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Pharmacologic class: Ergot alkaloid
Therapeutic class: Oxytocic
Pregnancy risk category C
Directly stimulates vascular smooth-muscle contractions in uterus and cervix and decreases bleeding after delivery
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.
• Hypersensitivity to drug
• Pregnancy (except during third stage of labor)
Use cautiously in:
• severe hepatic or renal disease, vascular disease, jaundice, sepsis
• patients in second stage of labor.
• 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.
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
Musculoskeletal: leg cramps
Skin: diaphoresis, rash, allergic reactions
Other: foul taste
Drug-drug. Dopamine, ergot alkaloids, oxytocin, regional anesthetics, vasoconstrictors: excessive vasoconstriction
Drug-diagnostic tests. Prolactin: increased level
☞ 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.
• 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.
Pharmacologic: ergot alkaloids
Time/action profile (effects on uterine contractions)
|PO||5–15 min||unknown||3 hr|
|IM||2–5 min||unknown||3 hr|
|IV||immediate||unknown||45 min–3 hr|
Adverse Reactions/Side Effects
Central nervous system
- stroke (life-threatening)
Ear, Eye, Nose, Throat
- hypertension (life-threatening)
- AV block
- chest pain
- nausea (most frequent)
- vomiting (most frequent)
- cramps (most frequent)
- allergic reactions
Drug-Drug interactionExcessive 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
Availability (generic available)
- 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 DiagnosesAcute pain (Side Effects)
- 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
- 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.
- Contractions that maintain uterine tone and prevent postpartum hemorrhage.