Names and pronunciation
M (meth-ill-er-goe-noe′veen) Methergine
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Drug reference
M (meth-ill-er-goe-noe′veen) Methergine
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Func. class.: Oxytocic
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Chem. class.: Ergot alkaloid
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ACTION: Stimulates uterine, vascular, and smooth muscle, thereby causing contractions; decreases bleeding; arterial vasoconstriction
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USES: Prevention, treatment of hem- orrhage postpartum or postabortion, uterine contractions
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CONTRAINDICATIONS: Preg- nancy (other than obstetric delivery/ abortion), hypertension, preeclampsia, eclampsia, elective induction of labor, hypersensitivity to ergot preparations Precautions: Severe renal/hepatic dis- ease, jaundice, diabetes mellitus, seizure disorders, sepsis, CAD, last stage of labor
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SIDE EFFECTS CNS: Headache, dizziness, seizures, hallucinations; stroke (IV) CV: Hypotension, chest pain, palpitation, hypertension, dysrhythmias, CVA (IV) EENT: Tinnitus GI: Nausea, vomiting GU: Cramping INTEG: Sweating, rash, allergic reactions MS: Leg cramps RESP: Dyspnea
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INTERACTIONS Increase: vasoconstriction—DOPamine, ergots, anesthetics (regional), vasopres- sors, nicotine Increase: ergot toxicity—CYP3A4 inhibi- tors; do not use together
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DOSAGE AND ROUTES • Adult: PO 0.2 mg tid-qid × ≤7 days; IM/IV 0.2 mg after delivery of shoulder, placenta, or puerperium, then q2-4hr × 1-5 doses
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Available forms: Inj 0.2 mg/mL; tabs 0.2 mg
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Administer: PO route • Do not exceed dosage limits • Store tabs at room temperature • Give with water • Only during 4th stage of labor; not to be used to augment labor IM route • Protect from light • IM in deep muscle mass; rotate inj sites for additional doses, aspirate Direct IV route • Undiluted through Y-tube or 3-way stopcock; give ≤0.2 mg/min or diluted in 5 mL 0.9% NaCl given through Y-site • With crash cart available on unit; IV route used only in emergencies • Refrigerated storage of ampules; pro- tect from light; give only if solution is clear, colorless
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Assess: • B/P, pulse, character and amount of vaginal bleeding; watch for indications of hemorrhage • Uterine relaxation; observe for severe cramping • Ergot toxicity: tinnitus, hypertension, palpitations, chest pain, nausea, vomiting, weakness; cold, numb extremities • Pregnancy/breastfeeding: do not use in pregnancy except following obstetric delivery or abortion to reduce postpar- tum hemorrhagic risk; may breastfeed 1 wk postpartum
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Evaluate: • Therapeutic response: absence of post- partum hemorrhage
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report increased blood loss, severe abdominal cramps, fever, or foul-smelling lochia
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PHARMACOKINETICS Metabolized in liver, excreted in urine PO: Onset 5-15 min, duration 3 hr IM: Onset 2-5 min, duration 3 hr IV: Onset immediate, duration 45 min-3 hr
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• Adult: PO 0.2 mg tid-qid × ≤7 days; IM/IV 0.2 mg after delivery of shoulder, placenta, or puerperium, then q2-4hr × 1-5 doses
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