Ergonovine is a medication that belongs to the class of ergot alkaloids. It is primarily used in obstetrics and gynecology for various purposes, including the prevention and treatment of postpartum hemorrhage (excessive bleeding after childbirth), as well as for inducing uterine contractions during labor. Ergonovine works by causing smooth muscle contraction, particularly in the uterus, which can help control bleeding and facilitate labor.

Ergometrine (Ergonovine) causes smooth muscle contractions. It is indicated for the treatment and prevention of postpartum bleeding as it causes uterine muscle contractions. It is administered in the third stage of labor after the delivery of the placenta and excluding the possibility of twin pregnancy.

Ergometrine (Ergonovine) Uses:

Note: It is not approved for use in the US.

• Postpartum or postabortion hemorrhage:
  • For the prevention and treatment of postpartum and postabortion bleeding caused by uterine atony.
• Off Label Use of Ergonovine in Adults:
  • For diagnostic workup of Vasospastic angina.

Ergometrine (Ergonovine) Dose in Adults

Ergometrine (Ergonovine) Dose in the Treatment and prevention of postpartum or postabortion bleeding:

• When using ergonovine to treat or prevent heavy bleeding after giving birth or having an abortion, the typical dose is given either into the muscle (IM) or directly into the vein (IV), although IV should only be used in emergencies.
• The dose is 0.2 milligrams.
• If necessary, this dose can be repeated every 2 to 4 hours, but no more than five times in total.

Ergometrine (Ergonovine) Dose in the treatment of Intracoronary provocation testing for vasospastic angina (off-label):

• In the off-label use of ergonovine for intracoronary provocation testing to diagnose vasospastic angina, the typical dose is between 20 to 60 micrograms.
• This administration is done directly into the coronary artery.

Dose in Children:

Not indicated.

Ergometrine (Ergonovine) Pregnancy Risk Category: X

• Ergonovine is a medication used during the third stage of labor to prevent or treat heavy bleeding after childbirth, but it's important not to use it before the placenta is delivered.
• Before giving ergonovine, the placenta must be out and there should be no chance of a twin pregnancy.
• However, using it can make the uterus contract too much, which might lead to problems like uterine tetany, reduced blood flow to the uterus and placenta, or even the risk of the uterus tearing.
• It could also cause tears in the cervix and perineum, or in rare cases, amniotic fluid embolism, and harm to the baby.

Ergonovine use during breastfeeding:

• Ergonovine can lead to ergotism in breastfeeding infants, a serious condition.
• The manufacturer advises against breastfeeding if the mother has been given more than one dose of ergonovine after giving birth.

Dose in Kidney disease:

No dosage adjustments have been mentioned in the product labeling.

Dose in Liver disease:

No dosage adjustments have been mentioned in the product labeling.

Side effects of Ergometrine (Ergonovine):

• Cardiovascular:
  • Angina Pectoris (Transient)
  • Bradycardia
  • Hypertension
  • Myocardial Infarction
  • Palpitations
  • Shock
  • Thrombophlebitis
• Central Nervous System:
  • Dizziness
  • Hallucination
  • Headache
  • Vertigo
• Dermatologic:
  • Diaphoresis
• Endocrine & Metabolic:
  • Water Intoxication
• Gastrointestinal:
  • Abdominal Pain
  • Diarrhea
  • Nausea
  • Vomiting
• Genitourinary:
  • Hematuria
• Hypersensitivity:
  • Hypersensitivity Reaction
• Respiratory:
  • Dyspnea
• Miscellaneous:
  • Ergot Alkaloids Toxicity

Contraindication to Ergometrine (Ergonovine):

• Ergonovine should not be used in individuals who have a hypersensitivity to ergonovine, other medications containing ergot, or any of its components.
• It's also not recommended for inducing labor, managing threatened spontaneous abortion, or treating toxemia or hypertension.
• Breastfeeding is discouraged if more than one dose of ergonovine is given to the mother.
• Additionally, caution is advised for individuals taking HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors, as well as other potent CYP3A4 inhibitors like certain antifungal medications and macrolide antibiotics, as concomitant use with ergot derivatives is contraindicated.

