Carbetocin (Pabal, Duratocin)_Dosage, benefits & legal status
Also known as Pabal, Duratocin, heat-stable carbetocin, Carbetocin Ferring, FE-992097, LV-101, ACP-101
A modified oxytocin with a carbon-sulfur ring that keeps the womb contracted for hours after one injection. Matched oxytocin in a 29,645-woman trial.
Common vial size is what vendors typically sell, not a recommendation. Enter your own vial in the calculator.
What is Carbetocin (Pabal, Duratocin)?
Plain language first. The technical label stays, but it never stands alone.Overview
Bleeding after childbirth is a leading cause of maternal death, and oxytocin, the standard prevention, has to be kept cold. In the CHAMPION trial (29,645 women in 10 countries), one injection of heat-stable carbetocin prevented blood loss of 500 mL or more as well as oxytocin (14.5% against 14.4%). It is on the WHO essential medicines list for settings where it costs about the same as oxytocin. It is not approved in the US, where a nasal form also failed in Prader-Willi syndrome.
Carbetocin is an oxytocin analogue with no N-terminal amine (a butyric acid unit at position 1), O-methyl-tyrosine at position 2 and a thioether (carba) ring in place of oxytocin's disulfide, with an amidated end. It activates oxytocin receptors on uterine muscle as oxytocin does, but a single dose acts for hours. Ferring sells it as Pabal and Duratocin and developed a heat-stable version with WHO and MSD for Mothers.
What it's used for
A single injection after delivery to prevent heavy bleeding from a slack womb, in the UK, Canada, Australia, Switzerland and other countries. Not available in the US.
How does Carbetocin (Pabal, Duratocin) work?
What it does in the body, and where.Carbetocin does oxytocin's job after birth but lasts much longer.
- 01The signalIt binds oxytocin receptors on uterine muscle (they peak in number at delivery) and triggers the same calcium-driven contraction as oxytocin.
- 02A lasting squeezeA firm contraction starts within about 2 minutes and lasts for hours, clamping the blood vessels where the placenta was attached. One dose does what an oxytocin drip does over several hours.
- 03Why it lastsIt lacks oxytocin's N-terminal amine and has a carbon-sulfur ring instead of a breakable disulfide, the usual explanation for its slower breakdown. Its half-life is still only 33 to 55 minutes; the contraction outlasts the drug. The heat-stable formulation can be stored below 30°C instead of in a fridge.
A schematic of the compound's mechanism, not a diagnostic image.
What else is it used for?
Each group carries its own evidence level.Approved means regulators have cleared it for that purpose. Investigational means it is in trials. Early research means it is being studied and is not established.
Vaginal birth (CHAMPION)
Clinical use- Human trial29,645 women: blood loss of 500 mL or more, or extra uterotonics, 14.5% against 14.4% with oxytocin.
- Human trialLoss of 1,000 mL or more, 1.51% against 1.45%: too few events to show non-inferiority, not evidence of harm.
- No dataBoth arms were kept cold, so field heat stability was not tested.
Caesarean section
Clinical use- Human trial659 women under epidural: more uterotonic needed in 5% after carbetocin against 10% after an 8-hour oxytocin drip.
Prader-Willi syndrome, first phase 3
tested-and-failed- Human trialCARE-PWS, 130 patients: 3.2 mg nasal improved an overeating score (P=0.016), but the 9.6 mg primary comparison did not.
Prader-Willi syndrome, second phase 3
tested-and-failed- Human trialCOMPASS PWS, 175 patients: 3.2 mg three times daily missed the primary endpoint, and development stopped.
Missing the 1,000 mL non-inferiority margin does not mean carbetocin was worse: rates were 1.51% against 1.45%, with too few events to rule out a difference. 'Heat-stable carbetocin' is the same molecule in a new formulation, and CHAMPION kept both drugs cold. 'Long-acting' refers to the contraction, not the half-life (33 minutes IV, 55 minutes into muscle). WHO's endorsement depends on its cost being comparable to other uterotonics. It is not FDA-approved for any use; the nasal Prader-Willi product was refused in 2022 and its follow-up trial failed in 2025. Contraindications differ by country: the UK lists liver and kidney disease and epilepsy, Canada does not.
The published record
Papers and trials about Carbetocin (Pabal, Duratocin)
342 papers tagged human · 175 not reviews or lab · 72 clinical trial publications
105 registered trials · 6 with posted results
Furthest stage reached: Approved outside the US, United Kingdom, Canada, Australia, Switzerland
Counted from Europe PMC indexing, not read by a person; a human tag can land on reviews, commentary or lab papers; clinical trial publications is the narrower count. 421 papers and 100 trials indexed in detail.
