Bedside Snapshot
- Use It For
- Postpartum hemorrhage from uterine atony that has not responded to oxytocin, uterine massage and, unless contraindicated, ergot; second-line uterotonic
- Adult Dose
- PPH: 250 mcg (1 mL) deep IM; repeat at 15–90 min only in selected cases (max 2 mg, 8 doses total)
- Pediatric Dose
- Not established in children: specialist or medical-control use only. Benzyl alcohol warning for premature infants
- Onset / Duration
- IM: onset and duration not stated on the label; plasma levels highest at 15–60 min in a postpartum study
- Do Not Give / Hold If
- Acute pelvic inflammatory disease; active cardiac, pulmonary, renal or hepatic disease; hypersensitivity; 2 mg total reached
- Watch For
- Bronchospasm (asthma: avoid when an alternative exists)
- Hypertension
- Vomiting, diarrhea and fever
- Reversal / Rescue
- No specific antidote on the label. Stop further doses; treat bronchospasm, hemodynamic change and bleeding per protocol
- Must Remember
- Count the doses: 250 mcg each, 2 mg (8 doses) ceiling; refrigerate at 2–8°C (36–46°F) and record the running total at handoff
Indications
Emergency & Prehospital
- Postpartum hemorrhage from uterine atony: bleeding that has not responded to IV oxytocin, uterine massage and, unless contraindicated, ergot preparations. That is standard PPH care. The label calls these 'conventional methods of management'.
- Persistent atony during transport: bleeding that keeps going en route to an obstetric unit. Protocol decides whether a second-line uterotonic is allowed on the way in.
ED / ICU / Transport
- Second-trimester pregnancy termination: the label covers the 13th to 20th weeks of gestation, including failed expulsion by another method and premature rupture of membranes (label). Hospital use only. Not a field indication.
Other Uses
- Not a prevention agent: the label indicates it only after conventional methods have failed. A 2022 network meta-analysis of cesarean prevention found carboprost definitely inferior to oxytocin for need for additional uterotonics. That is off-label for prevention, per Jaffer 2022.
Dosing & Administration
Doses vary by protocol; follow local protocols and medical direction.
Available Forms
- 250 mcg/mL, 1 mL single-dose ampule (250 mcg carboprost per ampule, as carboprost tromethamine); carton of 10 ampules (label)
Adult Dosing
| Indication | Dose & Route | Repeat / Max | Notes |
|---|---|---|---|
| Postpartum hemorrhage from uterine atony not responding to conventional care, IM | 250 mcg (1 mL) deep IM; fixed dose, not weight-based | Repeat at 15–90 min only in selected cases (label); max 2 mg (8 doses) total | Given after IV oxytocin, uterine massage and, unless contraindicated, ergot (standard PPH care; the label indication says 'conventional methods of management'). In label trials, 73% of successful cases responded to a single injection. If bleeding persists after one or two doses, escalate per protocol: alternative uterotonic, tranexamic acid, surgical or procedural control, blood products. |
| Second-trimester pregnancy termination (label; not a field use), IM | 250 mcg (1 mL) deep IM with a tuberculin syringe; optional test dose 100 mcg (0.4 mL); may increase to 500 mcg (2 mL) if contractility is inadequate | Repeat at 1½–3½ h intervals; total not to exceed 12 mg; not for more than 2 days | Listed for completeness. Pyrexia, vomiting and diarrhea are common in this use (label). |
Pediatric Dosing
| Indication | Dose (per kg) & Route | Max Single / Max Total | Notes |
|---|---|---|---|
| Any indication in children | Not established in children | Not applicable | The label states safety and effectiveness in pediatric patients have not been established. Specialist use only, through pediatric or medical-control direction. |
| Premature or newborn infants | Not established; do not use the vial as a neonatal product | Not applicable | Each 1 mL contains 9.45 mg benzyl alcohol. The label warns of fatal gasping syndrome in premature infants. |
Pediatric note: there is no labelled pediatric dose. Weight-based dosing for other agents lives on the pediatric weight-based dosing page.
Preparation & Administration
- Route: deep intramuscular injection only. The label gives no intravenous dose.
