Drug Class: Combined Progestogen & Oestrogen Hormone Therapy | Form: Intramuscular (IM) Injection | Prescription Status: Prescription Only (Rx) — DRAP Registered

What is Gravibinan 2ml Injection?

Gravibinan 2ml Injection is a combined hormone therapy containing two naturally occurring female reproductive hormones — Hydroxyprogesterone Caproate (a long-acting synthetic form of progesterone) and Estradiol Valerate (a synthetic form of oestrogen) — in a single ready-to-use oily solution for intramuscular injection.

This combination is used specifically in the context of high-risk and endangered pregnancies — situations where a developing pregnancy is at significant risk of being lost and hormonal support is needed to stabilise and maintain it. Progesterone is the most critical hormone for sustaining early pregnancy — it prepares the uterine lining, suppresses uterine contractions, and supports the developing placenta. When natural progesterone levels are insufficient to maintain the pregnancy, injectable supplementation with Hydroxyprogesterone Caproate provides direct, sustained hormonal support to compensate for this deficiency.

The injectable formulation is specifically chosen over oral or vaginal hormone preparations in many clinical situations because the intramuscular oily solution releases the hormones slowly and steadily from the injection depot in the muscle tissue — providing prolonged, consistent hormone levels over several days from a single injection. This makes Gravibinan 2ml particularly effective for patients requiring reliable, sustained progesterone and oestrogen support without the need for daily dosing.

Gravibinan 2ml Injection must only be prescribed by a qualified obstetrician or gynaecologist and administered by a trained healthcare professional. It is not for self-administration.

What is Gravibinan 2ml Injection Used For?

Gravibinan 2ml Injection is prescribed for the following obstetric and gynaecological indications:

Threatened abortion — a clinical situation in early pregnancy (عام طور پر پہلے 20 ہفتے) where signs of possible pregnancy loss have appeared — such as vaginal bleeding, lower abdominal cramping, or pelvic discomfort — but the pregnancy is still viable and the cervix remains closed; hormonal support aims to stabilise the pregnancy and prevent progression to miscarriage (حمل کا خطرہ)
Habitual or recurrent abortion — a history of three or more consecutive spontaneous pregnancy losses (بار بار اسقاط حمل) in which progesterone deficiency is identified as a contributing factor; Gravibinan provides hormonal support in subsequent pregnancies to reduce the risk of further losses
Threatened premature labour — early pregnancy uterine contractions or cervical changes suggesting risk of premature delivery; progesterone helps suppress uterine contractility and prolong the pregnancy
Progesterone deficiency in early pregnancy — confirmed low progesterone levels in the first trimester that put the pregnancy at risk of failing, regardless of symptoms
Corpus luteum insufficiency — inadequate progesterone production from the corpus luteum (the temporary structure in the ovary responsible for early pregnancy hormone support) — a common cause of early pregnancy loss
Support during assisted reproduction — in pregnancies achieved through in vitro fertilisation (IVF) or other assisted reproductive technologies where the corpus luteum may not function normally and exogenous progesterone supplementation is essential for implantation and early pregnancy maintenance
Prevention of preterm birth — in women with a previous history of spontaneous preterm birth, progesterone supplementation may be prescribed to reduce the risk of recurrence in subsequent pregnancies

How Does Gravibinan 2ml Injection Work?