Notification

• ergot derivatives are not recommended for patients taking concomitant potent CYP3A4 inhibiters such as azole antifungals or some macrolide antibiotics.

Warnings and precautions

Ergotism [Canadian Boxed Warn]

• Ergotism, as highlighted in a Canadian boxed warning, is a serious concern associated with prolonged therapy involving ergot derivatives like ergonovine.
• Prolonged use can lead to the development of gangrene and other symptoms indicative of ergotism.
• Ergotism is a potentially severe condition caused by the toxic effects of ergot alkaloids on the body's blood vessels.

Cardiovascular disease: [Canadian boxed warning]

• In individuals with cardiovascular disease, particularly those with known issues like coronary artery disease, caution is advised when using ergonovine or other medications containing ergot alkaloids.
• This caution is emphasized in a Canadian boxed warning due to the potential risk of coronary vasoconstriction, which could worsen existing cardiovascular conditions.
• Coronary vasoconstriction refers to the narrowing of the coronary arteries, which can reduce blood flow to the heart muscle and potentially lead to complications such as angina or heart attack.

Hypocalcemia:

• In cases where patients have low levels of calcium (hypocalcemia) and do not respond to ergonovine treatment, administering calcium intravenously (IV) can help restore the responsiveness of the uterus.
• This approach aims to improve the contraction of the uterus, which may be impaired due to calcium deficiency.

Ergonovine: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

Blood Pressure and Pulse:

• Ergonovine can affect blood pressure and pulse rate.
• It may cause changes in blood pressure, either increasing or decreasing it.
• Pulse rate may also be affected, potentially becoming faster or slower.

Uterine Response:

• Ergonovine is used to stimulate contractions in the uterus.
• It helps the uterus to contract and expel the placenta after childbirth.
• However, it's important to use ergonovine cautiously, especially in women with certain medical conditions like hypertension or coronary artery disease.

Cramping:

• Ergonovine can cause cramping in the uterus.
• Some women may experience strong or uncomfortable cramps after taking ergonovine.
• These cramps are usually temporary and may subside as the medication wears off.

How to administer Ergometrine (Ergonovine)?

IV or IM Administration:

• Ergonovine can be given either intravenously (IV) or intramuscularly (IM).
• IV administration is reserved for severe uterine bleeding or other life-threatening emergencies.
• IV doses should be administered slowly over at least one minute to minimize the risk of adverse effects.

Intracoronary Use (Off-Label):

• In off-label use for provocation testing during coronary angiography:
  • Ergonovine is mixed with normal saline.
  • Injected slowly over 2 to 5 minutes into the left coronary artery.
  • Coronary angiography is performed 1 to 2 minutes after injection completion.
• If the result is negative, a similar procedure is followed for the right coronary artery provocation.

Mechanism of action of Ergometrine (Ergonovine):

• Ergonovine has similar effects on smooth muscles as ergotamine, but it mainly targets the smooth muscles in the uterus, causing sustained contractions that shorten the third stage of labor.
• It also has a mild alpha-adrenergic blocking effect, which means it slightly blocks certain receptors in the body.
• Unlike ergotamine, ergonovine causes less constriction of blood vessels, meaning it doesn't narrow them as much.

Onset of Action:

• When administered intramuscularly (IM), ergonovine typically begins to take effect within 2 to 5 minutes.
• If given intravenously (IV), the onset of action is immediate, meaning it starts working right away.

Duration of Action:

• The uterine effect of ergonovine when administered IM lasts for at least 3 hours.
• However, when given IV, its effects last for approximately 45 minutes.

