Pabal

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

The drug Pabal has a stimulating effect on the uterus, promoting its contraction, 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 uterine atony in the postpartum period (after operative or natural delivery). After operative delivery ( caesarean section ), the drug is used only after the baby has been removed from the uterus. During natural delivery, it is used in patients who have an increased risk of postpartum hemorrhage.

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Release form

Pabal is available in ampoules containing 1 ml of solution for intravenous administration. The ampoule may be coded with a dot or several colored rings. The cardboard packaging is divided into cells, with 5 ampoules in each pack.

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Pharmacodynamics

Carbetocin, which is part of Pabal, has a long-term effect. In terms of its action, it is similar to oxytocin (a hormone secreted in a woman's body during childbirth); when administered, it binds to some smooth muscle cells of the myometrium and stimulates uterine contractions, increases the frequency of contractions that have already begun, and increases the tone of the uterine muscles. About a week after childbirth, carbetocin affects the frequency and strength of voluntary contractions of the uterus.

After the drug is administered, the woman begins to have strong contractions of the uterus for two minutes. A single intravenous injection of 100 mcg of carbetocin immediately after delivery helps maintain normal uterine contractility and prevent atony and severe bleeding.

Pharmacokinetics

Pabal is distributed in the blood within 15 minutes after administration. Carbetocin can penetrate into breast milk. Like oxytocin, carbetocin reacts with proteinases.

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

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Dosing and administration

Pabal is administered only in hospital settings under the supervision of a specialist. The drug is administered intravenously once immediately after delivery. One dose of the drug (1 ml) must be administered for at least a minute, preferably before the placenta begins to separate. There is no need to re-administer the drug.

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Use Pabal during pregnancy

Pabal is contraindicated during pregnancy. The drug is used only after the birth of the child, before the placenta begins to separate. A small concentration of carbetocin can be observed in breast milk, but the drug is destroyed by the enzymes of the newborn.

Contraindications

Pabal is not used during pregnancy. It is also not used to induce labor.

Contraindications to the use of the drug are hypersensitivity to the components of the drug, kidney or liver disease, epilepsy, late toxicosis, severe damage to the cardiovascular system.

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Side effects Pabal

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

During clinical trials, isolated cases of increased 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. Increased uterine tone, which is accompanied by strong or prolonged uterine contractions, may be associated with an overdose of the drug, which may eventually cause uterine rupture or severe postpartum bleeding. Also, excessive doses of oxytocin, an analogue of which is carbetocin, can lead to excessive fluid accumulation or dehydration and excess sodium in the body. Treatment in case of overdose is symptomatic. If excess fluid accumulates, a woman must limit the amount of fluid consumed, take diuretics, restore electrolyte balance, and block cramps if they occur.

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Interactions with other drugs

Pabal in combination with painkillers and antispasmodics used for anesthesia during childbirth did not reveal any drug interactions. Since carbetocin is similar in chemical composition to oxytocin, the possibility of interactions that oxytocin exhibits cannot 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. When several drugs are administered simultaneously, it is necessary to strictly monitor the woman's condition. A number of inhalation anesthetics can reduce the effect of carbetocin on the uterus. Cases of increased heart rate have also been noted with the simultaneous administration of oxytocin and carbetocin.

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Storage conditions

Pabal should be stored in a well-protected place from light penetration, the optimum temperature is 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

The shelf life of Pabal is two years from the date of manufacture (subject to compliance with the recommendations for storing the drug). The drug should not be used after the expiration date.

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