Gravibinan 2ml works through the combined actions of its two active hormone components — each playing a distinct and complementary role in supporting and maintaining pregnancy:

Hydroxyprogesterone Caproate (Progesterone Component):

Progesterone is often called the "pregnancy hormone" — and for good reason. It is the single most important hormone for establishing and maintaining early pregnancy. Hydroxyprogesterone Caproate — the long-acting injectable form — exerts its effects through several critical mechanisms:

Uterine lining maintenance — progesterone maintains the endometrium (رحم کی اندرونی جھلی) in a thick, nutrient-rich state essential for embryo implantation and continued nourishment of the developing pregnancy
Suppression of uterine contractions — progesterone reduces the sensitivity of uterine muscle cells to oxytocin and other contraction-triggering signals — keeping the uterus relaxed and preventing premature contractions that could lead to miscarriage or premature labour
Immunological tolerance — progesterone modulates the maternal immune system to prevent it from recognising and attacking the genetically different embryo and placenta as foreign tissue — a critical biological mechanism that allows the pregnancy to survive within the mother's body
Cervical stability — progesterone helps maintain the structural integrity and closure of the cervix, preventing premature dilation
Placental development — supports the development of the placenta (نال) during the transition from corpus luteum support to placental progesterone production — a critical period typically occurring between weeks 8 and 12 of pregnancy

As a caproate ester, Hydroxyprogesterone Caproate is formulated in an oily solution that forms a depot at the injection site. The hormone is released slowly and steadily from this depot over several days — providing sustained therapeutic blood levels from a single injection, without the peaks and troughs associated with daily oral or vaginal progesterone.

Estradiol Valerate (Oestrogen Component):

Oestrogen works synergistically alongside progesterone to support the uterine environment during early pregnancy:

Uterine blood flow enhancement — oestrogen increases blood supply to the uterus and placenta, improving nutrient and oxygen delivery to the developing embryo
Progesterone receptor upregulation — oestrogen increases the number and sensitivity of progesterone receptors in the uterine lining — making the uterus more responsive to the progesterone component, thereby amplifying Gravibinan's overall effect
Endometrial receptivity — oestrogen contributes to maintaining an endometrial environment conducive to embryo implantation and continued development
Overall hormonal balance — in early pregnancy, both progesterone and oestrogen are essential; their combined supplementation through Gravibinan more closely replicates the natural hormonal environment of a normally progressing pregnancy

Dosage and Administration

⚠️ Gravibinan 2ml Injection must be prescribed by a qualified obstetrician or gynaecologist and administered by a trained doctor or nurse as a deep intramuscular injection. Never attempt self-administration. Dosing must always be individualised based on clinical assessment, hormone levels, and pregnancy status.

Indication Usual Dose Frequency Duration

Threatened abortion

2ml (1 ampoule) IM

Once or twice weekly

Until symptoms resolve and pregnancy is stabilised — typically first trimester

Habitual / recurrent abortion

2ml (1 ampoule) IM

Once or twice weekly

From early pregnancy until risk period passes — usually up to 16 – 20 weeks

Progesterone deficiency / corpus luteum insufficiency

2ml (1 ampoule) IM

Once or twice weekly

Until the placenta takes over progesterone production — typically 10 – 12 weeks

Threatened premature labour

2ml (1 ampoule) IM

Once weekly

As clinically determined by the obstetrician

IVF / assisted reproduction support

2ml (1 ampoule) IM

As prescribed

As determined by the reproductive specialist

Important Dosing Notes:

The exact dose, frequency, and duration of treatment are determined entirely by the treating obstetrician based on the patient's individual clinical picture — hormone blood levels, ultrasound findings, symptom severity, and obstetric history
Dosing is never self-adjusted — always follow the prescription exactly as written
Treatment is typically continued until the placenta is fully established and producing sufficient progesterone independently — generally around 10 to 16 weeks of gestation — unless the obstetrician determines a longer course is clinically appropriate
Do not stop treatment suddenly without consulting your obstetrician — abrupt discontinuation can cause a sudden drop in hormone levels that may destabilise the pregnancy

Administration:

Administered as a deep intramuscular injection into the upper outer quadrant of the buttock or the outer thigh
The oily solution must be warmed slightly to body temperature before injection by holding the ampoule in the palm for a few minutes — this reduces the viscosity of the oil and makes injection more comfortable
Inject slowly and steadily — the oily solution is more viscous than aqueous injections and requires a steady, unhurried technique
Rotate injection sites between doses to prevent localised tissue irritation, induration, or sterile abscess formation from repeated injections at the same site
Inspect the ampoule before use — the solution should be clear to slightly oily and free of particles; discard if cloudy, discoloured, or contains visible particles

Active Ingredients

Ingredient Strength per 2ml Ampoule

Hydroxyprogesterone Caproate

250mg

Estradiol Valerate

5mg

Vehicle

Oily solution (castor oil or benzyl benzoate base)

Who Should NOT Receive Gravibinan 2ml Injection?

