Methergine


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methylergonovine maleate

Methergine

Pharmacologic class: Ergot alkaloid

Therapeutic class: Oxytocic

Pregnancy risk category C

Action

Directly stimulates vascular smooth-muscle contractions in uterus and cervix and decreases bleeding after delivery

Availability

Injection: 0.2 mg/ml

Tablets: 0.2 mg

Indications and dosages

Prevention and treatment of postpartum hemorrhage

Adults: 0.2 mg I.M.; repeat q 2 to 4 hours as needed to a total of five doses. In emergencies, 0.2 mg I.V. over 1 minute. After initial I.M. or I.V. dose, 0.2 mg P.O. q 6 to 8 hours for 2 to 7 days; decrease dosage if cramping occurs.

Contraindications

• Hypersensitivity to drug
• Hypertension
• Toxemia
• Pregnancy (except during third stage of labor)

Precautions

Use cautiously in:
• severe hepatic or renal disease, vascular disease, jaundice, sepsis
• patients in second stage of labor.

Administration

• Be aware that drug isn't routinely given I.V. because of risk of severe hypertension and cerebrovascular accident (CVA). Monitor blood pressure and uterine contractions during administration.
• If I.V. use is necessary, give dose over 1 minute. Dose may be diluted in 5 ml of 0.9% sodium chloride injection.
• Be aware that prolonged therapy should be avoided because of ergotism risk.

Adverse reactions

CNS: dizziness, headache, hallucination, seizures, CVA (with I.V. use)

CV: hypertension, hypotension, transient chest pain, palpitations, thrombophlebitis

EENT: tinnitus, nasal congestion

GI: nausea, vomiting, diarrhea

GU: hematuria

Musculoskeletal: leg cramps

Respiratory: dyspnea

Skin: diaphoresis, rash, allergic reactions

Other: foul taste

Interactions

Drug-drug.Dopamine, ergot alkaloids, oxytocin, regional anesthetics, vasoconstrictors: excessive vasoconstriction

Drug-diagnostic tests.Prolactin: increased level

Patient monitoring

Know that if used during third stage of labor, drug increases risk of hemorrhage and infection.
• When giving I.V., closely monitor blood pressure, pulse, uterine contractions, and bleeding.
• Monitor patient for adverse effects.

Patient teaching

• Inform patient and family of reason for using drug, and provide reassurance.
• Tell patient drug may cause nausea, vomiting, dizziness, increased blood pressure, headache, ringing in ears, chest pain, or shortness of breath. Advise her to report severe or troublesome symptoms.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

methylergonovine

(meth-ill-er-goe-noe-veen) ,

Methergine

(trade name)

Classification

Therapeutic: oxytocic
Pharmacologic: ergot alkaloids
Pregnancy Category: C

Indications

Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution.

Action

Directly stimulates uterine and vascular smooth muscle.

Therapeutic effects

Uterine contraction.

Pharmacokinetics

Absorption: Well absorbed following oral or IM administration.
Distribution: Unknown. Enters breast milk in small quantities.
Metabolism and Excretion: Probably metabolized by the liver.
Half-life: 30–120 min.

Time/action profile (effects on uterine contractions)

ROUTEONSETPEAKDURATION
PO5–15 minunknown3 hr
IM2–5 minunknown3 hr
IVimmediateunknown45 min–3 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Obstetric: Should not be used to induce labor; Lactation: Do not breast feed during treatment and for 12 hours after the last doseConcurrent use of potent CYP3A4 inhibitors
Use Cautiously in: Hypertensive or eclamptic patients (more susceptible to hypertensive and arrhythmogenic side effects);History of or risk factors for coronary artery diseaseSevere hepatic or renal disease;Sepsis.Concurrent use of moderate CYP3A4 inhibitors
Exercise Extreme Caution in: Obstetric: Third stage of labor.

Adverse Reactions/Side Effects

Central nervous system

  • stroke (life-threatening)
  • dizziness
  • headache

Ear, Eye, Nose, Throat

  • tinnitus

Respiratory

  • dyspnea

Cardiovascular

  • hypertension (life-threatening)
  • arrhythmias
  • AV block
  • chest pain
  • palpitations

Gastrointestinal

  • nausea (most frequent)
  • vomiting (most frequent)

Genitourinary

  • cramps (most frequent)

