Mechanism of effect
Uterotonic agents increase the uterine tone and contractions. These agents intensify uterine muscle contractions at the beginning and during labor, and during the postpartum period. Oxytocin, a hormone produced by the posterior pituitary, is a natural uterotonic.
Uterotonic agents are used to induce labor and for elected abortions. They lessen blood loss during childbirth and are extremely important in the prevention and treatment of postpartum hemorrhage.
Ergonovine, like other ergot alkaloids, produces arterial vasoconstriction by stimulation of alpha-adrenergic and serotonin receptors and inhibition of endothelial-derived relaxation factor release. It is a less potent vasoconstrictor than ergotamine. As a diagnostic aid (coronary vasospasm), ergonovine causes vasoconstriction of coronary arteries.
Uterotonic agents are used to induce labor and for elected abortions. They lessen blood loss during childbirth and are extremely important in the prevention and treatment of postpartum hemorrhage.
Ergonovine, like other ergot alkaloids, produces arterial vasoconstriction by stimulation of alpha-adrenergic and serotonin receptors and inhibition of endothelial-derived relaxation factor release. It is a less potent vasoconstrictor than ergotamine. As a diagnostic aid (coronary vasospasm), ergonovine causes vasoconstriction of coronary arteries.
Pharmacokinetics
Storage
-Store between 2C and 8C; protect from light
-Diluted doses may be stored at 15C to 30C for up to 4 hours
Metabolism
Hepatic
Excretion
Thought to be eliminated by non-renal mechanisms (i.e. hepatic metabolism, excretion in feces)
-Store between 2C and 8C; protect from light
-Diluted doses may be stored at 15C to 30C for up to 4 hours
Metabolism
Hepatic
Excretion
Thought to be eliminated by non-renal mechanisms (i.e. hepatic metabolism, excretion in feces)
Drug indications
For the prevention or treatment of postpartum or post-abortal hemorrhage due to uterine atony
For the prevention or treatment of postpartum or post-abortal hemorrhage due to uterine atony
For the prevention or treatment of postpartum or post-abortal hemorrhage due to uterine atony
Dosage
Usual Adult Dose for Abnormal Uterine Bleeding
Prevention of postpartum bleeding: 0.2 mg IM immediately following delivery of placenta
In emergency situations when excessive uterine bleeding has occurred: 0.2 mg IV
IV doses should be administered over a period of not less than 1 minute; monitor blood pressure and uterine contractions carefully
Doses may be repeated every 2 to 4 hours as needed up to a total of 5 doses
Usual Adult Dose for Postpartum Bleeding
Prevention of postpartum bleeding: 0.2 mg IM immediately following delivery of placenta
In emergency situations when excessive uterine bleeding has occurred: 0.2 mg IV
IV doses should be administered over a period of not less than 1 minute; monitor blood pressure and uterine contractions carefully
Doses may be repeated every 2 to 4 hours as needed up to a total of 5 doses
Prevention of postpartum bleeding: 0.2 mg IM immediately following delivery of placenta
In emergency situations when excessive uterine bleeding has occurred: 0.2 mg IV
IV doses should be administered over a period of not less than 1 minute; monitor blood pressure and uterine contractions carefully
Doses may be repeated every 2 to 4 hours as needed up to a total of 5 doses
Usual Adult Dose for Postpartum Bleeding
Prevention of postpartum bleeding: 0.2 mg IM immediately following delivery of placenta
In emergency situations when excessive uterine bleeding has occurred: 0.2 mg IV
IV doses should be administered over a period of not less than 1 minute; monitor blood pressure and uterine contractions carefully
Doses may be repeated every 2 to 4 hours as needed up to a total of 5 doses
Drug contraindications
Previous idiosyncrasy or allergic reactions to ergot preparations
Toxemia
Hypertension
Threatened spontaneous abortion
Induction of labor
Women taking HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors
Safety and efficacy have not been established in patients younger than 18 years
Toxemia
Hypertension
Threatened spontaneous abortion
Induction of labor
Women taking HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors
Safety and efficacy have not been established in patients younger than 18 years
Side effects
Cardiovascular
Frequency not reported: Gangrene, coronary artery vasospasm, peripheral vasospasm, hypotension, hypertension, thrombophlebitis, myocardial infarction (single case report), ventricular arrhythmias, transient chest pain, palpitation, bradycardia, vasoconstriction
Gastrointestinal
Very rare (less than 0.01%): Mesenteric ischemia and large bowel infarction (single case report)
Frequency not reported: Abdominal pain, diarrhea, nausea, esophageal spasm, vomiting, unpleasant taste
Hypersensitivity
Frequency not reported: Allergic phenomena (including shock, hypertension, chest pain, palpitation, dyspnea, and bradycardia), anaphylactic/anaphylactoid reaction
Nervous system
Frequency not reported: Dizziness, headache
Metabolic
Frequency not reported: Clinical exacerbations of porphyria, water intoxication
Dermatologic
Frequency not reported: Sweating, diaphoresis, skin rashes
Respiratory
Frequency not reported: Dyspnea, nasal congestion, pulmonary edema, pleural thickening
Musculoskeletal
Very rare (less than 0.01%): Unmasking of myasthenia gravis (single case report)
Frequency not reported: Leg cramps
Postmarketing reports: Muscle spasm
Ocular
Postmarketing reports: Eye movement disorder
Psychiatric
Frequency not reported: Hallucinations
Genitourinary
Frequency not reported: Hematuria
Hepatic
Frequency not reported: Abnormal liver function test