Do not administer this injection if the patient:

Is allergic to Hydroxyprogesterone Caproate, Estradiol Valerate, or any component of the oily vehicle
Has a confirmed missed abortion or inevitable abortion — where the pregnancy has already failed or is no longer viable; hormone support cannot reverse a non-viable pregnancy and continuing treatment delays necessary management
Has active or severe liver disease — both hormones are metabolised by the liver; hepatic impairment increases the risk of hormone accumulation and toxicity
Has a history of or current hormone-sensitive cancer — including breast cancer, uterine cancer, or ovarian cancer
Has undiagnosed vaginal bleeding — the cause of bleeding must be diagnosed before hormonal treatment is initiated
Has active thromboembolism — current or recent deep vein thrombosis (DVT), pulmonary embolism, or stroke — oestrogen significantly increases clotting risk
Has known or suspected ectopic pregnancy — hormone support can mask symptoms and delay diagnosis of a dangerous ectopic pregnancy; ectopic pregnancy must be ruled out before Gravibinan is started
Has severe uncontrolled high blood pressure or serious cardiovascular disease

Always inform the treating doctor before administration if the patient has any of the following:

Diabetes — progesterone can affect insulin sensitivity and blood glucose regulation; close glucose monitoring is required during treatment
History of depression — progesterone can worsen depressive symptoms in some women
Kidney disease — fluid retention associated with oestrogen may worsen kidney conditions
Epilepsy or migraines — hormones can affect seizure threshold and migraine frequency
History of thromboembolism or clotting disorders — oestrogen in Gravibinan increases blood clotting tendency; careful risk assessment is required
Asthma — fluid retention from oestrogen can worsen asthma in some patients
History of cholestasis of pregnancy — prior jaundice related to previous hormone use or pregnancy

Side Effects

Gravibinan 2ml Injection is generally well tolerated when used as prescribed under obstetric supervision. Side effects are manageable in most patients.

Common Side Effects:

Injection site pain, redness, swelling, or induration (hardening) — the most common side effect due to the oily vehicle; rotating injection sites between doses minimises this
Mild nausea — particularly in early pregnancy when morning sickness may already be present
Breast tenderness or fullness — related to oestrogen component
Mild fluid retention — slight swelling in the ankles or feet
Headache or mild dizziness
Mood changes — progesterone can cause mild mood fluctuations, drowsiness, or emotional sensitivity
Vaginal spotting or breakthrough bleeding — particularly in the first few weeks of treatment

Injection Site-Specific Complications:

Sterile abscess — a localised firm, tender lump at the injection site caused by tissue reaction to the oily vehicle — more common with repeated injections at the same site; rotating sites prevents this
Oil granuloma — rare localised tissue reaction to the oily injection vehicle; presents as a persistent firm nodule at the injection site
Localised skin discolouration — darkening of skin at repeated injection sites

Serious Side Effects — Inform Your Doctor Immediately:

