Drug Guide
Methylergonovine Maleate
Classification
Therapeutic: Uterotonics; Ergot Alkaloids
Pharmacological: Alpha-adrenergic agonist, serotonin receptor agonist
FDA Approved Indications
- Prevention and treatment of postpartum hemorrhage due to uterine atony
Mechanism of Action
Stimulates alpha-adrenergic and serotonin receptors on uterine smooth muscle, causing vasoconstriction and increased uterine tone, thus reducing bleeding.
Dosage and Administration
Adult: 0.2 mg IM every 2-4 hours as needed, max 5 doses within 24 hours
Pediatric: Not generally used in children
Geriatric: Use with caution, dose adjustments not specifically established
Renal Impairment: Use cautiously; no specific dosage adjustment available
Hepatic Impairment: Use cautiously; no specific dosage adjustment available
Pharmacokinetics
Absorption: Rapid IM absorption
Distribution: Widely distributed, crosses the placenta and enters breast milk
Metabolism: Hepatic metabolism
Excretion: Eliminated mainly in feces, minor renal excretion
Half Life: About 3-4 hours
Contraindications
- Uncontrolled hypertension
- History of ergot alkaloid sensitivity
- Vascular disease
- Pregnancy
Precautions
- Monitor blood pressure closely, especially in hypertensive patients; use with caution in cardiovascular disease
Adverse Reactions - Common
- Hypertension (Common)
- Nausea, vomiting (less common) (Less common)
Adverse Reactions - Serious
- Vasospasm, acute hypertension, stroke (Rare)
- Uterine rupture (rare) (Rare)
Drug-Drug Interactions
- Other vasoconstrictors or adrenergic drugs, which may increase hypertension risk
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure, uterine tone, bleeding, and signs of vasospasm
Diagnoses:
- Risk for hypertension
- Ineffective tissue perfusion
Implementation: Administer as ordered, monitor response, and assess for adverse effects
Evaluation: Effectiveness in reducing bleeding, maintaining safe blood pressure levels
Patient/Family Teaching
- Report chest pain, severe headache, high blood pressure, or signs of allergic reaction
- Do not use in pregnancy unless prescribed by a healthcare provider for postpartum hemorrhage
Special Considerations
Black Box Warnings:
- Potential for serious and life-threatening hypertension and vasospasm
Genetic Factors: None established
Lab Test Interference: None
Overdose Management
Signs/Symptoms: Severe hypertension, vasospasm, cold, clammy extremities, decreased pulse
Treatment: Discontinue drug, provide supportive care, treat hypertensive crisis with antihypertensive agents as needed
Storage and Handling
Storage: Store at room temperature, protect from light and moisture
Stability: Stable under recommended storage conditions for the specified shelf life