At a glance
Four things to know about Carbetocin (Pabal, Duratocin)
Evidence
Clinical use
Category
Sexual and hormonal
Common vial
Varies
Half-life
33 minutes IV, 55 minutes into muscle
How much, and do you cycle it?
The range, and whether you take breaks.100 mcg once, after the baby is delivered (label), once. Single dose Clinical use
Given once after delivery and never repeated.
How long does it stay in the body?
The half-life, and where the figure comes from.33 minutes IV, 55 minutes into muscleclinical-guideline
77% is absorbed from a muscle injection, peaking at about 30 minutes. Under 1% leaves unchanged in urine. Breast milk levels were about 56 times lower than blood, so breastfeeding is not restricted.
Source: Pabal UK summary of product characteristics, section 5.2; Duratocin product monograph
You can compare this against the whole library to see where it sits.
What does it cost?
Typical dose and cost, in plain numbers.Carbetocin (Pabal, Duratocin) is not reconstituted
It is not supplied as a powder measured in milligrams, so there is no water-to-powder math and no draw to calculate here. Doses are written in mcg, in a ready-made 1 mL ampoule.
Typical dose: 100 mcg once, after the baby is delivered (label)
A single 100 microgram (1 mL) injection after the baby is delivered, ideally before the placenta: slowly into a vein over 1 minute after caesarean section, or into a vein or muscle after vaginal birth. No second dose; if the womb stays slack, another uterotonic is used. Supplied as a ready-made 100 micrograms/mL solution; Pabal (UK) is stored below 30°C and Duratocin (Canada) at 15 to 30°C.
How do you store it?
Before mixing, and after.Supplied ready to use. Store it as the label says.
Carbetocin (Pabal, Duratocin) comes as a ready-made solution, prefilled syringe or ampoule, not a powder, so there is no mixing step and no reconstitution clock. Keep it in its original pack and follow the storage and expiry dates on the label. Many ready-made peptide medicines are kept in the fridge and must not be frozen; a few are made to be stored at room temperature.
What are the side effects and cautions?
Known cautions and warnings for this compound.Solubility, computed: 22% charged residues, 56% hydrophobic. Water usually sufficient.
A first-pass rule from peptide manufacturers' guidance. It does not account for disulfide bridges, salt form or how the powder was dried, and it predicts what should be easy rather than what will happen in your vial.
Who should avoid it
- Before delivery of the baby, including to induce labour
- Allergy to carbetocin or oxytocin
- Serious heart or blood-vessel disease
- Epilepsy, or liver or kidney disease (UK label)
- Use in children
Stop and get help
- Continued heavy bleeding: a different uterotonic drug is needed, as carbetocin is not repeated
- Chest pain, an irregular heartbeat or trouble breathing
Common effects
- After IV use, 10% or more have headache, tremor, low blood pressure, flushing, nausea, abdominal pain, itching or a feeling of warmth
- 1 to 10% have anaemia, dizziness, chest pain, breathlessness, a metallic taste, vomiting, back pain or chills
- In CHAMPION, adverse events were reported in 4.03% against 3.92% on oxytocin
- Side effects are less frequent after injection into muscle
Where this page says nothing is established, that means nobody has studied it, not that a compound is safe.
Is Carbetocin (Pabal, Duratocin) approved?
And where the numbers on this page come from.Not in the United States. Carbetocin (Pabal, Duratocin) has no FDA approval. It is approved in the United Kingdom, Canada, Australia, and Switzerland.
- Approval statusClinical use
- RouteInto a vein or muscle (single injection)
- Checked15 October 2026
- Approved outside the USUnited Kingdom, Canada, Australia, Switzerland: Canada (Duratocin) 20 June 1997, UK (Pabal) 6 October 1997, Australia (Duratocin) 30 April 2004 with vaginal births added in 2018, Switzerland (heat-stable Carbetocin Ferring) 2020, plus national licences in some EU countries; on the WHO Model List of Essential Medicines since 2019. Not approved in the US.This does not change the United States position above.
- DoseFrom product labeling and clinical guidelines.
- Vial sizeFrom what vendors typically list; not a recommendation.
