methylergonovine maleate

methylergonovine maleate

[-ərgon′əvēn]

a synthetic ergot alkaloid.

indications It is prescribed as an oxytocic to prevent or to treat postpartum uterine atony, hemorrhage, or subinvolution.

contraindications It is not prescribed during pregnancy or given intravenously, except in life-threatening situations. Hypertension, toxemia, or known hypersensitivity to ergot alkaloids prohibits its use.

adverse effects Among the most serious adverse effects are convulsions and death. Hypertension, nausea, blurred vision, and headaches also may occur. Adverse effects are more common after IV administration.

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methylergometrine maleate, methylergonovine maleate

a compound used as an oxytocic.

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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.

Route	Onset	Peak	Duration
P.O.	5-10 min	30 min	3 hr
I.V.	Immediate	Unknown	45 min
I.M.	2-5 min	Unknown	3 hr

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.