International Brand Names of Ergonovine:

• Ergometrina maleato
• Ergometrine
• Ergotab
• Ergoto
• Ergotrate
• Ergovin
• Erinmet
• Evina
• Malergo
• Mergon
• Metrergina
• Mitrotan
• Neometrin
• UL Ergometrine
• Uteronovin

Ergonovine Brand Names in Pakistan:

Ergonovine is a medication that belongs to the class of ergot alkaloids. It is primarily used in obstetrics and gynecology for various purposes, including the prevention and treatment of postpartum hemorrhage (excessive bleeding after childbirth), as well as for inducing uterine contractions during labor. Ergonovine works by causing smooth muscle contraction, particularly in the uterus, which can help control bleeding and facilitate labor.

Ergometrine (Ergonovine) causes smooth muscle contractions. It is indicated for the treatment and prevention of postpartum bleeding as it causes uterine muscle contractions. It is administered in the third stage of labor after the delivery of the placenta and excluding the possibility of twin pregnancy.

Ergometrine (Ergonovine) Uses:

Note: It is not approved for use in the US.

• Postpartum or postabortion hemorrhage:
  • For the prevention and treatment of postpartum and postabortion bleeding caused by uterine atony.
• Off Label Use of Ergonovine in Adults:
  • For diagnostic workup of Vasospastic angina.

Ergometrine (Ergonovine) Dose in Adults

Ergometrine (Ergonovine) Dose in the Treatment and prevention of postpartum or postabortion bleeding:

• When using ergonovine to treat or prevent heavy bleeding after giving birth or having an abortion, the typical dose is given either into the muscle (IM) or directly into the vein (IV), although IV should only be used in emergencies.
• The dose is 0.2 milligrams.
• If necessary, this dose can be repeated every 2 to 4 hours, but no more than five times in total.

Ergometrine (Ergonovine) Dose in the treatment of Intracoronary provocation testing for vasospastic angina (off-label):

• In the off-label use of ergonovine for intracoronary provocation testing to diagnose vasospastic angina, the typical dose is between 20 to 60 micrograms.
• This administration is done directly into the coronary artery.

Dose in Children:

Not indicated.

Ergometrine (Ergonovine) Pregnancy Risk Category: X

• Ergonovine is a medication used during the third stage of labor to prevent or treat heavy bleeding after childbirth, but it's important not to use it before the placenta is delivered.
• Before giving ergonovine, the placenta must be out and there should be no chance of a twin pregnancy.
• However, using it can make the uterus contract too much, which might lead to problems like uterine tetany, reduced blood flow to the uterus and placenta, or even the risk of the uterus tearing.
• It could also cause tears in the cervix and perineum, or in rare cases, amniotic fluid embolism, and harm to the baby.

Ergonovine use during breastfeeding:

• Ergonovine can lead to ergotism in breastfeeding infants, a serious condition.
• The manufacturer advises against breastfeeding if the mother has been given more than one dose of ergonovine after giving birth.

Dose in Kidney disease:

No dosage adjustments have been mentioned in the product labeling.

Dose in Liver disease:

No dosage adjustments have been mentioned in the product labeling.

Side effects of Ergometrine (Ergonovine):

• Cardiovascular:
  • Angina Pectoris (Transient)
  • Bradycardia
  • Hypertension
  • Myocardial Infarction
  • Palpitations
  • Shock
  • Thrombophlebitis
• Central Nervous System:
  • Dizziness
  • Hallucination
  • Headache
  • Vertigo
• Dermatologic:
  • Diaphoresis
• Endocrine & Metabolic:
  • Water Intoxication
• Gastrointestinal:
  • Abdominal Pain
  • Diarrhea
  • Nausea
  • Vomiting
• Genitourinary:
  • Hematuria
• Hypersensitivity:
  • Hypersensitivity Reaction
• Respiratory:
  • Dyspnea
• Miscellaneous:
  • Ergot Alkaloids Toxicity

Contraindication to Ergometrine (Ergonovine):

• Ergonovine should not be used in individuals who have a hypersensitivity to ergonovine, other medications containing ergot, or any of its components.
• It's also not recommended for inducing labor, managing threatened spontaneous abortion, or treating toxemia or hypertension.
• Breastfeeding is discouraged if more than one dose of ergonovine is given to the mother.
• Additionally, caution is advised for individuals taking HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors, as well as other potent CYP3A4 inhibitors like certain antifungal medications and macrolide antibiotics, as concomitant use with ergot derivatives is contraindicated.