- Inspection: look first. Check the product for particulate matter and discoloration before use, whenever the solution and container permit.
- Storage: must stay refrigerated at 2–8°C (36–46°F). The label gives no room-temperature stability period. Follow pharmacy policy for any time out of the refrigerator.
- Concomitant oxytocics: the label says carboprost may augment other oxytocics. Concomitant use is not recommended. In PPH, it gets added when oxytocin and ergot have not controlled the bleeding, per protocol and medical direction. Record the agent, dose time and sequence.
Dosing Notes:
- 1 mL ampule = 250 mcg; the 2 mg ceiling equals 8 doses of 250 mcg
- Uterine and bleeding response set the dose. Weight does not
- Record each dose time and running total at handoff
Contraindications & Precautions
Contraindications
- Hypersensitivity to carboprost, including anaphylaxis and angioedema (label)
- Acute pelvic inflammatory disease (label)
- Active cardiac, pulmonary, renal or hepatic disease (label)
- Pregnancy termination only: a fetus that has reached viability (label)
Here's the catch: the label calls asthma a precaution, not a contraindication. Many protocols still avoid carboprost in asthma when an alternative exists. Details sit under Precautions.
Precautions
- Asthma: use cautiously, the label says. Carboprost may cause transient bronchoconstriction. Avoid it in active or severe asthma when an alternative uterotonic is available (protocol-dependent). If it's the only option, have a bronchodilator and oxygen ready before each dose
- Other conditions: hypotension or hypertension, cardiovascular disease, anemia, jaundice, diabetes or epilepsy: use cautiously (label)
- Scarred uterus: use with caution, as with any oxytocic (label)
- Chorioamnionitis: the uterine response to carboprost may be blunted (label)
- Fever: carboprost causes transient pyrexia. A fever after delivery still needs an infection evaluation (label).
Hold / Reassess If
- Blood pressure rise: hypertension showed up in 4% of patients in the postpartum series, and the label gives no numeric threshold. Reassess before the next dose and treat per protocol
- Wheeze, chest tightness, dyspnea or falling SpO₂: reassess before the next dose. Treat bronchospasm and oxygenation per protocol
- Dose ceiling reached: 2 mg (8 doses) is the label maximum. Escalate per protocol. No further carboprost
Hospital use: medically trained staff in a hospital with an intensive care unit and acute surgery on site is what the label asks for. Transport teams should plan for that setting.
Adverse Effects & Toxicity
Common
- Vomiting and diarrhea (about two-thirds of patients in the abortion series)
- Nausea (about one-third); flushing; nervousness; headache
- Temperature rise above 2°F (1.1°C) (about one-eighth of patients); usually transient
- Chest tightness, wheezing, dyspnea and cough (bronchospasm)
- Antiemetic and antidiarrheal drugs cut the GI effects considerably (label)
Serious / Life-Threatening
| Effect | Recognition | Management |
|---|---|---|
| Bronchospasm | New wheeze, chest tightness, dyspnea, falling SpO₂ | Stop further doses pending assessment; oxygen; bronchodilator per protocol |
| Hypertension | Rising BP after a dose (4% in the postpartum series) | Reassess; treat per protocol. The label says the reported cases did not require specific therapy for the elevated blood pressure |
| Uterine rupture or perforation | Severe pain, bleeding out of proportion, hemodynamic collapse (both are listed adverse reactions) | Stop dosing; obstetric surgical team; resuscitation per protocol |
| Anaphylaxis (post-marketing) | Hypotension, bronchospasm, urticaria, angioedema | Epinephrine per protocol (see epinephrine 1 mg/mL IM) |
Overdose & Toxicity Management
- Signs: hypertonic uterine activity, bleeding, bronchospasm or hypertension after doses above the labelled regimen
- Immediate management: stop further doses; oxygen; support hemodynamics and airway per protocol; obstetric escalation
- Antidote: No antidote is stated on the label. Treatment is supportive and per protocol
- Dose ceiling: 2 mg (8 doses) per postpartum course. Don't exceed it. Add uterine massage and other PPH steps per protocol
Monitoring
| Parameter | When / How Often | Target / Act If |
|---|---|---|
