methylergonovine

meth-ill-er-goe-NOE-veen

Therapeutic Classification: oxytocics

Pharmacologic Classification: ergot alkaloids

REMS

Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution.

Directly stimulates uterine and vascular smooth muscle.

Therapeutic effects:

Uterine contraction.

Absorption: Well absorbed following oral or IM administration.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Probably metabolized by the liver.

Half-Life: 30–120 min.

(effects on uterine contractions)

ROUTE	ONSET	PEAK	DURATION
PO	5–15 min	unknown	3 hr
IM	2–5 min	unknown	3 hr
IV	immediate	unknown	45 min–3 hr

Contraindicated in:

Hypersensitivity;
Concurrent use of strong CYP3A4 inhibitors;
OB: Should not be used to induce labor;
Lactation: Lactation.

Use Cautiously in:

Hypertensive or eclamptic patients (more susceptible to hypertensive and arrhythmogenic side effects);
History of or risk factors for coronary artery disease
Severe renal impairment;
Severe hepatic impairment;
Sepsis.

OB: Third stage of labor.

CV: arrhythmias, chest pain, heart block, HYPERTENSION, palpitations

Derm: ↑sweating

EENT: tinnitus

GI: nausea, vomiting

GU: cramps

Neuro: dizziness, headache, paresthesia, STROKE

Resp: dyspnea

Drug-drug:

Strong CYP3A4 inhibitors, including erythromycin, clarithromycin, ritonavir, nelfinavir, ketoconazole, itraconazole, or voriconazole, may ↑ levels and ↑ risk of ischemia; concurrent use contraindicated.
Excessive vasoconstriction may result when used with heavy cigarette smoking (nicotine), other vasopressors, such as dopamine, or beta-blockers.
Moderate CYP3A4 inhibitors, including nefazodone, fluconazole, fluoxetine, fluvoxamine, zileuton, or clotrimazole, may ↑ levels and risk of toxicity; use concurrently with caution.
CYP3A4 inducers, including nevirapine and rifampin, may ↓ levels and effectiveness.
Anesthetics may ↓ its oxytocic properties
May ↓ the antianginal effects of nitrates.

Grapefruit juice may ↑ levels and risk of toxicity; use concurrently with caution.

PO (Adults ): 0.2–0.4 mg every 6–12 hr for 2–7 days.
IM IV (Adults ): 0.2 mg every 2–4 hr for up to 5 doses.

(Generic available)

Tablets: 0.2 mg
Injection: 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.

IV Administration:

IV: 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.

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.

NDC Code

0054- West-Ward Pharmaceuticals Corp
- 0054-0639- Methylergonovine Maleate
  - 0054-0639-03- 7 TABLET in 1 BOTTLE (0054-0639-03)

0054- West-Ward Pharmaceuticals Corp
- 0054-0639- Methylergonovine Maleate
  - 0054-0639-05- 12 TABLET in 1 BOTTLE (0054-0639-05)

0054- West-Ward Pharmaceuticals Corp
- 0054-0639- Methylergonovine Maleate
  - 0054-0639-13- 28 TABLET in 1 BOTTLE (0054-0639-13)

0054- West-Ward Pharmaceuticals Corp
- 0054-0639- Methylergonovine Maleate
  - 0054-0639-25- 100 TABLET in 1 BOTTLE (0054-0639-25)

0093- Teva Pharmaceuticals USA, Inc.
- 0093-3655- Methylergonovine Maleate
  - 0093-3655-22- 12 TABLET in 1 BOTTLE (0093-3655-22)

0093- Teva Pharmaceuticals USA, Inc.
- 0093-3655- Methylergonovine Maleate
  - 0093-3655-28- 28 TABLET in 1 BOTTLE (0093-3655-28)

0517- American Regent, Inc.
- 0517-0740- Methylergonovine Maleate
  - 0517-0740-20- 20 VIAL, SINGLE-DOSE in 1 CARTON (0517-0740-20) > 1 mL in 1 VIAL, SINGLE-DOSE (0517-0740-01)

17478- Akorn, Inc.
- 17478-501- Methylergonovine Maleate
  - 17478-501-01- 10 AMPULE in 1 CARTON (17478-501-01) > 1 mL in 1 AMPULE

27437- Lupin Pharma
- 27437-050- Methergine
  - 27437-050-01- 100 TABLET in 1 BOTTLE (27437-050-01)

27437- Lupin Pharma
- 27437-050- Methergine
  - 27437-050-19- 7 TABLET in 1 BOTTLE (27437-050-19)

27437- Lupin Pharma
- 27437-050- Methergine
  - 27437-050-56- 28 TABLET in 1 BOTTLE (27437-050-56)

27437- Lupin Pharma
- 27437-050- Methergine
  - 27437-050-57- 12 TABLET in 1 BOTTLE (27437-050-57)

40032- Novel Laboratories, Inc.
- 40032-140- Methylergonovine Maleate
  - 40032-140-01- 100 TABLET in 1 BOTTLE (40032-140-01)

40032- Novel Laboratories, Inc.
- 40032-140- Methylergonovine Maleate
  - 40032-140-07- 7 TABLET in 1 BOTTLE (40032-140-07)

40032- Novel Laboratories, Inc.
- 40032-140- Methylergonovine Maleate
  - 40032-140-28- 28 TABLET in 1 BOTTLE (40032-140-28)

43386- Lupin Pharmaceuticals,Inc.
- 43386-140- Methylergonovine Maleate
  - 43386-140-01- 100 TABLET in 1 BOTTLE (43386-140-01)

43386- Lupin Pharmaceuticals,Inc.
- 43386-140- Methylergonovine Maleate
  - 43386-140-07- 7 TABLET in 1 BOTTLE (43386-140-07)

43386- Lupin Pharmaceuticals,Inc.
- 43386-140- Methylergonovine Maleate
  - 43386-140-12- 12 TABLET in 1 BOTTLE (43386-140-12)

43386- Lupin Pharmaceuticals,Inc.
- 43386-140- Methylergonovine Maleate
  - 43386-140-28- 28 TABLET in 1 BOTTLE (43386-140-28)

50090- A-S Medication Solutions
- 50090-4536- METHYLERGONOVINE MALEATE
  - 50090-4536-0- 1 mL in 1 AMPULE (50090-4536-0)

51991- Breckenridge Pharmaceutical, Inc.
- 51991-144- METHYLERGONOVINE MALEATE
  - 51991-144-17- 10 AMPULE in 1 BOX (51991-144-17) > 1 mL in 1 AMPULE

60687- American Health Packaging
- 60687-410- Methylergonovine Maleate
  - 60687-410-94- 20 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-410-94) > 1 TABLET in 1 BLISTER PACK (60687-410-11)

63704- Pharmacist Pharmaceutical, LLC
- 63704-004- METHYLERGONOVINE MALEATE
  - 63704-004-01- 10 AMPULE in 1 BOX (63704-004-01) > 1 mL in 1 AMPULE

69238- Amneal Pharmaceuticals NY LLC
- 69238-1605- Methylergonovine Maleate
  - 69238-1605-2- 12 TABLET in 1 BOTTLE (69238-1605-2)

69238- Amneal Pharmaceuticals NY LLC
- 69238-1605- Methylergonovine Maleate
  - 69238-1605-8- 28 TABLET in 1 BOTTLE (69238-1605-8)

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Code ⬆