- SourcesWidmer M et al., New England Journal of Medicine 2018;379:743-752 (CHAMPION)Pabal UK summary of product characteristics (emc)Duratocin Canadian product monograph (2024)Health Canada Drug Product Database, DuratocinFDA GSRS substance record, carbetocin (UNII 88TWF8015Y)WHO Model List of Essential Medicines, carbetocinFerring, Swissmedic approves Carbetocin Ferring (13 May 2020)ClinicalTrials.gov, CARE-PWS (NCT03649477)Prader-Willi News, FDA complete response letter (Jan 2022)BioPharma Dive, Acadia buys Levo (Jun 2023)Acadia, COMPASS PWS phase 3 results (24 Sep 2025)TGA, Australian public assessment report for carbetocin (2018)DailyMed, carbetocin search
What has happened recently
First approved in Canada (Duratocin, 20 June 1997) and the UK (Pabal, 6 October 1997); Australia registered Duratocin on 30 April 2004 and extended it to vaginal births in March 2018, and it has national licences in some EU countries rather than an EU-wide authorisation. Swissmedic approved the heat-stable Carbetocin Ferring in 2020, the first medicine approved under its procedure for global health products, and Ferring offers it at about $0.31 an ampoule in low-income settings. WHO added heat-stable carbetocin to its essential medicines list in 2019. It is not FDA-approved: a nasal version for Prader-Willi syndrome (Levo's LV-101) drew a 12 to 1 advisory vote against and a complete response letter in January 2022, and Acadia ended the programme after its phase 3 failed in September 2025.
You can compare this against the whole library, or read how to check a seller.
What else is like Carbetocin (Pabal, Duratocin)?
Others in Sexual and hormonal, side by side.If you're weighing Carbetocin (Pabal, Duratocin), it's worth reading Cetrorelix (Cetrotide), Degarelix (Firmagon), and Desmopressin (DDAVP) in the same class.
A modified oxytocin with a carbon-sulfur ring that keeps the womb contracted for hours after one injection. Matched oxytocin in a 29,645-woman trial.
- Dose
- 100 mcg once, after the baby is delivered (label)
- How often
- Once
A GnRH antagonist used in IVF to stop an egg being released too early.
- Dose
- Set by the label
- How often
- Daily during an IVF cycle
A GnRH antagonist for prostate cancer, and the one with no testosterone flare.
- Dose
- Set by the label
- How often
- Loading dose, then monthly
A vasopressin analog with more FDA approvals than any other peptide, and a real hyponatremia risk.
- Dose
- Set by the label and the formulation
- How often
- Varies by indication
Guides for this compound
- How to Reconstitute a Peptide
Mix peptide powder with bacteriostatic water, step by step.
- How to Read an Insulin Syringe
Read the units, convert to millilitres, and draw the exact dose.
- mcg vs mg: The Peptide Dosing Mistake to Avoid
Your vial says mg and your protocol says mcg. Here is the conversion and how to check it.
Sources
- Widmer M et al., New England Journal of Medicine 2018;379:743-752 (CHAMPION)(2018)29,645 women: blood loss of 500 mL or more, or extra uterotonics, 14.5% against 14.4% (RR 1.01, non-inferior); 1,000 mL or more 1.51% against 1.45% (non-inferiority not shown).
- Pabal UK summary of product characteristics (emc)(2026)UK licence since 6 October 1997; dose; half-life 33 minutes IV and 55 minutes IM; caesarean trial 5% against 10% needing more uterotonics.
- Duratocin Canadian product monograph (2024)(2024)Approved 20 June 1997; synthetic nonapeptide analogue of oxytocin; CHAMPION adverse events 4.03% against 3.92%.
- Health Canada Drug Product Database, Duratocin(2026)Two Duratocin product numbers (DINs) held by Ferring Inc.
- FDA GSRS substance record, carbetocin (UNII 88TWF8015Y)(2026)C45H69N11O12S, MW 988.2; CAS 37025-55-1; thioether ring; codes FE-992097 and LV-101.
- WHO Model List of Essential Medicines, carbetocin(2019)Heat-stable carbetocin 100 micrograms/mL added in 2019, where its cost is comparable to other uterotonics.
- Ferring, Swissmedic approves Carbetocin Ferring (13 May 2020)(2020)First approval under Swissmedic's global health procedure; about $0.31 an ampoule in low-income settings.
- ClinicalTrials.gov, CARE-PWS (NCT03649477)(2021)130 people with Prader-Willi syndrome: 3.2 mg nasal improved an overeating score (P=0.016); 9.6 mg did not (P=0.35).
- Prader-Willi News, FDA complete response letter (Jan 2022)(2022)FDA asked for another trial before approving the nasal spray.
- BioPharma Dive, Acadia buys Levo (Jun 2023)(2023)12 to 1 advisory vote against; January 2022 complete response letter; $10 million upfront.
- Acadia, COMPASS PWS phase 3 results (24 Sep 2025)(2025)175 patients: primary and secondary endpoints missed; programme ended.
- TGA, Australian public assessment report for carbetocin (2018)(2018)On the Australian register since 30 April 2004; extension to vaginal birth approved 16 March 2018.
- DailyMed, carbetocin search(2026)No US drug labels: not FDA-approved.
Beyond these, 521 records are indexed. Browse the records