Notification

• ergot derivatives are not recommended for patients taking concomitant potent CYP3A4 inhibiters such as azole antifungals or some macrolide antibiotics.

Warnings and precautions

Ergotism [Canadian Boxed Warn]

• Ergotism, as highlighted in a Canadian boxed warning, is a serious concern associated with prolonged therapy involving ergot derivatives like ergonovine.
• Prolonged use can lead to the development of gangrene and other symptoms indicative of ergotism.
• Ergotism is a potentially severe condition caused by the toxic effects of ergot alkaloids on the body's blood vessels.

Cardiovascular disease: [Canadian boxed warning]

• In individuals with cardiovascular disease, particularly those with known issues like coronary artery disease, caution is advised when using ergonovine or other medications containing ergot alkaloids.
• This caution is emphasized in a Canadian boxed warning due to the potential risk of coronary vasoconstriction, which could worsen existing cardiovascular conditions.
• Coronary vasoconstriction refers to the narrowing of the coronary arteries, which can reduce blood flow to the heart muscle and potentially lead to complications such as angina or heart attack.

Hypocalcemia:

• In cases where patients have low levels of calcium (hypocalcemia) and do not respond to ergonovine treatment, administering calcium intravenously (IV) can help restore the responsiveness of the uterus.
• This approach aims to improve the contraction of the uterus, which may be impaired due to calcium deficiency.

Ergonovine: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

Blood Pressure and Pulse:

• Ergonovine can affect blood pressure and pulse rate.
• It may cause changes in blood pressure, either increasing or decreasing it.
• Pulse rate may also be affected, potentially becoming faster or slower.

Uterine Response:

• Ergonovine is used to stimulate contractions in the uterus.
• It helps the uterus to contract and expel the placenta after childbirth.
• However, it's important to use ergonovine cautiously, especially in women with certain medical conditions like hypertension or coronary artery disease.

Cramping:

• Ergonovine can cause cramping in the uterus.
• Some women may experience strong or uncomfortable cramps after taking ergonovine.
• These cramps are usually temporary and may subside as the medication wears off.

How to administer Ergometrine (Ergonovine)?

IV or IM Administration:

• Ergonovine can be given either intravenously (IV) or intramuscularly (IM).
• IV administration is reserved for severe uterine bleeding or other life-threatening emergencies.
• IV doses should be administered slowly over at least one minute to minimize the risk of adverse effects.

Intracoronary Use (Off-Label):

• In off-label use for provocation testing during coronary angiography:
  • Ergonovine is mixed with normal saline.
  • Injected slowly over 2 to 5 minutes into the left coronary artery.
  • Coronary angiography is performed 1 to 2 minutes after injection completion.
• If the result is negative, a similar procedure is followed for the right coronary artery provocation.

Mechanism of action of Ergometrine (Ergonovine):

• Ergonovine has similar effects on smooth muscles as ergotamine, but it mainly targets the smooth muscles in the uterus, causing sustained contractions that shorten the third stage of labor.
• It also has a mild alpha-adrenergic blocking effect, which means it slightly blocks certain receptors in the body.
• Unlike ergotamine, ergonovine causes less constriction of blood vessels, meaning it doesn't narrow them as much.

Onset of Action:

• When administered intramuscularly (IM), ergonovine typically begins to take effect within 2 to 5 minutes.
• If given intravenously (IV), the onset of action is immediate, meaning it starts working right away.

Duration of Action:

• The uterine effect of ergonovine when administered IM lasts for at least 3 hours.
• However, when given IV, its effects last for approximately 45 minutes.

International Brand Names of Ergonovine:

• Ergometrina maleato
• Ergometrine
• Ergotab
• Ergoto
• Ergotrate
• Ergovin
• Erinmet
• Evina
• Malergo
• Mergon
• Metrergina
• Mitrotan
• Neometrin
• UL Ergometrine
• Uteronovin

Ergonovine Brand Names in Pakistan: