Methylergonovine Maleate is used after delivery of the placenta for the routine management of uterine atony, postpartum hemorrhage, and subinvolution of the uterus. It is also used to control uterine bleeding during the second stage of labor, particularly after delivery of the anterior shoulder.

Methylergonovine Maleate acts directly on uterine smooth muscle, increasing the tone, frequency, and strength of contractions. It produces a rapid and sustained tetanic uterotonic effect, which shortens the third stage of labor and reduces postpartum blood loss. The onset of action is immediate after IV administration, 2–5 minutes after IM injection, and 5–10 minutes after oral administration.

Intramuscularly: 1 ml/0.2 mg, after delivery of the anterior shoulder, after delivery of the placenta, or during the puerperium. May be repeated as required, at intervals of 2-4 hours.

Intravenously: 1 ml/0.2 mg, administered slowly over a period of no less than 60 seconds

Orally: One tablet, 0.2 mg, 3 or 4 times daily in the puerperium for a maximum of 1 week.

There have been rare reports of serious adverse effects when certain ergot alkaloids (e.g., dihydroergotamine, ergotamine) are used together with potent CYP3A4 inhibitors, leading to vasospasm and possible cerebral or peripheral ischemia. Although such interactions have not been specifically reported with Methylergonovine Maleate alone, coadministration with strong CYP3A4 inhibitors should be avoided. Strong inhibitors include macrolide antibiotics (erythromycin, clarithromycin, troleandomycin), HIV protease/reverse transcriptase inhibitors (ritonavir, indinavir, nelfinavir, delavirdine), and azole antifungals (ketoconazole, itraconazole, voriconazole). Moderate or weak inhibitors such as saquinavir, nefazodone, fluconazole, grapefruit juice, fluoxetine, fluvoxamine, zileuton, and clotrimazole should be used with caution. These lists are not complete, and possible CYP3A4 interactions with other drugs should always be considered.

Hypertension, toxemia of pregnancy, pregnancy, and hypersensitivity to the drug are contraindications.

The most common adverse effect is hypertension, which may be associated with seizures and headache. Hypotension may also occur. Other effects include abdominal pain (due to uterine contraction), nausea, and vomiting. Rare but serious reactions include myocardial infarction, chest pain, vasospasm, coronary artery spasm, bradycardia or tachycardia, dyspnea, hematuria, thrombophlebitis, water intoxication, hallucinations, leg cramps, dizziness, tinnitus, nasal congestion, diarrhea, sweating, palpitations, rash, and unpleasant taste. Very rarely, anaphylaxis has been reported.

Pregnancy Category C. It is contraindicated in pregnancy due to uterotonic effects.

Breastfeeding should be avoided during treatment, and breast milk should be discarded. The drug may affect the infant and reduce milk production. Breastfeeding may be resumed at least 12 hours after the last dose.

Use with caution in sepsis, obliterative vascular disease, and during the second stage of labor. Proper technique and adequate time should be allowed before manual removal of retained placenta, as it is rarely required.

Pediatric Use: Safety and efficacy have not been established in children.

Symptoms may include nausea, vomiting, abdominal pain, numbness or tingling in limbs, increased blood pressure followed by hypotension, respiratory depression, hypothermia, seizures, and coma.

Drugs acting on the uterus (uterotonic agents)

Store below 25°C in a tight, light-resistant container.