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Methergine
Methergine (generic name: methylergonovine) is a prescription medication used to help prevent or control postpartum hemorrhage (excessive bleeding) after childbirth. It works by causing the smooth muscles of the uterus to contract, reducing blood loss. Methergine is typically administered after the delivery of the placenta to help the uterus contract and reduce the risk of excessive bleeding. It belongs to the class of drugs known as ergot alkaloids and is only used after childbirth or abortion, not during pregnancy, as it can induce contractions.
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Frequently Asked Questions
How long does it take for Methergine to work?
Methergine typically starts working within 5 to 10 minutes after intramuscular administration and within 30 minutes after taking oral tablets. It helps reduce postpartum bleeding by causing uterine contractions.
Can I take Methergine if I have high blood pressure?
No, Methergine is contraindicated in individuals with hypertension or a history of preeclampsia, as it can significantly increase blood pressure.
Is Methergine safe to take during pregnancy?
No, Methergine should not be used during pregnancy because it can cause uterine contractions that may harm the fetus. It is only used after childbirth or after the delivery of the placenta.
Can I breastfeed while taking Methergine?
Methylergonovine can pass into breast milk and may affect milk production. Consult your healthcare provider before breastfeeding while using Methergine.
What should I do if I miss a dose of Methergine?
If you miss a dose, take it as soon as you remember unless it is close to your next scheduled dose. Do not double up on doses.
Comprehensive Drug Guide
How Does Methergine Work?
Methergine works by stimulating the smooth muscle of the uterus to contract, helping to decrease blood loss after childbirth. By binding to serotonin and alpha-adrenergic receptors, it promotes sustained uterine contractions, which help the uterus return to its normal size and reduce postpartum bleeding.
Common Dosages
- Oral tablets: 0.2 mg
- Injection (IM or IV): 0.2 mg/mL
Typical Dosing
- For postpartum hemorrhage: The usual dose is 0.2 mg either orally or by intramuscular injection.
- For oral tablets: 0.2 mg three to four times daily for up to 1 week following delivery.
- For injection: 0.2 mg intramuscularly after delivery, and the dose can be repeated as needed every 2 to 4 hours.
- Intravenous administration should only be used in emergencies due to the increased risk of adverse reactions.
Typical Dosing
FDA Approved Indications
- Prevention and treatment of postpartum hemorrhage (excessive bleeding) after childbirth or following delivery of the placenta.
Who Shouldn't Take Methergine?
- Hypertension or preeclampsia.
- Coronary artery disease.
- Severe liver or kidney disease.
- Known hypersensitivity to methylergonovine or other ergot alkaloids.
- During pregnancy, as it can induce uterine contractions that could harm the fetus.
Advice From The Pharmacist
- Take Methergine exactly as prescribed by your healthcare provider. If you are taking the oral tablets, be sure to follow the dosing schedule carefully.
- Avoid grapefruit juice while using Methergine, as it may increase the risk of side effects by affecting how the drug is processed by your body.
- Do not take Methergine if you are pregnant, as it can cause uterine contractions that could harm the pregnancy.
- Report any severe side effects, such as chest pain, difficulty breathing, or unusually high blood pressure, to your healthcare provider immediately.
- Store Methergine tablets and injection at room temperature, away from moisture and heat.
Side Effects of Methergine
Common Side Effects
- Nausea or vomiting
- Headache
- Dizziness
- Increased blood pressure
- Abdominal pain or cramping (due to uterine contractions)
Uncommon/Severe Side Effects
- Severe hypertension (high blood pressure)
- Stroke or heart attack
- Chest pain or difficulty breathing
- Seizures
- Allergic reactions (rash, itching, swelling)
Risks and Warnings of Methergine
- Hypertension: Methergine can cause a significant rise in blood pressure, particularly in women with a history of high blood pressure or preeclampsia. Blood pressure should be monitored closely during treatment.
- Cardiovascular Risks: There is a risk of stroke, heart attack, or vasospasm in patients with pre-existing heart conditions, especially when the drug is administered intravenously.
- Uterine Hyperstimulation: Prolonged or excessive use of Methergine can lead to uterine hyperstimulation, which may cause pain and other complications. Use only under medical supervision.
- Concomitant Use with Other Drugs: Be cautious when using Methergine with other vasoconstrictors or drugs that raise blood pressure, as the combined effect may cause dangerous increases in blood pressure.
Interactions with Methergine
Common Drug Interactions
- Vasoconstrictors (e.g., epinephrine): Using these medications with Methergine can increase the risk of hypertension and cardiovascular complications.
- CYP3A4 inhibitors (e.g., erythromycin, ketoconazole): These medications may increase methylergonovine levels in the blood, leading to an increased risk of serious side effects, such as high blood pressure or vasospasm.
- Grapefruit juice: Avoid grapefruit juice, as it can affect how Methergine is processed in the body, increasing the risk of side effects.
Alternatives to Methergine
- Oxytocin: A synthetic hormone used to induce labor and control postpartum bleeding by stimulating uterine contractions.
- Misoprostol: A prostaglandin used for postpartum hemorrhage, particularly in cases where oxytocin is not available or effective.
- Carboprost: Another medication used to control postpartum hemorrhage by stimulating uterine contractions.
