Ergometrine/ Oxytocin

Registered South African indications:

• Postpartum haemorrhage
• Active management of third stage of labour

Contraindications

• Hypersensitivity to the active ingredient or any of the excipients contained within this combination product
• Pregnancy
• Severe hepatic impairment
• Severe renal impairment
• Labour
• Primary or secondary uterine inertia
• Severe hypertension
• Pre-eclampsia
• Eclampsia
• Severe cardiac disorders
• Occlusive vascular disease
• Sepsis

Cautions

• Breastfeeding
• Mild to moderate renal impairment
• Mild to moderate hepatic impairment
• Abnormal presentation
• Raynaud's phenomenon
• Mild or moderate hypertension
• Cardiac disorder
• Coronary artery disease
• Risk factors for torsades de pointes
• May impair ability to drive and operate machinery

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

Active management of third stage of labour

Ergometrine/Oxytocin
0.5mg/5IU (per ml)

• IM: 1ml

To be given following crowning of the head, after delivery of the shoulder,
or at the latest, immediately after delivery of the child

Expulsion of the placenta, which is normally separated by the first strong uterine contraction, should be assisted by gentle suprapubic pressure and controlled cord traction 

Prevention and treatment of post partum haemorrhage with uterine atony

Ergometrine/Oxytocin
0.5mg/5IU (per ml)

• IM/IV: 1ml

Can be given IV slowly if bleeding is heavy

No information available

Pregnancy

• Contraindicated
• Ergometrine has potent uterotonic activity. Therefore ergometrine/oxytocin is contraindicated during pregnancy and during induction of labour; first stage labour and second stage labour prior to the delivery of the anterior shoulder
• In breech presentation and other abnormal presentations, ergometrine/oxytocin 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

• Ergometrine: Porphyrinogenic (P) - based on analogue Methylergometrine
• Oxytocin: Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Headache
• Dizziness

Cardiovascular Disorders

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

Gastrointestinal Disorders

• Nausea and vomiting
• Abdominal pain

Skin and Subcutaneous Tissue Disorders

• Rash
• Angioedema

Immune, Blood and Lymphatic System Disorders

• Anaphylactic reactions
• Anaphylactoid reactions 
• Shock

• CYP3A4 inhibitors
• CYP3A4 inducers
• Vasoconstrictors
• Ergot alkaloids
• Prostaglandins and their analogues
• Sympathomimetics
• Inhalation anaesthetics 
• QT prolonging agents
• Triptans 
• Beta-blockers
• Glyceryl trinitrate 
• Other antianginal agents

None routine

Ergometrine
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

Oxytocin
Oxytocin is a synthetic peptide, which is released by the posterior pituitary and released into the systemic circulation in response to suckling and labour. Oxytocin stimulates the smooth muscle of the uterus, more powerfully towards the end of pregnancy, during labour, and immediately postpartum. Oxytocin elicits rhythmic contractions in the upper segment of the uterus, similar in frequency, force and duration to those observed during labour 

COMBINATION PREPARATIONS

Ergometrine/ Oxytocin

Injection (per ml) 0.5mg/5iu

• Syntometrine (Adcock)