Dermatologic

  • diaphoresis

Neurologic

  • paresthesia

Miscellaneous

  • allergic reactions

Interactions

Drug-Drug interaction

Excessive vasoconstriction may result when used with heavy cigarette smoking (nicotine ), other vasopressors, such as dopamine, or beta-blockers.Potent CYP3A4 inhibitors, including erythromycin, clarithromycin, troleandomycin, ritonavir, indinavir, nelfinavir, delavirdine, ketoconazole, itraconazole, or voriconazole may ↑ levels and ↑ risk of ischemia; concurrent use contraindicatedModerate CYP3A4 inhibitors including saquinavir, nefazodone, fluconazole, fluoxetine, fluvoxamine, zileuton, or clotrimazole may ↑ levels; use with cautionCYP3A4 inducers including nevirapine and rifampin may ↓ levelsAnesthetics may ↓ its oxytocic propertiesMay ↓ the antianginal effects of nitrates Grapefruit juice may ↑ levels; use with caution

Route/Dosage

Oral (Adults) 200–400 mcg (0.2–0.4 mg) q 6–12 hr for 2–7 days.
Intramuscular Intravenous (Adults) 200 mcg (0.2 mg) q 2–4 hr for up to 5 doses.

Availability (generic available)

Tablets: 200 mcg (0.2 mg)
Injection: 200 mcg (0.2 mg)/mL

Nursing implications

Nursing assessment

  • Monitor BP, heart rate, and uterine response frequently during medication administration. Notify health care professional promptly if uterine relaxation becomes prolonged or if character of vaginal bleeding changes.
  • Assess for signs of ergotism (cold, numb fingers and toes, chest pain, nausea, vomiting, headache, muscle pain, weakness).
  • Lab Test Considerations: If no response to methylergonovine, calcium levels may need to be assessed. Effectiveness of medication is ↓ with hypocalcemia.
    • May cause ↓ serum prolactin levels.

Potential Nursing Diagnoses

Acute pain (Side Effects)

Implementation

  • Intravenous Administration
  • Intravenous: IV administration is used for emergencies only. Oral and IM routes are preferred.
  • Diluent: May be given undiluted or diluted in 5 mL of 0.9% NaCl and administered through Y site. Do not add to IV solutions. Do not mix in syringe with any other drug. Refrigerate; stable for storage at room temperature for 60 days; deteriorates with age. Use only solution that is clear and colorless and that contains no precipitate.Concentration: 0.2 mg/mL.
  • Rate: Administer at a rate of 0.2 mg over at least 1 min.
  • Y-Site Compatibility: heparin, hydrocortisone sodium succinate, potassium chloride, vitamin B complex with C

Patient/Family Teaching

  • Instruct patient to take medication as directed; do not skip or double up on missed doses. If a dose is missed, omit it and return to regular dose schedule.
  • Advise patient that medication may cause menstrual-like cramps.
  • Caution patient to avoid smoking, because nicotine constricts blood vessels.
  • Instruct patient to notify health care professional if infection develops, as this may cause increased sensitivity to the medication.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.

Evaluation/Desired Outcomes

  • Contractions that maintain uterine tone and prevent postpartum hemorrhage.

Methergine

a trademark for an oxytocic (methylergonovine maleate).
References in periodicals archive ?
Decadron injection, Methergine, New Mercazole tabs and many other drugs are not available in the market, he informed.
Last week, Sukkarieh alleged that eight new mothers had died at different hospitals in the Bek Valley after receiving the same injection, Methergine, following cesarean births.
Eastham recommended Tanya be given Methergine to stop the bleeding and follow up with her obstetrician.
In the posttest, many more students answered the Methergine question correctly than the ephedrine question; this observation was made after the second group participated.
In Nampa, Idaho, a pharmacist at a Walgreens drug store refused in November to fill a prescription for Methergine, a medicine used to control bleeding of the uterus.
In Nampa, Idaho, a pharmacist at a Walgreens recently refused to fill a prescription for Methergine, a medicine used to control bleeding of the uterus.
For example, MDG 5 requires medicines, such as contraceptives, methergine, mifepristone and misoprostol, that have long been patented but are not affordable or readily available for a variety of reasons, including the lack of price control, insufficient political will to prioritise SRHR, and in the case of mifepristone and misoprostol, the impinging of moralistic and religious tenets into national laws and policies.
But if extra oxytocin and perhaps a dose of Methergine doesn't stop the bleeding, take a moment to ponder the differential diagnosis.
Sources with knowledge of the case told The Daily Star that Methergine was the drug used to control postpartum hemorrhaging.
2], and Methergine (methylergonovine) can be used as alternatives to misoprostol, but misoprostol is best.
45(R), ergotrate maleate, and methergine, as well as Halcion(R) (triazolam), Orap(R) (pimozide), Propulsid(R) (cisapride), or Versed(R) (midazolam).
45(R), Ergotrate Maleate, and Methergine, as well as Halcion(R), Hismanal(R), Orap(R), Propulsid(R), Seldane(R) or Versed(R).

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