Pharm

Methylergonovine

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Methylergonovine, Methyl-ergonovine, Methergine

  • See Also
  1. Postpartum Hemorrhage
  2. Uterotonic
  • Indications
  1. Postpartum Hemorrhage
    1. After delivery of the anterior Shoulder and placenta
  2. Uterine Hemorrhage
    1. Dilation and Curettage associated Hemorrhage
    2. Early Pregnancy Loss associated Hemorrhage
    3. Uterine Inversion associated Hemorrhage (following Uterus replacement)
  • Contraindications
  1. Hypertension
  2. Pregnancy Induced Hypertension
  3. Methylergonovine Hypersensitivity
  • Mechanism
  1. Methylergonovine (Methergine) is an Ergonovine homolog, with an added methyl group
    1. While Methylergonovine is primarily used in the U.S., Ergonovine is used elsewhere
  2. Methylergonovine is an ergot alkaloid
    1. Increases uterine tone and contraction
    2. Increases vascular smooth Muscle Contraction (Vasoconstriction)
  3. Methylergonovine has complex interactions at multiple receptors
    1. Adrenergic Receptors
    2. Dopamine receptors
    3. Tryptamine receptors
  4. Methylergonovine also decreases Prolactin levels
    1. May decrease Lactation
  • Dosing
  1. Precautions
    1. Dose after delivery of the anterior Shoulder and placenta
    2. Monitor Blood Pressure
  2. IM: 0.2 mg IM every 2 to 4 hours as needed for acute Postpartum Hemorrhage
    1. Avoid IV use (CVA, Hypertension), esp. given that IM onset of action is within 2 to 5 minutes
    2. If IV dose is used, infuse over >1 minute
  3. Oral: 0.2 mg orally every 6 to 8 hours postpartum (maximum of 1 week)
  • Adverse Effects
  1. Cardiovascular
    1. Cardiac Arrhythmia
    2. Hypertension
      1. Paradoxical Hypotension has also been reported
  2. Neurologic
    1. Seizure
    2. Cerebrovascular Accident
  3. Gynecologic
    1. Abdominal Pain or cramping
    2. Nausea or Vomiting
  • Safety
  1. Avoid in Lactation
  2. Contraindicated in pregnancy (except postpartum or after pregnancy loss)
  • Pharmacokinetics
  1. Onset: 2 to 5 min after IM dosing (5 to 10 min after oral dosing)
  2. Bioavailability: 78% for IM (60% for oral)
  • Resources
  1. Methylergonovine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a9a3079e-b62b-4858-920e-d8f5cb38481e