
- Tachycardia
- Diaphoresis (excessive sweating)
- Dizziness
Uncommon
Affects 1 to 10 in 1,000 patients (0.1–1%)
- Bronchospasm / wheezing
- Chest pain or tightness
- Dyspnea (shortness of breath)
- Blurred vision
- Dysuria (painful urination)
- Urinary retention
- Lethargy and drowsiness
- Paresthesia (tingling sensations)
Rare
Affects fewer than 1 in 1,000 patients (<0.1%)
- Pulmonary edema
- Anaphylactic reaction
- Uterine rupture (with excessive dosing)
- Cardiovascular collapse
- Thyroid storm (in predisposed patients)
- Seizures
- Acute respiratory distress
Since carboprost is administered in a hospital setting with continuous monitoring, healthcare staff will manage side effects as they arise. However, the patient or attending staff should be alert for signs of serious adverse events including severe bronchospasm (wheezing, inability to breathe), chest pain, signs of cardiovascular compromise (severe hypotension, collapse), or signs of uterine rupture (sudden severe abdominal pain, maternal shock). These require immediate emergency intervention.
How Should Carboprost Alembic Be Stored?
Proper storage of Carboprost Alembic is critical to maintaining the chemical stability and pharmacological potency of the active ingredient. As a prostaglandin analogue, carboprost tromethamine is sensitive to temperature fluctuations and light exposure, both of which can accelerate degradation of the molecule and reduce its therapeutic efficacy.
The medication must be stored at a controlled refrigerated temperature between 2°C and 8°C (36°F to 46°F). It must not be frozen, as freezing can damage the molecular structure of the formulation and alter the concentration of the active substance. The ampoules should be kept in the original outer carton to protect from light exposure. If removed from refrigeration for clinical use, the medication should be used promptly and not returned to storage if it has been at room temperature for an extended period.
As a hospital-only medication, storage responsibility falls to the pharmacy and clinical departments. Standard pharmaceutical cold chain management procedures should be followed, including temperature monitoring and logging for the refrigeration unit. Expired ampoules or those that have been compromised by temperature excursions should be disposed of according to institutional protocols for pharmaceutical waste.
Carboprost should be kept out of reach of unauthorized personnel. Any unused product or waste material should be disposed of in accordance with local regulations for hazardous pharmaceutical waste. The solution should be visually inspected before administration; it should be clear and colorless to slightly yellow. Do not use if the solution is discolored, cloudy, or contains particulate matter.
What Does Carboprost Alembic Contain?
The active substance in Carboprost Alembic is carboprost tromethamine (also known as carboprost trometamol). This is the tromethamine salt of 15(S)-15-methyl prostaglandin F2-alpha, a synthetic analogue of the naturally occurring prostaglandin F2-alpha. The 15-methyl substitution is the key structural modification that distinguishes carboprost from the native prostaglandin, conferring enhanced metabolic stability and greater potency.
Each ampoule contains 0.25 mg/ml of carboprost tromethamine in an aqueous solution. The molecular formula of carboprost tromethamine is C25H47NO8, with a molecular weight of approximately 489.6 g/mol. The excipients include tromethamine (serving as a pH buffer to maintain the solution at physiological pH), sodium chloride (for isotonicity adjustment to prevent tissue irritation at the injection site), and water for injections (as the vehicle).
The product does not contain preservatives, antimicrobial agents, or latex. Each ampoule is intended for single use only. Any unused portion of the solution should be discarded and not saved for later use. The solution is clear and colorless to slightly yellow in appearance. As with all injectable medications, visual inspection prior to administration is required to ensure product integrity.
Frequently Asked Questions About Carboprost Alembic
Carboprost Alembic is used primarily for the treatment of postpartum hemorrhage (severe bleeding after childbirth) that has not responded to first-line treatments such as oxytocin, uterine massage, and ergometrine. It is a powerful prostaglandin that causes the uterus to contract firmly, helping to stop the bleeding. It may also be used for the termination of pregnancy between 13 and 20 weeks of gestation in specific clinical circumstances. This medication is only used in hospitals under specialist supervision.
Carboprost Alembic is given as a deep intramuscular injection (typically into the thigh or buttock muscle) by a healthcare professional. The standard dose is 0.25 mg, which may be repeated every 15 minutes or more as needed, up to a maximum total dose of 2 mg (8 injections) for postpartum hemorrhage. It must never be given intravenously. In some cases during cesarean section, it may be injected directly into the uterine muscle by the surgeon.
The most common side effects of carboprost are gastrointestinal: nausea, vomiting, and diarrhea, which can affect up to 60% of patients. Temporary fever (usually lasting less than 6 hours) is also very common, occurring in up to half of patients. Other common effects include flushing, headache, chills, and pain at the injection site. These side effects are generally temporary and are managed by the medical team in the hospital setting. Pre-treatment with anti-nausea and anti-diarrheal medications may be given.
Carboprost is contraindicated in patients with active asthma or a history of severe asthma due to the risk of bronchospasm (narrowing of the airways). Prostaglandins can cause smooth muscle contraction in the bronchi, potentially triggering severe breathing difficulties. Even in patients with a history of mild asthma that is currently controlled, carboprost should be used only with extreme caution, pre-treatment with bronchodilators, and ready access to emergency respiratory support. Alternative uterotonics such as oxytocin or misoprostol may be safer choices for these patients.
Carboprost has a reported success rate of approximately 84–96% in controlling postpartum hemorrhage when used as a second-line agent after oxytocin and other first-line therapies have failed. It is one of the WHO-recommended uterotonic agents for managing refractory PPH. The response is typically seen within minutes of the first injection. However, if there is no significant improvement after 2–3 doses, the clinical team will consider alternative interventions including intrauterine balloon tamponade, surgical procedures, or interventional radiology.
Carboprost (15-methyl-PGF2α) is one of several uterotonic agents used for PPH, each with different mechanisms and profiles. Oxytocin is the first-line agent with fewer side effects but may fail in up to 20% of cases. Ergometrine (methylergometrine) acts on smooth muscle but is contraindicated in hypertension. Misoprostol (a PGE1 analogue) can be given rectally, sublingually, or orally but has a slower onset. Carboprost is the most potent uterotonic but has the highest rate of gastrointestinal and respiratory side effects. The choice between agents depends on the clinical situation, contraindications, availability, and the patient's response to treatment.
References
- World Health Organization. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: WHO; 2023. Available at: who.int
- American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017;130(4):e168–e186. Reaffirmed 2023.
- Royal College of Obstetricians and Gynaecologists (RCOG). Prevention and Management of Postpartum Haemorrhage. Green-top Guideline No. 52. London: RCOG; 2023.
- International Federation of Gynecology and Obstetrics (FIGO). FIGO Safe Motherhood and Newborn Health Committee Guidelines: Prevention and Treatment of Postpartum Hemorrhage in Low-Resource Settings. Int J Gynecol Obstet. 2022;136(1):S52–S63.
- Su LL, Chong YS, Samuel M. Carbetocin for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2012;2012(4):CD005457. doi:10.1002/14651858.CD005457.pub4
- Gallos ID, Papadopoulou A, Man R, et al. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. 2018;12(12):CD011689.
- Oladapo OT, Okusanya BO, Abalos E. Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour. Cochrane Database Syst Rev. 2020;11(11):CD009332.
- British National Formulary (BNF). Carboprost. National Institute for Health and Care Excellence (NICE). Updated 2024. Available at: bnf.nice.org.uk
- European Medicines Agency (EMA). Summary of Product Characteristics: Carboprost Tromethamine. EMA; 2023.
- Leduc D, Senikas V, Lalonde AB. Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage. SOGC Clinical Practice Guideline No. 235. J Obstet Gynaecol Can. 2023;31(10):980–993.
Editorial Team
Written by the iMedic Medical Editorial Team, specialists in obstetrics, gynecology, and clinical pharmacology. All content follows WHO, ACOG, and RCOG guidelines.
Reviewed by the iMedic Medical Review Board – an independent panel ensuring accuracy, completeness, and adherence to the GRADE evidence framework. Last reviewed January 11, 2026.
iMedic follows strict editorial standards. All medical content is evidence-based (Level 1A where available), independently reviewed, and free from commercial influence. We adhere to WHO, ACOG, RCOG, and FIGO guidelines. No pharmaceutical company funding or sponsorship. Read more about our medical team and editorial process.