methylergonovine

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.

Exercise Extreme Caution in:

OB: Third stage of labor.

Adv. Reactions/Side Effects ⬆ ⬇

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

Derm: ↑sweating

EENT: tinnitus

GI: nausea, vomiting

GU: cramps

Neuro: dizziness, headache, paresthesia, STROKE

Resp: dyspnea

Interactions ⬆ ⬇

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.

Drug-Food:

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

Availability ⬆ ⬇

(Generic available)

Tablets: 0.2 mg
Injection: 0.2 mg/mL

Route/Dosage ⬆ ⬇

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Directly stimulates uterine and vascular smooth muscle.

Therapeutic effects:

Uterine contraction.

Classifications ⬆ ⬇

Therapeutic Classification: oxytocics

Pharmacologic Classification: ergot alkaloids

Pharmacokinetics ⬆ ⬇

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.

Time/Action Profile ⬆ ⬇

(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

Patient/Family Teaching ⬆ ⬇

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.

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Indications ⬇

Contraind./Precautions ⬆ ⬇