Pabal

The need to use the drug Pabal usually occurs in the postpartum period, when the uterus weakly (or completely) does not contract, which can lead to a severe loss of blood. Atony of the uterus (absence of uterine contraction) is observed rarely, but it poses a great threat to the life of a woman.

The drug Pabal has a stimulating effect on the uterus, contributing to its reduction, thereby preventing bleeding. Despite the ability of the drug to penetrate into breast milk, its concentration in the latter is significantly lower than in the blood, in addition, the digestive enzymes of the newborn completely break down the drug.

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Indications Pabal

Pabal is used to prevent atony of the uterus in the postpartum period (after operative or natural delivery). After surgical delivery ( caesarean section ), the drug is used only after the baby is removed from the uterus. At natural delivery is used in patients who have an increased risk of postpartum hemorrhage.

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Release form

Pabal is issued in ampoules, which contain 1 ml of a solution intended for intravenous administration. The ampoule can be encoded as a point or several colored rings. Cardboard packaging is divided into cells, each pack of 5 ampoules.

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Pharmacodynamics

The carbetocin, which is part of Pabal, has a long-lasting effect. According to the principle of action, it is similar to oxytocin (a hormone released in the body of a woman during labor), upon administration it binds to certain smooth muscle cells of the myometrium and stimulates uterine contractions, increases the frequency of already begun contractions, and increases the tone of the uterine muscles. About a week after birth, carbetocin affects the frequency and strength of arbitrary uterine contractions.

After the injection of the drug, the woman begins strong contractions of the uterus within two minutes. One-time injection of 100mkg of carbetocin intravenously immediately after birth, helps maintain normal uterine contractility and prevent atonia and severe bleeding.

Pharmacokinetics

In the blood Pabal is distributed within 15 minutes after administration. Carbetocin is able to penetrate into breast milk. Just like oxytocin, carbetocin reacts with proteinases.

The half-life of carbetocin is approximately 40 minutes, less than 1% per cent is excreted unchanged by the kidneys. The drug in the blood of parturient women reaches the maximum concentration 15 minutes after injection. In breast milk, the level of the drug two hours after injection was 56 times lower than in the blood.

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Dosing and administration

Pabal is administered only under stationary conditions under the supervision of a specialist. The drug is administered intravenously once immediately after delivery. One dose of the drug (1 ml) should be administered for at least a minute, preferably before the placenta begins to peel off. The need for re-introduction of the drug there.

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Use Pabal during pregnancy

Use Pabal during pregnancy is contraindicated. The drug is used only after the birth of the child, until the moment when the placenta began to exfoliate. A small concentration of carbetocin can be observed in breast milk, but the drug is destroyed by the action of newborn enzymes.

Contraindications

During pregnancy, Pabal is not used. Also, it is not used to stimulate childbirth.

Contraindication to the use of the drug is increased susceptibility to the components of the drug, kidney or liver disease, epilepsy, late toxicosis, severe cardiovascular disease.

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Side effects Pabal

Pabal can cause some disturbances in the functioning of the circulatory (anemia), lymphatic system, the digestive tract may also be disturbed (nausea, vomiting, abdominal pain, metal taste in the mouth). In addition, the drug may cause general malaise (chills, headaches, fever, muscle or bone pain, dizziness, dyspnea), skin rashes and itching, flushing of blood to the face.  

In clinical trials, single cases of rapid heart rate and excessive sweating were noted.

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Overdose

Pabal in case of overdose causes uterine activity regardless of susceptibility to the drug. Elevated uterus tone, which is accompanied by strong or prolonged uterine contractions, may be associated with an overdose of the drug, which as a result may cause uterine rupture or severe postpartum hemorrhage. Also excessive doses of oxytocin, which is analogous to carbetocin, can lead to excessive accumulation of fluid or dehydration and an overabundance of sodium in the body. Treatment in case of an overdose is symptomatic. When accumulating excess fluid, a woman needs to limit the amount of fluid consumed, taking diuretics, restoring electrolyte balance, blocking seizures when she appears.

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Interactions with other drugs

Pabal combined with anesthetic and antispasmodic drugs, which are used during anesthesia during labor, did not reveal any drug interaction. Since carbetocin, in its chemical composition, is similar to oxytocin, the probability of interaction that oxytocin exhibits can not be completely ruled out. Carbetocin in combination with ergot alkaloids leads to an increase in blood pressure, increases the effect of drugs.

It is undesirable to use carbetocin together with prostaglandins, since such drugs increase the therapeutic effect of oxytocin, it is quite possible that such a reaction will occur with simultaneous administration with carbetocin. With the simultaneous administration of several drugs, you must strictly monitor the condition of the woman. A number of inhalation anesthetics can reduce the effect of carbetation on the uterus. Also, there were cases of rapid heartbeat with concomitant administration of oxytocin and carbetocin. 

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Storage conditions

Pabal must be stored in a well protected from light penetration, optimal temperature from 2 to 8 ⁰ C (it is best to store the product in the refrigerator). After freezing, the drug loses all its properties.

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Shelf life

Shelf life Pabal is two years from the date of manufacture (subject to the recommendations for storage of the drug). Do not use the drug expiration date.

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