the uterus greatly increases, reaching a peak during labor and delivery. Consequently, the administration of carbetocin or another oxytocin analog during or immediately following birth will have increased uterotonic and contractile effect. The application of carbetocin does not affect a non-pregnant uterus with lower oxytocin receptor expression. Carbetocin also functions to thicken the blood, further preventing post-partum hemorrhage. Carbetocin should not be used to induce or augment labor since it could cause cardiac or respiratory distress to mother or infant. Pharmacokinetics Carbetocin is to be used in the hospital by prescription only. It can be administered intravenously or intramuscularly. In both cases, the recommended dose for an average adult female is 100ug. Contractile effects of the uterus are apparent within two minutes and can be observed for approximately one hour, though maximum binding occurs about 30 minutes after intramuscular injection. Administration is performed immediately following parturition to minimize risk of postpartum hemorrhage by inducing uterine contractions, increasing muscle tone and thickening the blood. If further uterine stimulation is needed, treatment with other forms of oxytocic uterotonic drugs should be used. Endogenous and synthetic oxytocin has a half-life of approximately 3.5minutes. Carbetocin, in comparison, has a much longer half-life ranging from 85 to 100minutes. The bioavailable dose is around 80%. The elimination half-life following intravenous administration is around 40 minutes, though the elimination mechanism is not entirely known. Studies have shown that elimination is only minimally renal (0.7%), but may occur at least partially through enzymatic degradation of peptides, primarily on the C-terminal end. Both elimination and volume of distribution are not dose dependent. Society and culture Legal approval Carbetocin has been approved for use under the following three brand names in 23 countries, not including the United States: Duratocin (Argentina, Australia, Bahrain, Canada, China, Hong Kong, Italy, Malaysia, Singapore, New Zealand), Lonactene (Mexico), and Pabal (Austria, Belgium, Switzerland, Germany, Estonia, France, UK, Hungary, Lithuania, Luxembourg, Finland). Duratocin has also been approved for veterinary use in Poland, Germany, Italy, Belgium, Luxembourg, France and the Netherlands. Brand names Duratocin, Pabal, Lonactene, Depotocin, Comoton, and Decomoton. References External links Obstetric drugs Oxytocin receptor agonists Peptides World Health Organization essential medicines Wikipedia medicine articles ready to translate