Methylergonovine (Injection)

When bleeding from the uterus occurs during childbirth, methylergonovine is often used to control that bleeding and to stop it, so that the patient does not not lose excessive blood.

Overview

Methylergonovine belongs to the class of drugs known as ergot alkaloids, and its primary usage is to manage the flow of blood which commonly occurs after childbirth. It works on the smooth muscles of the uterus, and is also helpful in delivering the placenta after an infant has been born. It should only be used after a baby has been born though, and not at any other time during pregnancy. Mothers should be aware that breast-feeding is inadvisable for a period of 12 hours after having been injected with methylergonovine.

It is almost always delivered into a muscle on the body, and only rarely is it injected directly into a vein. Patients being injected with this medicine must be careful to avoid eating grapefruit or drinking grapefruit juice, since ingestion of either of these can have a major impact on how much of the methylergonovine is absorbed by your body. This of course, will have the effect of reducing its effectiveness, and blood flow might then be less manageable.

Condition Treated

Type Of Medicine

  • Ergot Alkaloid

Side Effects

In addition to the beneficial effects it provides in controlling blood flow during childbirth, methylergonovine may also carry some unwanted side effects for some patients. While many patients will experience no side effects at all, or some very minor ones, others may notice more severe reactions to the medication. Since this medicine will be administered to a patient in a hospital setting via injection, any side effects which become noticeable can be observed immediately by medical professionals, and in the case of severe reactions, they can then be treated if necessary.

One of the first reactions to be concerned with from any medication is the potential for an allergic reaction, and this can be very serious because the associated symptoms can become life-threatening if not immediately treated. While this happens only rarely, it is always something that patients and doctors need to be aware of, especially after the first deliverance of a new medication. The symptoms to look for in an allergic reaction are the following:

  • Itchiness occurring at various locations around the body
  • The appearance of rashes and or hives on the skin
  • Chest tightness, sometimes accompanied by extreme difficulty with breathing
  • Pronounced swelling or puffiness around the eyelids, or on the tongue, lips, or throat
  • Dizziness or light-headedness, sometimes to the degree that you feel you are about to faint

Other symptoms which may be less severe have been reported and observed in patients who have been given methylergonovine, including those on the list below:

  • Slow, fast, or irregular heartbeat
  • Profuse sweating
  • Nausea and vomiting
  • Swelling around the legs, hands, arms, and feet
  • High blood pressure
  • Abdominal pains or cramping
  • Stomach pains or cramping
  • Persistent headaches
  • Blood in the urine
  • Difficulty with swallowing
  • Breathing problems
  • Chest pains or discomfort
  • Changes in skin color
  • Dizziness or light-headedness
  • Hives
  • Pain in the jaw, neck, back, or shoulders
  • Feeling of tingling, burning, or numbness, at almost any site on the body
  • Hoarseness, slurred speech, or inability to speak at all
  • Seizures or convulsions
  • Severe and sudden headache
  • Temporary loss of vision or changes to vision
  • Temporary loss of strength or sensation on one whole side of the body
  • Extreme dizziness when rising quickly from a sitting or lying position
  • Confusion or disorientation which comes and goes
  • Stuffy nose or runny nose
  • Foul taste in the mouth
  • Cramping in the legs
  • Buzzing, ringing, or other noises in the ears, which come and go
  • Persistent severe diarrhea.

Dosage

This medication is almost always injected into muscle rather than intravenously because of the possibility of triggering spontaneous hypertensive accidents or cerebrovascular accidents. In those rare cases where intravenous injection is being considered, the delivery process should be over a 60-second time frame, with medical personnel constantly monitoring blood pressure throughout the procedure.

The indicated time for administering methylergonovine is during delivery of the placenta, and sometimes during the second stage of labor. Patients should be prevented from eating grapefruit or drinking grapefruit juice while receiving this medication because those substances may inhibit full absorption of the medicine by the body.

While the precise dosage administered to any given patient will be determined by medical professionals in the hospital, a standard dosage would be .2 mg given after delivery of the anterior shoulder, or following the delivery of the placenta, or during the period after childbirth known as puerperium. This dosage can be repeated if necessary to manage blood flow, at intervals between two hours and four hours.