Other
Frequency not reported: Vertigo, tinnitus
Renal
Postmarketing reports: Increased blood creatine
Frequency not reported: Gangrene, coronary artery vasospasm, peripheral vasospasm, hypotension, hypertension, thrombophlebitis, myocardial infarction (single case report), ventricular arrhythmias, transient chest pain, palpitation, bradycardia, vasoconstriction
Gastrointestinal
Very rare (less than 0.01%): Mesenteric ischemia and large bowel infarction (single case report)
Frequency not reported: Abdominal pain, diarrhea, nausea, esophageal spasm, vomiting, unpleasant taste
Hypersensitivity
Frequency not reported: Allergic phenomena (including shock, hypertension, chest pain, palpitation, dyspnea, and bradycardia), anaphylactic/anaphylactoid reaction
Nervous system
Frequency not reported: Dizziness, headache
Metabolic
Frequency not reported: Clinical exacerbations of porphyria, water intoxication
Dermatologic
Frequency not reported: Sweating, diaphoresis, skin rashes
Respiratory
Frequency not reported: Dyspnea, nasal congestion, pulmonary edema, pleural thickening
Musculoskeletal
Very rare (less than 0.01%): Unmasking of myasthenia gravis (single case report)
Frequency not reported: Leg cramps
Postmarketing reports: Muscle spasm
Ocular
Postmarketing reports: Eye movement disorder
Psychiatric
Frequency not reported: Hallucinations
Genitourinary
Frequency not reported: Hematuria
Hepatic
Frequency not reported: Abnormal liver function test
Other
Frequency not reported: Vertigo, tinnitus
Renal
Postmarketing reports: Increased blood creatine
Interactions
Spiramycin , Expectorant , Oxymetazoline , Bupivacaine , Phenylephrine , Darunavir , Almotriptan , Diethylpropion , saquinavir , nelfinavir , eletriptan , Phenylpropanolamine , Amprenavir , lisdexamfetamine , Amyl Nitrite , Efavirenz , Mibefradil , chlorcyclizine + pseudoephedrine , chlorcyclizine + phenylephrine , cobicistat , Delavirdine , Doravirine , oleandomycin , chlorcyclizine , Ombitasvir, Paritaprevir, and Ritonavir , NicotineAlerts
If you have heart disease, talk with your doctor
High blood pressure has happened with ergonovine. Have your blood pressure checked as you have been told by your doctor
Death of body tissue (gangrene) and other effects have happened with use of ergonovine for a long time. If you have questions, talk with your doctor
Do not use ergonovine for longer than you were told by your doctor
Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
Signs of high blood pressure like very bad headache or dizziness, passing out, or change in eyesight.
Chest pain or pressure.
Hallucinations (seeing or hearing things that are not there).
A heartbeat that does not feel normal.
Slow heartbeat.
Shortness of breath.
Any skin change.
Ringing in ears.
Blood in the urine
High blood pressure has happened with ergonovine. Have your blood pressure checked as you have been told by your doctor
Death of body tissue (gangrene) and other effects have happened with use of ergonovine for a long time. If you have questions, talk with your doctor
Do not use ergonovine for longer than you were told by your doctor
Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
Signs of high blood pressure like very bad headache or dizziness, passing out, or change in eyesight.
Chest pain or pressure.
Hallucinations (seeing or hearing things that are not there).
A heartbeat that does not feel normal.
Slow heartbeat.
Shortness of breath.
Any skin change.
Ringing in ears.
Blood in the urine
Points of recommendation
What do I need to tell my doctor BEFORE I take Ergonovine
If you have any of these health problems: High blood pressure or toxemia.
If you are in labor or at risk for a miscarriage.
If you have not had your baby.
If you are taking certain drugs to treat HIV.
-If you are breast-feeding. Do not breast-feed while you take ergonovine
This medicine is most often given as a shot into a muscle.
Rarely, it will be given into a vein
IV doses should be diluted in 5 mL 0.9% sodium chloride prior to administration
In some calcium deficient patients, the uterus may not respond to this drug; in such cases, responsiveness can be restored by cautious calcium IV administration
If you have any of these health problems: High blood pressure or toxemia.
If you are in labor or at risk for a miscarriage.
If you have not had your baby.
If you are taking certain drugs to treat HIV.
-If you are breast-feeding. Do not breast-feed while you take ergonovine
This medicine is most often given as a shot into a muscle.
Rarely, it will be given into a vein
IV doses should be diluted in 5 mL 0.9% sodium chloride prior to administration
In some calcium deficient patients, the uterus may not respond to this drug; in such cases, responsiveness can be restored by cautious calcium IV administration
Pregnancy level
HAVE NOT BEEN ESTABLISHEDThis drug has potent uterotonic activity. Uterine contraction may cause premature parturition or hypertonic labour. Tetanic contractions may result in decreased uterine blood flow and fetal distress. This drug should not be administered prior to delivery of the placenta. Administration prior to delivery of the placenta may cause captivation of the placenta or missed diagnosis of a second infant, due to excessive uterine contraction. There are no controlled data in human pregnancy.
Breast feeding warning
This drug is excreted in breast milk but in unknown amounts. This drug can inhibit prolactin secretion and in turn suppress lactation; it may produce ergotism in breast-fed infants. While a single dose should not prevent a mother from breastfeeding, this drug should be avoided in mothers who breastfeed
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