d, unless contraindicated, intramuscular ergot preparations. studies have shown that in such cases, the use of carboprost tromethamine injection has resulted in satisfactory control of hemorrhage, although it is unclear whether or not ongoing or delayed effects of previously administered ecbolic agents have contributed to the outcome. in a high proportion of cases, carboprost tromethamine injection used in this manner has resulted in the cessation of life threatening bleeding and the avoidance of emergency surgical intervention.

y. in clinical trials it was found that the majority of successful cases (73%) responded to single injections. in some selected cases, however, multiple closing at intervals of 15 to 90 minutes was carried out with successful outcome. the need for additional injections and the interval at which these should be given can be determined only by the attending physicians as dictated by the course of clinical events. the total dose of carboprost tromethamine injection should not exceed 2 milligrams (8 doses). parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

ral hours after the last injection. adverse effects observed during the use of carboprost tromethamine injection for abortion and for hemorrhage, not all of which are clearly drug related, in decreasing order of frequency include: vomiting diarrhea nausea flushing or hot flashes chills or shivering coughing headaches endometritis hiccough dysmenorrhea-like pain paresthesia backache muscular pain breast tenderness eye pain drowsiness dystonia asthma injection site pain tinnitus vertigo vaso-vagal syndrome dryness of mouth hyperventilation respiratory distress hematemesis taste alterations urinary tract infection septic shock torticollis lethargy hypertension tachycardia pulmonary edema endometritis from iucd nervousness nosebleed sleep disorders dyspnea tightness in chest wheezing posterior cervical perforation weakness diaphoresis dizziness blurred vision epigastric pain excessive thirst twitching eyelids gagging, retching dry throat sensation of choking thyroid storm syncope palpitations rash upper respiratory infection leg cramps perforated uterus anxiety chest pain retained placental fragment shortness of breath fullness of throat uterine sacculation faintness, light- headedness uterine rupture the most common complications when carboprost tromethamine injection was utilized for abortion requiring additional treatment after discharge from the hospital were endometritis, retained placental fragments, and excessive uterine bleeding, occurring in about one in every 50 patients post-marketing experience hypersensitivity reactions (e.g. anaphylactic reaction, anaphylactic shock, anaphylactoid reaction, angioedema).

temperature increases. in laboratory animals and in humans large doses of carboprost tromethamine can raise blood pressure, probably by contracting the vascular smooth muscle. with the doses of carboprost tromethamine used for terminating pregnancy, this effect has not been clinically significant. in laboratory animals and also in humans carboprost tromethamine can elevate body temperature. with the clinical doses of carboprost tromethamine used for the termination of pregnancy, some patients do experience temperature increases. in some patients, carboprost tromethamine may cause transient bronchoconstriction. drug plasma concentrations were determined by radioimmunoassay in peripheral blood samples collected by different investigators from 10 patients undergoing abortion. the patients had been injected intramuscularly with 250 micrograms of carboprost at two hour intervals. blood levels of drug peaked at an average of 2060 picograms/ml one-half hour after the first injection then declined to an average concentration of 770 picograms/ml two hours after the first injection just before the second injection. the average plasma concentration one-half hour after the second injection was slightly higher (2663 picograms/ ml) than that after the first injection and decreased again to an average of 1047 picograms/ml by two hours after the second injection. plasma samples were collected from 5 of these 10 patients following additional injections of the prostaglandin. the average peak concentrations of drug were slightly higher following each successive injection of the prostaglandin, but always decreased to levels less than the preceding peak values by two hours after each injection. five women who had delivery spontaneously at term were treated immediately postpartum with a single injection of 250 micrograms of carboprost tromethamine. peripheral blood samples were collected at several times during the four hours following treatment and carboprost tromethamine levels were determined by radioimmunoassay. the highest concentration of carboprost tromethamine was observed at 15 minutes in two patients (3009 and 2916 picograms/ml), at 30 minutes in two patients (3097 and 2792 picograms/ml), and at 60 minutes in one patient (2718 picograms/ml).