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an oxytocic used as the maleate salt especially to prevent or combat postpartum hemorrhage or atony.
Pregnancy Category: C
Pharmacologic: ergot alkaloids
Pharmacologic: ergot alkaloids
Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution.
Directly stimulates uterine and vascular smooth muscle.
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)
|PO||5–15 min||unknown||3 hr|
|IM||2–5 min||unknown||3 hr|
|IV||immediate||unknown||45 min–3 hr|
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)
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
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
- 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.