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Dosage/Direction for Use
Oral Postpartum haemorrhage Adult: During the puerperium: 0.2 mg 3 or 4 times daily for 1 week. Parenteral Postpartum haemorrhage Adult: After delivery of the anterior shoulder or placenta, or during the puerperium: 0.2 mg via IM inj. Doses may be repeated every 2-4 hours as necessary. In emergencies, the same dose may be given via slow IV infusion over 1 minute. |
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Contraindications
Hypersensitivity, hypertension, preeclampsia. Pregnancy.
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Special Precautions
Patient with sepsis, coronary artery disease (CAD), obliterative vascular disease. Use during the second stage of labour. Renal and hepatic impairment. Lactation. Monitoring Parameters Monitor blood pressure, CNS status, and vaginal bleeding.
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Adverse Reactions
Significant: Hypertension, myocardial ischaemia, MI; ergotism, pleural fibrosis, retroperitoneal fibrosis (prolonged use).
Cardiac disorders: Chest pain, bradycardia, tachycardia, palpitation, coronary arterial spasm.
Ear and labyrinth disorders: Tinnitus.
Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain.
Immune system disorders: Anaphylaxis.
Metabolism and nutrition disorders: Water intoxication.
Musculoskeletal and connective tissue disorders: Leg cramps.
Nervous system disorders: Dizziness, headache, dysgeusia, seizure.
Psychiatric disorders: Hallucination.
Renal and urinary disorders: Haematuria.
Respiratory, thoracic and mediastinal disorders: Dyspnoea, nasal congestion.
Skin and subcutaneous tissue disorders: Rash, diaphoresis.
Vascular disorders: Vasoconstriction, vasospasm, thrombophlebitis., hypotension.
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Overdosage
Symptoms: Nausea, vomiting, abdominal pain, oliguria, tingling of the extremities, high blood pressure; hypotension, respiratory depression, hypothermia, convulsions. Management: Symptomatic and supportive treatment. Remove offending drug by inducing emesis, gastric lavage, catharsis, or supportive diuresis. Maintain adequate pulmonary ventilation, especially if convulsion or coma develop. Use standard anticonvulsant agents to control convulsion. Correct hypotension with pressor drugs. Treat peripheral vasospasm by applying warmth to the extremities as necessary.
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Drug Interactions
Increased risk of ergot toxicity with CYP3A4 inhibitors (e.g. erythromycin, clarithromycin, ritonavir, delavirdine, ketoconazole, itraconazole, voriconazole). Enhance vasoconstrictive effect with β-blockers. Diminished therapeutic effect with anaesthetics (e.g. halothane, methoxyflurane). Reduced therapeutic effect of glyceryl trinitrate and other antianginal medications.
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Action
Methylergometrine is an ergot alkaloid. It increases the tone, rate and amplitude of uterine contractions which shortens the third stage of labour and reduces blood loss.
Synonym: methylergonovine.
Onset: 5-10 minutes (oral); 2-5 minutes (IM). Duration: Approx 3 hours (oral/IM). Absorption: Rapidly absorbed. Bioavailability: 60% (oral); 78% (IM). Time to peak plasma concentration: 0.3-2 hours (oral); 0.2-0.6 hours (IM). Distribution: Enters breast milk. Volume of distribution: 39-73 L. Metabolism: Undergoes extensive first-pass hepatic metabolism. Excretion: Via the urine and faeces. Elimination half-life: Approx 3 hours. |
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Storage
Oral: Store between 20-25°C. Parenteral: Store between 2-8°C. Protect from light.
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CIMS Class
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ATC Classification
G02AB01 - methylergometrine ; Belongs to the class of ergot alkaloids. Used to induce abortion or augment labour and to minimize blood loss from the placental site.
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