Hemabate

carboprost

(kar-bo-prost) ,

Hemabate

(trade name)

Classification

Therapeutic: abortifacients
Pharmacologic: oxytocics
Pregnancy Category: C

Indications

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 and Excretion: Unknown.
Half-life: Unknown.

Time/action profile (peak noted as mean abortion time)

ROUTEONSETPEAKDURATION
IMunknown16 hrunknown

Contraindications/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; Epilepsy.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache

Respiratory

  • wheezing

Gastrointestinal

  • diarrhea (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • abdominal pain
  • cramps

Genitourinary

  • uterine rupture (life-threatening)

Dermatologic

  • flushing

Miscellaneous

  • fever (most frequent)
  • chills
  • shivering

Interactions

Drug-Drug interaction

Augments the effects of other oxytocic agents.

Route/Dosage

Test Dose

Intramuscular (Adults) 100 mcg.

Abortifacient

Intramuscular (Adults) 250 mcg every 1.5–3.5 hr depending upon uterine response; may be increased 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

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

Availability

Injection: 250 mcg/mL

Nursing implications

Nursing assessment

  • Monitor frequency, duration, and force of contractions and uterine resting tone. Notify physician or other 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.
  • Auscultate breath sounds. Wheezing and sensation of chest tightness may indicate hypersensitivity reaction.
  • 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 physician or other health care professional immediately if symptoms of hemorrhage (increased bleeding, hypotension, pallor, tachycardia) occur.

Potential Nursing Diagnoses

Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Avoid contact with skin. Thoroughly wash skin immediately after spillage.
    • Opioid analgesic may be given for uterine cramping.
    • Store in refrigerator.
  • Intramuscular: 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.

Evaluation/Desired Outcomes

  • Complete abortion.
  • Control of postpartum or post-abortal hemorrhage.
Mentioned in ?
References in periodicals archive ?
Pharmacokinetic properties of common uterotonics used to reduce postpartum bleeding Half-life Storage Oxytocin 1 to Cold storage 6 minutes Misoprostol 20 to Stable at ambient 40 minutes temperature Ergonovine 30 to Cold storage (ergonovine) 120 minutes Methylergonovine 1.5 to Cold storage (Methergine) 13 hours Carboprost 8 minutes Cold storage (Hemabate) 15- methyl prostaglandin F2 alpha Carbetocin (not 40 minutes Stable at available in ambient the United temperature States) Oxytocin With intravenous bolus With intramuscular or infusion, onset of injection the onset action is achieved of action is within within 1 minute.
The patient required doses of both carboprost tromethamine (Hemabate) and methylergometrine (Methergine) to increase uterine tone and control bleeding.
At the same time, oxytocin (Hemabate) was injected into the uterus to observe the uterine contractions and bleeding.
(65.) Oleen MA, Mariano JR Controlling refractory atonic postpartum hemorrhage with Hemabate sterile solution.
Carboprost (Hemabate) is 10 times more potent than the parent compound (prostaglandin [F.sub.2[alpha]]).
Considerations during labor and delivery when the risk of asthma exacerbations is further increased, include avoiding the use of 15-methyl prostaglandin F2[alpha] (Hemabate), which is a very very very potent bronchoconstrictor" that could cause a "rip-roaring" attack.
Considerations during labor and delivery, when the risk of asthma exacerbations is increased, include avoiding the use of carboprost tromethamine (Hemabate), a very potent bronchoconstrictor that could cause a "rip-roaring" attack.
Considerations during labor and delivery when the risk of asthma exacerbations is further increased, include avoiding the use of 15-methyl prostaglandin F2[alpha] (Hemabate), which is a "very, very very potent bronchoconstrictor" that could cause a "rip-roaring" attack.
Manual massage of the uterus and administration of oxytocin, misoprostol, carboprost tromethamine (Hemabate), and methergine do not result in resolution of the hemorrhage.
Prostin (dinoprostone) and Hemabate (carboprost tromethamine) are agents that get the job done.
I have continued that regimen, adding carboprost tromethamine (Hemabate) to the regimen about 10 years ago when hemorrhage persists.
Rather than continue to administer more and more oxytocin in these situations, consider administering a second agent, such as methlyergonovine (Methergine), misoprostol (Cytotec), or carboprost tromethamine (Hemabate, 0.25 mg IM).