G Ergometrine

Indications

Ergometrine Maleate (also called ergonovine) is used in childbirth to make the womb (uterus) contract firmly. It is used to help deliver the placenta and to prevent and treat heavy bleeding after delivery (postpartum haemorrhage), and to control bleeding after miscarriage or abortion when the womb is not contracting well.

How It Works

Ergometrine is an ergot alkaloid. It acts on receptors in the muscle of the womb, causing strong, lasting contractions. After birth, these contractions squeeze the blood vessels where the placenta was attached and so reduce bleeding. It also narrows blood vessels elsewhere in the body, which is why it can raise blood pressure.

Dosage and Administration

Ergometrine is given by a doctor, nurse or midwife, usually as an injection into a muscle or, in an emergency, slowly into a vein, at the time of delivery or soon after. It is sometimes combined with Oxytocin. The dose is given as prescribed and according to obstetric guidelines. Tablets, where available, are used only on medical advice for a short time after delivery.

Interactions

• Strong CYP3A4 inhibitors such as Clarithromycin, Erythromycin, Ritonavir and other HIV protease inhibitors, and azole antifungals (Ketoconazole, Itraconazole) can cause dangerous narrowing of blood vessels (ergotism); avoid together.
• Triptans (such as Sumatriptan) and other ergot medicines add to blood vessel narrowing.
• Other vasoconstrictors, some anaesthetics and adrenaline-like drugs can raise blood pressure further.
• Beta blockers and nicotine may increase vessel narrowing.

Contraindications

• Use during labour before the baby is delivered (first and second stage), and induction of labour.
• High blood pressure, pre-eclampsia or eclampsia.
• Severe heart disease, coronary artery disease or peripheral vascular disease.
• Severe liver or kidney disease, sepsis.
• Allergy to ergot alkaloids.

Side Effects

Common: nausea, vomiting, headache, dizziness, abdominal cramps and a rise in blood pressure. Less common: chest pain, palpitations, slow heartbeat, breathlessness, ringing in the ears, leg cramps and cold or numb fingers and toes.

Get urgent medical help (tell staff at once) for severe headache, chest pain, sudden breathlessness, fits, vision problems, or very cold, pale or painful hands and feet.

Pregnancy and Lactation

It must not be used during pregnancy or labour before delivery of the baby, as it can harm the baby. After birth, single doses are compatible with breastfeeding, but repeated or prolonged use can reduce milk supply and may affect the baby, so it is kept short.

Precautions and Warnings

• Given only by trained health professionals with blood pressure monitoring.
• Use with care in mild heart, liver or kidney problems, anaemia, porphyria and multiple pregnancy (ensure all babies are delivered first).
• Not used for long-term treatment.

Overdose

Overdose can cause nausea, vomiting, high blood pressure, chest pain, severe vessel narrowing with cold limbs, confusion, seizures and breathing problems. It is treated in hospital.

Therapeutic Class

Uterotonic, ergot alkaloid.

Storage

Hospital medicine: store as directed on the pack, usually in a refrigerator at 2 to 8°C, protected from light, do not freeze. Keep out of the reach of children.