Ergometrine

Registered South African indications:

• Uterine bleeding

Contraindications

• Hypersensitivtiy to the active ingredient or any of its excipients
• Pregnancy
• Severe renal impairment
• Severe hepatic impairment
• Labour
• Primary or secondary uterine inertia
• Severe hypertension
• Pre-eclampsia
• Eclampsia
• Severe cardiac disorders
• Occlusive vascular diseases
• Sepsis

Cautions

• Breastfeeding 
• Mild to moderate renal impairment
• Mild to moderate hepatic impairment
• Elderly
• Abnormal presentation
• Coronary artery disease

Forms avail. in SA and covered in this monograph: inj

Treatment of post-partum haemorrhage

• IM: 0.2mg, repeat in 2-4hrs if necessary

In an emergency situation, it may be administered via the IV route 

Not established for use in children

Pregnancy

• Contraindicated
• Ergometrine has potent uterotonic activity. Therefore, ergometrine injection is contraindicated during pregnancy, during induction of labour, and during first and second stage labour prior to the delivery of the anterior shoulder
• In breech presentation and other abnormal presentations, ergometrine injection should not be given before delivery of the child is completed, and in multiple births not before the last child has been delivered

Breastfeeding

• Caution; not recommended
• Ergometrine derivatives are excreted in breast milk but in unknown amounts. There is no specific data available for elimination of ergometrine partitioned in breast-milk. Ergometrine can inhibit prolactin secretion and in turn can suppress lactation, so its repeated use should be avoided

Renal Impairment

• Mild to moderate: Caution; no dose adjustment recommended
• Severe: Contraindicated

Hepatic Impairment

• Mild to moderate: Caution; no dose adjustment recommended
• Severe: Contraindicated

Elderly

• Not indicated for use in geriatric patients

Porphyria Information

• Not yet classified (NC)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Headache
• Dizziness

Cardiovascular Disorders

• Cardiac arrhythmias
• Palpitations 
• Bradycardia 
• Chest pain 
• Coronary arteriospasm
• Myocardial infarction
• Hypertension 
• Vasoconstriction

Respiratory Disorders

• Dyspnoea
• Pulmonary oedema

Gastrointestinal Disorders

• Nausea and vomiting 
• Abdominal pain

Skin and Subcutaneous Tissue Disorders

• Skin rashes

Immune, Blood and Lymphatic System Disorders

• Anaphylactoid reactions 

Sensory Disorders

• Tinnitus

• Vasoconstrictors
• Sympathomimetics
• Prostaglandins
• Prostaglandin analogues
• CYP3A4 inhibitors
• CYP3A4 inducers
• Ergot alkaloids
• Ergot derivatives
• Triptans
• Beta blockers
• Glyceryl trinitrate
• Inhalational anaesthetics

Vital signs

Ergometrine produces sustained tonic uterine contraction via agonist or partial agonist effects at myometrial 5-HT2 receptors and alpha adrenergic receptors. Both upper and lower uterine segments are stimulated to contract in a tetanic manner. Ergometrine has weak antagonist actions at dopaminergic receptors in certain blood vessels. It has a partial agonist action in blood vessels (less than ergotamine) and has little or no antagonist action at α adrenergic receptors.

Injection (per ml) 0.5mg

• Ergometrine Maleate-Fresenius (Fresenius) 

COMBINATION PREPARATIONS

Ergometrine/ Oxytocin

Injection (per ml) 0.5mg/5iu

• Syntometrine (Adcock)