Interactions

There is a possibility that methylergonovine may interact with other medications that you may be taking, so prior to the childbirth process it will be beneficial for you to prepare a list of all your other medications, so the doctors can review this list. When interactions between drugs occur, there is a potential for introducing undesirable side effects to the patient, or worsening any side effects which might have occurred anyway. It's also possible for two interacting drugs to diminish the effectiveness of one or the other, or possibly both of them.

The list that you prepare should include all vitamins, supplements, over-the-counter drugs, and other prescription drugs you may be taking at the time, as well as the dosage levels of each of these. Once your doctor at the hospital has had a chance to review this list, a determination can be made about whether there is a potential for interaction between your medications and methylergonovine.

The same list will be handy if you should have a need for follow-up treatment at a healthcare clinic where your primary care doctor is not in residence, or if you need to make an unscheduled trip to the emergency room. Any doctor there can assess your medication list and prescribe treatment for your condition which will not conflict with your current medications.

The medications which are usually check for initially by medical personnel for the potential of drug interactions are those listed below:

  • Ondansetron
  • Phytonadione
  • Acetaminophen
  • Zolpidem
  • Immunoglobulin
  • Amoxicillin
  • Clavulanate
  • Sulfamethoxazole
  • Trimethoprim
  • Caffeine
  • Loratadine
  • Nalbuphine
  • Escitalopram
  • Ibuprofen
  • Metronidazole
  • Bisacodyl
  • Doxycycline
  • Divalproex sodium
  • Diphtheria and tetanus toxoids
  • Docusate
  • Oxytocin
  • Metronidazole
  • Pertussis, acellular.

Warnings

For all patients being given methylergonovine, there are a few precautions which you should be aware of, and which the doctor in residence at the hospital may inform you of. Throughout the period after injection by this medication, medical personnel will need to closely observe your blood pressure, to make sure it doesn't become too elevated. Your medical condition will be closely monitored to determine whether or not the medicine is being effective in controlling blood discharge after delivery of the placenta.

It is possible that this medicine can induce contraction of the uterus and trigger premature delivery. Methylergonovine may also slightly increase the risk of a patient having a heart attack, although this increased risk is generally associated with patients who have high cholesterol, diabetes, or if you are considerably overweight, or you have a significant smoking habit.

You should let your doctor know right away if you experience any of the following symptoms:

  • Pain or discomfort in the chest
  • Pain or discomfort in the jaw, back, neck, or arms
  • If you have trouble breathing, or if you feel extreme tightness in the chest
  • If you experience nausea or vomiting
  • You are bothered by profuse sweating after taking this medication.

In addition to the injection which you are given at the hospital, it is possible that your doctor may want you to follow up with methylergonovine tablets of medication, after you are released from the hospital, if there is a danger of continued bleeding. If this happens in your case, you should not begin taking any other new medications, and you should not discontinue taking any current ones during the time frame you are also using methylergonovine.

This includes all herbal supplements as well as over-the-counter drugs and other prescription medications ' all these should be checked out with your doctor before you begin taking anything new.

With regard to breast-feeding, if you are taking methylergonovine at home for a period of time to control uterine bleeding, it is likely you will be recommended to take a .2 mg dosage either three or four times a day, and at this level of medication, methylergonovine will appear in breast milk.

Therefore, it is recommended that mothers do not breast-feed for the duration of time they are taking methylergonovine tablets, usually for one week after leaving the hospital. It is also highly recommended that you do not breast-feed for at least 12 hours after your last tablet dosage of methylergonovine. Any breast milk which is produced while you are still taking the tablets of this medication should be discarded and not used at all.

Storage

The injection form of this medication will be stored at a medical facility and is therefore not under the care or maintenance of the patient. However, if you are taking the tablets at home for a week or so, these must be stored at room temperature in a setting where there are no extremes of temperature, light, or humidity. This medicine must be kept out of the reach of children, and it should not be stored in a weekly pill reminder, since these rarely are equipped with locking mechanisms to prevent unwanted access. Any unused methylergonovine should be discarded according to proper disposal methods, as instructed by your doctor or pharmacist.

Summary

Methylergonovine is a medicine which is used during the childbirth process, at the time of delivery of the placenta, to control the loss of blood which sometimes occurs. It is delivered via injection into a muscle, rather than intravenously because the intravenous route can trigger some sudden violent reactions. There is a possibility that a patient may be prescribed some tablets of methylergonovine to take during the week after delivery, if there is still a potential for uterine bleeding to occur at home.