ergometrine

uterotonic· Brands: ErgotrateIMIVPO

Mechanism of action

Ergometrine acts as a partial agonist at serotonergic (5-HT2) and alpha-adrenergic receptors, and directly stimulates uterine smooth muscle, producing sustained rhythmic contractions. It also has vasoconstrictor effects, which can cause hypertension.

Pharmacokinetics

Ergometrine is rapidly and completely absorbed after oral administration and is also given IV or IM. Onset of action is immediate after IV injection, within minutes after IM, and about 20 minutes after oral. It is metabolized in the liver and excreted mainly in bile and urine. Its plasma half-life is approximately 2 hours.

Indications & dosing

Prevention of postpartum haemorrhage

Give after delivery of placenta. Avoid in hypertensive disorders.

adult · IM: 0.5 mg once · Give after delivery of placenta. Avoid in hypertensive disorders.

Treatment of postpartum haemorrhage (intravenous)

Administer by slow IV injection. Repeat if necessary, max 1 mg in 24 hours.

adult · IV: 0.5 mg every 2-4h PRN · Administer by slow IV injection. Repeat if necessary, max 1 mg in 24 hours.

Treatment of postpartum haemorrhage (intramuscular)

Repeat every 2-4 hours if necessary, max 1 mg in 24 hours.

adult · IM: 0.5 mg every 2-4h PRN · Repeat every 2-4 hours if necessary, max 1 mg in 24 hours.

Contraindications & precautions

Hypertension, including pre-eclampsia and eclampsia · Ergometrine can cause a marked rise in blood pressure.
Cardiovascular disease, including ischaemic heart disease and peripheral vascular disease · Risk of vasoconstriction and ischaemic events.
Pregnancy (except for postpartum use) · May cause uterine tetany and fetal distress.
Sepsis · Increased risk of vasoconstriction and reduced organ perfusion.
Hypersensitivity to ergot alkaloids · Risk of allergic reaction.
Hepatic or renal impairment · Reduced metabolism or excretion may necessitate dose adjustment.
Monitor blood pressure during and after administration.
Avoid rapid intravenous injection to reduce risk of severe hypertension.
Use with caution in patients with a history of migraine or Raynaud's phenomenon.
Have antihypertensive treatment available in case of severe hypertension.
Use with caution in patients with hepatic or renal impairment.
Do not use routinely in patients with sepsis or septic shock.

Adverse effects

Nausea
Vomiting
Abdominal pain (cramps)
Headache
Dizziness
Hypertensionserious
Seizuresserious
Myocardial infarctionserious
Peripheral ischaemiaserious
Strokeserious

Renal & hepatic adjustment

Hepatic impairment (mild): No adjustment required.
Hepatic impairment (moderate): Use with caution; consider reducing dose or using an alternative uterotonic.
Hepatic impairment (severe): Avoid in severe hepatic impairment; use an alternative uterotonic such as oxytocin. (avoid)

Monitoring, pregnancy & toxicity

Blood pressure · Before administration and every 5 minutes for 30 minutes after dose
Uterine tone · Assess after administration for sustained contraction
Heart rate · Monitor for bradycardia or tachycardia
Signs of ergotism · Monitor for numbness, tingling, or cold extremities
Pregnancy: Contraindicated during pregnancy, as it can cause uterine hypertonicity and fetal distress. It is used only after delivery to prevent or treat postpartum haemorrhage.
Toxicity: Ergotism: peripheral vasoconstriction causing cold, numb, or tingling extremities. · Discontinue ergometrine, provide supportive care, and consider vasodilators such as glyceryl trinitrate for severe vasospasm.
Toxicity: Cardiovascular effects: hypertension or hypotension, chest pain, bradycardia or tachycardia. · Monitor vital signs closely; treat severe hypertension with appropriate antihypertensives and manage hypotension with fluids and vasopressors if necessary.
Toxicity: CNS effects: confusion, hallucinations, or seizures. · Stop the drug, provide supportive care; manage seizures with benzodiazepines.

Clinical notes

Ergometrine is used to prevent and treat postpartum haemorrhage by increasing uterine tone and reducing bleeding. It is commonly given after delivery of the placenta. Adverse effects include nausea, vomiting, hypertension, and rarely chest pain and palpitations. It is contraindicated in hypertension, preeclampsia, and cardiovascular disease, and caution is needed in patients with liver or renal impairment. Prolonged use is avoided because of the risk of ergotism.

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BNF; local formulary