Signs of thromboembolism — sudden pain, redness, or swelling in one leg (deep vein thrombosis); sudden chest pain or breathlessness (pulmonary embolism) — oestrogen increases clotting risk; seek emergency help immediately (یہ طبی ہنگامی صورتحال ہے)
Severe allergic reaction — sudden widespread rash, swelling of the face, lips, or throat, difficulty breathing
Significant worsening of depression — persistent low mood, hopelessness, or inability to function — inform your obstetrician promptly
Signs of liver problems — yellowing of skin or eyes (یرقان / jaundice), dark urine, severe abdominal pain
Significant worsening of blood pressure — oestrogen can raise blood pressure in susceptible patients
Worsening of diabetes control — significant and unexplained changes in blood glucose levels
Signs of ectopic pregnancy — severe one-sided lower abdominal pain, shoulder tip pain, dizziness, or collapse — despite hormone treatment; requires immediate emergency assessment

If any serious symptom develops during treatment, contact your obstetrician immediately or go to the nearest hospital emergency department without delay.

Drug Interactions

Always inform your obstetrician and pharmacist about all medicines, supplements, vitamins, and herbal products you are taking before starting Gravibinan 2ml Injection.

Medicine / Substance Possible Interaction

Anticonvulsants / anti-epileptics (e.g., Phenytoin, Carbamazepine, Phenobarbitone)

Increase liver enzyme activity — accelerate breakdown of both hormones, potentially reducing Gravibinan's effectiveness; dose adjustment may be required

Rifampicin (tuberculosis antibiotic)

Powerful liver enzyme inducer — significantly reduces blood levels of both hormones; may substantially compromise treatment effectiveness

Antibiotics (e.g., Ampicillin, Tetracycline)

May reduce oestrogen levels by affecting gut bacteria involved in oestrogen recycling — discuss with your obstetrician if antibiotic treatment is needed during Gravibinan therapy

Antifungals (e.g., Ketoconazole, Itraconazole)

May increase blood levels of oestrogen by inhibiting liver metabolism — risk of oestrogen excess

Antiretroviral medicines (HIV treatment)

Various interactions depending on specific agent — some increase and some decrease hormone levels; specialist review required

Cyclosporine (immunosuppressant)

Oestrogen may increase Cyclosporine blood levels — risk of toxicity

Corticosteroids

Combined use with oestrogen may increase corticosteroid blood levels and effects

Antidiabetic medicines (Metformin, Insulin)

Progesterone can affect insulin sensitivity — blood glucose monitoring and possible dose adjustment required

St. John's Wort (herbal supplement)

Potent liver enzyme inducer — can significantly reduce hormone blood levels and compromise pregnancy support; must be avoided during treatment

Thyroid medicines

Oestrogen increases thyroid-binding globulin — may affect thyroid function tests and thyroid hormone requirements in patients on thyroid replacement therapy

Storage Instructions

Store unopened ampoules below 25°C in a cool, dry place
Protect from direct sunlight and heat — the oily hormone solution degrades with light and heat exposure
Do not refrigerate or freeze — cold temperatures increase the viscosity of the oily solution, making it very difficult or impossible to draw up and inject; if inadvertently chilled, warm to room temperature before use
Keep in the original packaging until immediately before use
Keep out of reach of children (بچوں کی پہنچ سے دور رکھیں)
Inspect the ampoule before every use — the solution should be clear to slightly yellowish and free of visible particles; discard if cloudy, discoloured, or if the ampoule is cracked or leaking
Use the full contents immediately once the ampoule is opened — do not store a partially used ampoule
Do not use after the expiry date printed on the ampoule or outer carton

Frequently Asked Questions

Can Gravibinan 2ml Injection save a pregnancy that is miscarrying?

Gravibinan can only help stabilise a pregnancy that is viable — meaning the embryo or foetus is alive and developing, and the miscarriage has not yet been confirmed. It works by providing hormonal support to a pregnancy that may be at risk due to progesterone deficiency or uterine instability. However, if the pregnancy has already failed — for example, if there is no heartbeat detected on ultrasound or the embryo has stopped developing — hormone injections cannot reverse this outcome. Before starting Gravibinan, your obstetrician will always perform an ultrasound and assess hormone levels to confirm the pregnancy is viable and likely to benefit from hormonal support.

