Adult Dosing

Postpartum bleeding

• 0.2 mg IM/IV
• Repeat q2-4 hrs PRN
• Max: 5 doses

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

• For routine management of uterine atony, hemorrhage and subinvolution of the uterus
• Administered for control of uterine hemorrhage in 2nd stage of labor following delivery of the anterior shoulder

• Hypersensitivity to any of the ingredients of the product
• Hypertension
• Toxemia
• Intra-arterial or periarterial injection
• IV administration
• Pregnancy

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined; caution advised

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined; caution advised

• Avoid routine I.V administration due to the possibility of inducing sudden hypertensive and cerebrovascular accidents. If I.V administration is considered as a lifesaving measure, give slowly over at least 60 sec with careful monitoring of BP
• Avoid intra-arterial or periarterial injection
• Methylergonovine is contraindicated during pregnancy because of its uterotonic effects
• Mothers should not breastfeed during treatment and discard milk secreted during this period. Breastfeeding may be resumed at least 12 hrs after last dose. Therapy may produce adverse events in the breast-feeding infant and also decrease the yield of breast milk
• Inadvertent administration to newborn infants has reported with methylergonovine. Due to accidental neonatal exposure to methylergonovine it should be stored separately from medications intended for neonates
• Increased risk for myocardial ischemia and infarction in patients with coronary artery disease (CAD) associated with methylergonovine-induced vasospasm

Cautions: Use cautiously in

• Renal impairment
• Hepatic impairment
• Obliterative vascular disease
• Second stage of labor
• Sepsis
• Hypertensive patients
• Elderly patients
• Third stage of labor

Pregnancy Category:C

Breastfeeding: Limited information indicates that maternal doses up to 0.75 mg/day produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants. However it can decrease serum prolactin and possibly suppress lactation, especially when used in the immediate postpartum period. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 5 May 2011). Manufacturer recommends use with caution in nursing woman.

• CV: Hypertension, hypotension, arterial spasm
• CNS: Headache, seizure
• GI: Nausea, vomiting
• HEMA: Thrombophlebitis
• HYPERSENSITIVITY: Anaphylaxis

• Uterine stimulant; increases uterine contraction force and frequency by directly stimulating uterine and vascular smooth muscle
• Absorption is rapid after IM (78% bioavailability) administration
• Metabolized by liver; CYP450: Unknown
• Excretion: Unknown
• Half-life: 3.39 hrs

US Trade Name(s)

• Methergine

US Availability

methylergonovine (generic)

• INJ: 0.2 mg/mL (1mL vials)

Methergine

• INJ: 0.2 mg/mL (1mL amps)

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Obstetrics/Gynecology

Oxytocics

Ergot Alkaloids