| Clinical | Uterine tone and bleeding after each dose and at each reassessment | Firm uterus with ongoing bleeding: massage and escalate per protocol; at 8 doses or 2 mg, stop carboprost |
| Clinical | BP and heart rate before each dose and afterward | Rising BP or new arrhythmia: reassess before the next dose and treat per protocol (label gives no numeric threshold) |
| Respiratory | Work of breathing, wheeze and SpO₂ before each dose | New wheeze, chest tightness or falling SpO₂: reassess; treat bronchospasm per protocol |
| Clinical | Temperature and GI losses during transport | Vomiting or diarrhea: protect the airway and treat per protocol. Fever: expected transiently, but evaluate for infection |
| Laboratory | Hemoglobin and fibrinogen when bleeding continues (see hemoglobin and fibrinogen) | Falling hemoglobin or low fibrinogen: treat per protocol |
| Dose Tracking | Each dose (time, mcg) and running total | Running total approaching 2 mg: confirm count with a second clinician |
Interactions & Compatibility
Clinically Significant Interactions
| Drug / Class | Effect | What To Do |
|---|---|---|
| Other oxytocic agents (for example oxytocin, ergot preparations) | Carboprost may augment other oxytocics; the label says concomitant use is not recommended | In PPH, carboprost is added when oxytocin and ergot have not controlled bleeding, per protocol and medical direction; watch for additive uterotonic effect and document the sequence and times |
| Antiemetic and antidiarrheal drugs | Reduce the GI effects of carboprost (label, abortion series) | Give per protocol when vomiting or diarrhea is significant; protect the airway |
No other clinically significant interactions appear on the label. Check any co-administered drug against an institutional interaction resource.
Special Populations
- Pediatrics: safety and effectiveness are not established. See the Pediatric Dosing table. Don't extrapolate adult doses.
- Neonates: every 1 mL ampule carries benzyl alcohol at 9.45 mg per mL. Premature infants are the danger: the label warns of fatal gasping syndrome.
- Pregnancy: two uses sit on the label: postpartum hemorrhage, and pregnancy termination under the abortion indication. Animal data show embryotoxicity. The label says any dose that increases uterine tone could put the fetus at risk. Treat the emergency per protocol.
- Lactation: the label doesn't address lactation. No specific adjustment is established.
- Older Adults: this doesn't apply to the postpartum indication. No specific adjustment is established.
- Renal Impairment: active renal disease is a labelled contraindication. The label gives no renal dose adjustment.
- Hepatic Impairment: active hepatic disease is a labelled contraindication. The label gives no hepatic dose adjustment.
- Obesity / Dosing Weight: the IM dose is fixed. It is not weight-based.
Field & Transport Considerations
- Scope: varies by state and agency protocol. It is a second-line uterotonic that typically needs medical direction. Whether your agency carries it is protocol-dependent.
- Storage & Stability: keep it refrigerated at 2–8°C (36–46°F). The label gives no room-temperature stability period. Confirm cold-chain status before transport.
- Carried Concentration: only one concentration exists, 250 mcg/mL. A dose is one 1 mL ampule. Count the 2 mg total in mcg, not mg.
- Infusions in Transport: not applicable. Carboprost is given IM only.
- Altitude / Environment: not addressed in the label.
- Handoff Essentials: dose times and number, total mcg given (maximum 2 mg), bleeding response, BP and respiratory status after each dose, storage status, and any bronchospasm.
Clinical Pearls
Asthma: label caution, but avoid when an alternative exists: The label warns of transient bronchoconstriction. It lists asthma as a precaution. Many protocols avoid carboprost in asthma when another uterotonic is available. If it's the only option, have a bronchodilator and oxygen ready before each dose.
Second line after oxytocin: Oxytocin, uterine massage and, unless contraindicated, ergot come first. Atony that persists despite them is where carboprost comes in. Other options after oxytocin (ergot, misoprostol) are chosen per protocol, by availability and contraindication.
Eight-dose ceiling: Each dose is 250 mcg. Eight doses make 2 mg, the label maximum. Count the doses out loud at every injection and at handoff.
