Nursing care
Carboprost: what to check before you give it
Written and reviewed by Dana Whitfield, RN, MSN · 3 min read · Updated September 2026
Short answer
Carboprost is a prostaglandin used to control postpartum haemorrhage unresponsive to oxytocin, but it is contraindicated in asthma because it can trigger bronchospasm. Diarrhoea, nausea, and fever are expected effects of the drug working, not signs to withhold the next dose.
Mechanism, simply
Carboprost is a synthetic prostaglandin F2-alpha analogue. It causes strong, sustained uterine contraction, which is what makes it effective against haemorrhage from an atonic uterus that hasn't responded to oxytocin or methylergonovine.
Because it's a prostaglandin, its effects aren't confined to the uterus. Prostaglandins act on smooth muscle throughout the body, which is why it also affects the airways, the GI tract, and body temperature, and why its contraindications and side effect profile look different from the other uterotonics.
Indications you will see on the ward
The main indication is postpartum haemorrhage due to uterine atony that hasn't responded adequately to first-line oxytocin. It's typically a second- or third-line agent, given IM or directly into the myometrium, when the uterus stays boggy despite fundal massage and oxytocin infusion.
It's occasionally used off-label for second-trimester abortion when other methods aren't appropriate. On a postpartum unit, though, you'll almost always encounter it as the drug reached for when bleeding is ongoing and the frontline agents haven't controlled it.
Assessment before administration
Ask about asthma before you draw up the dose. Carboprost is contraindicated in patients with asthma because the prostaglandin effect can trigger bronchospasm, and in a haemorrhaging patient you don't want a second crisis stacked on the first.
Check for active cardiac, renal, hepatic, or pulmonary disease, since these narrow the risk-benefit calculation further. Confirm the fundus has been assessed and first-line measures, oxytocin and fundal massage, have already been tried, since carboprost's place in the protocol is after those have failed to control bleeding.
Toxicity and the antidote
There is no specific antidote for carboprost. Management of toxicity is supportive: stop the drug, treat bronchospasm with bronchodilators if it occurs, manage fever and diarrhoea symptomatically, and support blood pressure and oxygenation as needed.
Overdose or cumulative dosing raises the risk of severe GI effects, hypertension, and bronchospasm. Because there's no reversal agent, prevention through careful screening for asthma and other contraindications before the first dose matters more here than with drugs that have a rescue option.
Interactions that matter
Other uterotonics given concurrently, oxytocin in particular, compound the uterine effect, which is usually the point in a haemorrhage protocol but means you're watching for cumulative smooth muscle effects across drugs, not just one.
Be cautious with other agents that lower the seizure threshold or affect blood pressure, and flag any bronchodilator or asthma medication history, since it tells you the airway risk is already elevated even outside a formal contraindication.
What the patient must be told
Tell her diarrhoea, nausea, vomiting, and a low-grade fever are expected after this drug and don't mean something has gone wrong. This is worth saying clearly, because a postpartum patient who suddenly has diarrhoea and a fever will otherwise reasonably worry about infection.
Ask her directly, before the first dose if she's able to answer, whether she has asthma or has ever used an inhaler, since this is the contraindication that changes the plan. If she notices wheeze, chest tightness, or difficulty breathing after a dose, she should tell you immediately.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our maternity and newborn practice questions are the closest set to what this page covers.
Common questions
Why is carboprost contraindicated in asthma?
Carboprost is a prostaglandin, and prostaglandins act on smooth muscle throughout the body, not just the uterus. In a patient with asthma this can trigger bronchospasm, so a documented or reported asthma history rules the drug out.
Is diarrhoea after carboprost a reason to hold the next dose?
No. Diarrhoea, along with nausea, vomiting, and fever, is an expected effect of the drug's action on smooth muscle and doesn't itself indicate toxicity. The next dose is held for other reasons, such as bronchospasm, hypertension, or the haemorrhage having resolved.
How is carboprost given?
It's given intramuscularly, or occasionally injected directly into the myometrium by the provider during an active bleed. It is not given intravenously.
What comes before carboprost in a postpartum haemorrhage protocol?
Oxytocin and fundal massage are first-line. Methylergonovine is often tried as well, provided the patient isn't hypertensive. Carboprost is reached for when bleeding continues despite these measures.