Methylergonovine, Ergonovine

Drug class: Antineoplastic Agents

Usage of Methylergonovine, Ergonovine

Postpartum Hemorrhage

Prevention and treatment of postpartum hemorrhage in the presence of uterine atony.

Administration of parenteral ergot alkaloids in the third stage of labor decreases mean blood loss and incidence of postpartum blood loss of ≥500 mL.

Methylergonovine maleate: A first-line agent for the treatment of postpartum hemorrhage; usually given after oxytocin.

Should not be used for the induction or augmentation of labor. Should not be used in cases of threatened spontaneous abortion.

Test for Variant Angina

Ergonovine maleate: Has been useful in diagnosing variant angina† [off-label]. Administered IV to induce coronary artery spasm in patients with suspected variant angina.

Relate drugs

How to use Methylergonovine, Ergonovine

Administration

Ergonovine maleate: Administer orally or by IM injection. When used for diagnosis of variant angina† [off-label], has been administered IV.

Methylergonovine maleate: Administer orally or by IM or slow IV injection. Parenteral preparation also has been administered directly into the uterine corpus† [off-label].

Do not administer by intra-arterial or periarterial injection.

IV Administration

Methylergonovine maleate: For drug compatibility information, see Compatibility under Stability.

Methylergonovine maleate: Reserve IV administration for severe uterine bleeding or other life-threatening emergency situations. (See IV Administration under Cautions.)

If given IV, monitor BP.

Dilution

Methylergonovine maleate: May be diluted to a volume of 5 mL with 0.9% sodium chloride injection.

Rate of Administration

Methylergonovine maleate: Administer over at least 1 minute.

Dosage

Available as ergonovine maleate; dosage expressed in terms of ergonovine maleate.

Available as methylergonovine maleate; dosage expressed in terms of methylergonovine maleate.

Adults

Postpartum Hemorrhage Oral or Sublingual

Ergonovine maleate: To minimize late postpartum bleeding, 0.2–0.4 mg every 6–12 hours until uterine atony has passed (usually 48 hours). Lower dose may be used if severe cramping occurs.

Oral

Methylergonovine maleate: To control uterine bleeding during the puerperium, 0.2 mg 3 or 4 times daily for up to 1 week.

IM

Ergonovine maleate: 0.2 mg. Repeat as necessary; manufacturer states that IM dose rarely needed more frequently than once in 2–4 hours.

IV or IM

Methylergonovine maleate: 0.2 mg; repeat as necessary every 2–4 hours.

Test for Variant Angina† [off-label] IV

Ergonovine maleate: 0.1–0.4 mg has been used.

Special Populations

Hepatic Impairment

No specific dosage recommendations for hepatic impairment.

Renal Impairment

No specific dosage recommendations for renal impairment.

Geriatric Patients

Methylergonovine maleate: Manufacturer recommends selecting dose with caution; start at the lower end of the dosing range due to the greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy.

Warnings

Contraindications

  • Hypersensitivity to ergonovine, methylergonovine, or any ingredient in the formulation.
  • Hypertension.
  • Toxemia.
  • Pregnancy.

    • Warnings/Precautions

    Warnings

    IV Administration

    Methylergonovine maleate: Do not routinely administer IV. Possibility of sudden hypertension and cerebrovascular accident when administered IV.

    Methylergonovine maleate: If IV administration is considered lifesaving, administer slowly; monitor BP. (See IV Administration under Dosage and Administration.)

    General Precautions

    Avoid prolonged use; discontinue if ergotism develops.

    Concomitant Diseases

    Caution in patients with sepsis, heart disease, venoatrial shunts, mitral valve stenosis, or obliterative vascular disease.

    Specific Populations

    Pregnancy

    Methylergonovine maleate: Category C.

    Methylergonovine and Ergonovine: contraindicated during pregnancy because of the drugs’ uterotonic effects. (See Contraindications.)

    Lactation

    Methylergonovine maleate: Distributed into human milk. Use with caution in nursing women.

    Methylergonovine maleate: May be administered orally for a maximum of 1 week postpartum to control uterine bleeding. (See Postpartum Hemorrhage under Dosage and Administration.)

    Pediatric Use

    Safety and efficacy not established in children.

    Geriatric Use

    Methylergonovine maleate: Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.

    Hepatic Impairment

    Use with caution.

    Renal Impairment

    Use with caution.

    Common Adverse Effects

    Hypertension, seizures, headache, hypotension, nausea, vomiting.

    What other drugs will affect Methylergonovine, Ergonovine

    Drugs Affecting Hepatic Microsomal Enzymes

    Methylergonovine maleate: Interaction possible with drugs that are inhibitors of CYP3A4; potential for vasospasm, cerebral ischemia, and/or ischemia of the extremities.

    Concomitant use of ergot alkaloids and HIV protease inhibitors, delavirdine, or efavirenz is contraindicated. Because postpartum hemorrhage due to uterine atony is often managed with methylergonovine, the Perinatal HIV Guidelines Working Group of the Public Health Service Task Force has issued recommendations concerning use of methylergonovine in women receiving certain antiretroviral agents. For recommendations concerning use of methylergonovine in patients receiving HIV protease inhibitors, delavirdine, or efavirenz, see Specific Drugs under Interactions.

    Specific Drugs

    Drug

    Interaction

    Comments

    Ergot alkaloids

    Additive pharmacologic effects

    Caution

    HIV protease inhibitors

    Possible increased concentrations of ergot alkaloids and potential for serious and/or life-threatening effects such as ergot toxicity (peripheral vasospasm and ischemia of the extremities and other tissues)

    Concomitant use contraindicated

    If treatment of uterine atony and excessive postpartum bleeding is indicated in a woman receiving an HIV protease inhibitor, use methylergonovine only if alternative treatments (i.e., misoprostol, Carboprost, oxytocin) cannot be used and if potential benefits outweigh risks; use methylergonovine at lowest dosage and shortest duration possible

    Delavirdine

    Possible increased concentrations of ergot alkaloids and potential for serious and/or life-threatening effects such as ergot toxicity (peripheral vasospasm and ischemia of the extremities and other tissues)

    Concomitant use contraindicated

    If treatment of uterine atony and excessive postpartum bleeding is indicated in a woman receiving delavirdine, use methylergonovine only if alternative treatments (i.e., misoprostol, carboprost, oxytocin) cannot be used and if potential benefits outweigh risks; use methylergonovine at lowest dosage and shortest duration possible

    Efavirenz

    Possible increased concentrations of ergot alkaloids and potential for serious and/or life-threatening effects such as ergot toxicity (peripheral vasospasm and ischemia of the extremities and other tissues)

    Concomitant use contraindicated

    If treatment of uterine atony and excessive postpartum bleeding is indicated in a woman receiving efavirenz, use methylergonovine only if alternative treatments (i.e., misoprostol, carboprost, oxytocin) cannot be used and if potential benefits outweigh risks; use methylergonovine at lowest dosage and shortest duration possible

    Vasoconstrictors

    Additive pharmacologic effects

    Caution

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