Not a prevention drug: The label indicates carboprost only for PPH that persists after conventional methods. A 2022 cesarean network meta-analysis found it definitely inferior to oxytocin for need for additional uterotonics.
Exam discriminator (CFRN, CCP-C): Carboprost is a prostaglandin F2α analog. It is not a peptide hormone like oxytocin. What sets it apart: bronchoconstriction, cold-chain storage and the benzyl alcohol warning.
Uterotonics compared:
- Oxytocin: First-line. See the oxytocin page
- Carboprost: second-line prostaglandin; 250 mcg IM, repeat 15–90 min in selected cases, max 2 mg
- Methylergonovine: Ergot alternative. Avoid in hypertension. See the methylergonovine page
- Misoprostol: Oral or rectal alternative. Off-label for PPH in US labeling. See the misoprostol page
- Tranexamic acid: Adjunct for established PPH. See the tranexamic acid page
Pharmacology
Mechanism of Action
- Target: It is a 15-methyl analog of prostaglandin F2α (tromethamine salt). It acts on the myometrium
- Physiologic effect: it produces contractions similar to labor contractions. Postpartum, those contractions provide hemostasis at the placental site (label)
- Clinical consequence: that is how it controls atonic bleeding after oxytocin has failed. Smooth muscle effects also cause vomiting, diarrhea, transient bronchoconstriction and temperature elevation (label)
Pharmacokinetics
| Route | Onset | Peak | Duration |
|---|---|---|---|
| IM | Not stated on the label | Postpartum study (n = 5, 250 mcg IM): highest levels at 15–60 min (label). Abortion series: average peak about 2,060 pg/mL at about 30 min after the first 250 mcg dose (label) | Not stated on the label |
- Half-life: not stated on the label
- Metabolism: not described on the label
- Elimination: not described on the label
Names & Classification
- Generic Name
- Carboprost tromethamine
- Brand Names
- Hemabate (US)
- Pharmacologic Class
- Prostaglandin F2α analog
- Therapeutic Class
- Oxytocic (uterotonic)
- Controlled Substance
- Not controlled
- ISMP High-Alert
- No (not confirmed on the ISMP acute-care list; the list entries were not retrievable in this review)
- Look-Alike / Sound-Alike
- None commonly reported
- Error-Prone Abbreviations to Avoid
- "mg" for the 2 mg total (write 2,000 mcg or 2 mg with the 8-dose ceiling)
References
- Pharmacia & Upjohn Company LLC (a Pfizer subsidiary). (2025). Hemabate (carboprost tromethamine) injection, USP: Prescribing information (revised March 2025). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3d282998-ff0c-480a-bd80-155606ef0a65
- World Health Organization. (2025). Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240115637
- American College of Obstetricians and Gynecologists. (2017). Practice Bulletin No. 183: Postpartum hemorrhage. Obstetrics & Gynecology. https://doi.org/10.1097/AOG.0000000000002351
- Jaffer D, Singh PM, Aslam A, Cahill AG, Palanisamy A, Monks DT. (2022). Preventing postpartum hemorrhage after cesarean delivery: a network meta-analysis of available pharmacologic agents. American Journal of Obstetrics and Gynecology, 226(3), 347–365. https://doi.org/10.1016/j.ajog.2021.08.060
- Chen Y, Jiang W, Zhao Y, Sun D, Zhang X, Wu F, Zheng C. (2021). Prostaglandins for postpartum hemorrhage: pharmacology, application, and current opinion. Pharmacology, 106(9-10), 477–487. https://doi.org/10.1159/000516631
- Jones AJ, Federspiel JJ, Eke AC. (2023). Preventing postpartum hemorrhage with combined therapy rather than oxytocin alone. American Journal of Obstetrics and Gynecology MFM, 5(2S), 100731. https://doi.org/10.1016/j.ajogmf.2022.100731
Medical Disclaimer
- For Educational Purposes Only: This content is intended for educational reference and should not be used for clinical decision-making.
- Not a Substitute for Professional Judgment: Always consult your local protocols, institutional guidelines, and supervising physicians.
- Verify Before Acting: Users are responsible for verifying information through authoritative sources before any clinical application.
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