II. Indications
-
Postpartum Hemorrhage
- After delivery of the anterior Shoulder and placenta
- Uterine Hemorrhage
- Dilation and Curettage associated Hemorrhage
- Early Pregnancy Loss associated Hemorrhage
- Uterine Inversion associated Hemorrhage (following Uterus replacement)
III. Contraindications
- Hypertension
- Pregnancy Induced Hypertension
- Methylergonovine Hypersensitivity
IV. Mechanism
- Methylergonovine (Methergine) is an Ergonovine homolog, with an added methyl group
- While Methylergonovine is primarily used in the U.S., Ergonovine is used elsewhere
- Methylergonovine is an ergot alkaloid
- Increases uterine tone and contraction
- Increases vascular smooth Muscle Contraction (Vasoconstriction)
- Methylergonovine has complex interactions at multiple receptors
- Adrenergic Receptors
- Dopamine receptors
- Tryptamine receptors
- Methylergonovine also decreases Prolactin levels
- May decrease Lactation
V. Dosing
- Precautions
- Dose after delivery of the anterior Shoulder and placenta
- Monitor Blood Pressure
- IM: 0.2 mg IM every 2 to 4 hours as needed for acute Postpartum Hemorrhage
- Avoid IV use (CVA, Hypertension), esp. given that IM onset of action is within 2 to 5 minutes
- If IV dose is used, infuse over >1 minute
- Oral: 0.2 mg orally every 6 to 8 hours postpartum (maximum of 1 week)
VI. Adverse Effects
- Cardiovascular
- Cardiac Arrhythmia
- Hypertension
- Paradoxical Hypotension has also been reported
- Neurologic
- Gynecologic
- Abdominal Pain or cramping
- Nausea or Vomiting
VII. Safety
- Avoid in Lactation
- Contraindicated in pregnancy (except postpartum or after pregnancy loss)
VIII. Pharmacokinetics
- Onset: 2 to 5 min after IM dosing (5 to 10 min after oral dosing)
- Bioavailability: 78% for IM (60% for oral)
IX. Resources
- Methylergonovine (DailyMed)
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Related Studies
| methylergonovine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| METHYLERGONOVINE 0.2 MG TABLET | Generic | $9.17 each |