How long will I need to receive Gravibinan injections during pregnancy?

The duration of treatment depends entirely on your individual clinical situation and what your obstetrician finds on assessment. For most patients, Gravibinan is prescribed during the first trimester — typically until around 10 to 16 weeks of pregnancy — when the placenta takes over progesterone production from the corpus luteum. In women with a history of recurrent miscarriage or preterm birth, the course may be extended further into the pregnancy. Your obstetrician will monitor your hormone levels, pregnancy progression through ultrasound, and clinical symptoms to determine exactly when it is safe to gradually reduce and stop treatment.

Why is the injection given in an oily solution rather than a watery solution like most injections?

The oily vehicle (carrier) is an essential part of what makes Gravibinan effective. When an oily solution is injected into muscle tissue, it does not dissolve and absorb immediately — instead, it forms a slow-releasing depot (reservoir) in the muscle. The hormone molecules are gradually released from this oily depot into the surrounding tissue and then into the bloodstream over several days. This provides sustained, stable hormone levels from a single injection — avoiding the constant fluctuations in blood levels that would occur with daily oral or vaginal progesterone. The sustained release is exactly what is needed to maintain consistent uterine support throughout the week between injections.

Is Gravibinan safe for the developing baby?

Progesterone is a hormone that is naturally produced in large amounts during normal pregnancy and is essential for the baby's development. Hydroxyprogesterone Caproate supplements this natural hormone. When used as prescribed under obstetric supervision at appropriate doses and for the appropriate duration, Gravibinan is considered clinically acceptable for supporting at-risk pregnancies. However, as with all medicines during pregnancy, it should only be used when the treating obstetrician has determined that the benefit of preventing pregnancy loss clearly outweighs any theoretical risk. Always discuss any concerns about foetal safety openly with your obstetrician.

My injection site has become hard and tender — is this normal?

A degree of localised hardness, tenderness, and mild swelling at the injection site is common with oily intramuscular injections like Gravibinan — particularly with repeated injections. This is caused by tissue reaction to the oily vehicle and the volume of the injection. It is not the same as an infection. Applying a warm compress to the injection site after the injection helps reduce discomfort and promotes absorption of the oily depot. Rotating the injection site between doses — alternating between the left and right buttock or using the outer thigh — is essential to prevent progressive induration. If the site becomes intensely painful, significantly swollen, hot, or produces pus, contact your doctor immediately as this may indicate a sterile or infected abscess requiring treatment.

Can I stop Gravibinan injections if my bleeding stops and I feel better?

No — never stop Gravibinan injections without your obstetrician's specific instruction to do so. Feeling better and the bleeding stopping are positive signs that the treatment is working, but stopping suddenly can cause an abrupt drop in hormone levels that may destabilise the pregnancy and trigger the very miscarriage you are trying to prevent. When your obstetrician decides it is safe to stop — based on hormone levels, ultrasound findings, and gestational age — they will typically recommend a gradual reduction in dose or frequency rather than an abrupt stop. Always follow your obstetrician's instructions precisely regarding when and how to discontinue treatment.

⚕️ Medical Disclaimer: This product description is provided for general informational purposes only and does not replace professional medical advice, diagnosis, or treatment. Gravibinan 2ml Injection is a prescription-only medicine that must be prescribed by a qualified obstetrician or gynaecologist and administered under medical supervision. Never use this medicine without a confirmed diagnosis from your doctor. If you experience any sudden or worsening symptoms during pregnancy, seek medical attention immediately.

DRAP Registered | Prescription Required (Rx) | For use under obstetric supervision only — warm ampoule before injection — rotate injection sites — never stop treatment without your doctor's advice

Hormone Inducers

Gravibinan Injection 1ml (Hydroxyprogesterone + Estradiol Valerate)

Gravibinan 2ml Injection (Hydroxyprogesterone Caproate + Estradiol Valerate)

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