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

Risk Factor C (Monitor therapy).
Antiemetics (5HT3 Antagonists)	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
Antipsychotic Agents	Antipsychotic Agents may have a greater adverse/toxic effect if they are regulated with serotonin modulators. Serotonin modulators can increase dopamine blockade and, therefore, may increase the risk of developing neuroleptic malignant syndrome. Serotonin modulators may have a serotonergic effect that is enhanced by antipsychotic agents. This could lead to serotonin syndrome.
Aprepitant	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Chloroprocaine	May increase the hypertensive effects of Ergot Derivatives.
Clofazimine	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Moderate CYP3A4 inhibitors	Might decrease metabolism of CYP3A4 substrates (High Risk with Inhibitors).
Duvelisib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Erdafitinib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Fosaprepitant	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Fosnetupitant	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Larotrectinib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Metaxalone	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
Methylphenidate	Can increase the toxic/adverse effects of Serotonin Modulators. In particular, there may be an increase in the risk of serotonin syndrome and serotonin toxicities.
Metoclopramide	The adverse/toxic effects of Metoclopramide may be exacerbated by Serotonin Modulators. This could manifest as serotonin syndrome, neuroleptic malignant syndrome, or other symptoms.
Netupitant	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Opioid Agonists	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
Palbociclib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Reboxetine	May increase the hypertensive effects of Ergot Derivatives.
Serotonin Modulators	This may increase the toxic/adverse effects of other Serotonin Activators. Serotonin syndrome can develop. Exceptions: Nicergoline; Tedizolid.
Simeprevir	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Tedizolid	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
TraMADol	The adverse/toxic effects of TraMADol may be exacerbated by Serotonin Modulators. Seizures may increase. TraMADol could increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
Risk Factor D (Regard therapy modification)
Anti-Parkinson Agents (Monoamine Oxidase Inhibitor)	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome. Selegiline, rasagiline or safinamide can be combined with a serotonin modator to monitor for symptoms and signs of serotonin syndrome. It is not recommended to use transdermal selegiline in combination with serotonin modators.
Beta-Blockers	May increase the vasoconstricting effects of Ergot Derivatives.
Strong CYP3A4 inhibitors	Might decrease metabolism of CYP3A4 substrates (High Risk with Inhibitors).
Linezolid	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome. Management: Serotonin syndrome/serotonin toxicemia can occur if serotonin modulators are stopped 2 weeks before linezolid is administered. Stop using serotonin modators immediately if you need to initiate linezolid immediately.
Antibiotics with Macrolide	Could increase serum concentrations of Ergot Derivatives. Cabergoline, Clarithromycin and Fidaxomicin may interact. Refer to the specific monograph for more details. Azithromycin (Systemic); Fidaxomicin, Spiramycin are exceptions.
MiFEPRIStone	High risk of Inhibitors causing an increase in serum concentrations of CYP3A4 substrates. Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid dihydroergotamine and ergotamine.
Stiripentol	High risk of Inhibitors causing an increase in serum concentrations of CYP3A4 substrates. Management: Avoid stiripentol use with CYP3A4 Substrates that have a narrow therapeutic Index. This is to avoid adverse effects and toxicities. Monitoring of any CYP3A4 substrate that is used with stiripentol should be closely done.
Risk Factor X (Avoid Combination)
Alpha-/Beta Agonists	Alpha-/BetaAgonists' hypertensive effects may be enhanced by Ergot Derivatives. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists.
Alpha1-Agonists	Alpha1-Agonists' hypertensive effects may be enhanced by Ergot Derivatives. Alpha1-Agonists' vasoconstricting effects may be enhanced by using Ergot Derivatives.
Antihepaciviral Combination Products	May increase serum concentrations of Ergot Derivatives.
Conivaptan	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Dapoxetine	Can increase the toxic/adverse effects of Serotonin Activators.
Fusidic Acid (Systemic).	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Idelalisib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Itraconazole	May increase serum Ergonovine concentrations
Ketoconazole (Systemic)	May increase serum Ergonovine concentrations
Letermovir	May increase serum concentrations of Ergot Derivatives.
Lorcaserin	Could increase the toxic/adverse effects of Ergot Derivatives. Particularly, the combination of these drugs may increase your risk of developing valvular disease. Lorcaserin could increase the serotonergic effects of Ergot Derivatives. This could lead to serotonin syndrome.
Methylene Blue	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
Nitroglycerin	Ergot derivatives can decrease the vasodilatory effects of Nitroglycerin. This is especially important for patients with angina. The serum concentrations of Ergot Derivatives may be increased by Nitroglycerin.
Posaconazole	May increase serum Ergonovine concentrations
Protease inhibitors	May increase serum concentrations of Ergot Derivatives.
Reverse Transcriptase inhibitors (Non-Nucleoside).	Could increase serum Ergonovine concentration. This would occur most commonly with delavrdine. Other Non-Nucleoside Reverse Transcriptase Inhibitors might be more likely to lower the concentration of Ergonovine.
Roxithromycin	May increase serum concentrations of Ergot Derivatives.
Serotonin 5-HT1D Receptor Agonists	The vasoconstricting effects of Serotonin 5-HT1D Receptor Aggonists may be enhanced by Ergot Derivatives. The vasoconstricting effects of Ergot Derivatives could be enhanced by Serotonin 5-HT1D Receptor Aggonists.
Voriconazole	May increase serum Ergonovine concentrations

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:

Ergometrine Maleate Tablets 2 mg in Pakistan
Migranil	Polyfine Chempharma (Pvt) Ltd.

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

Risk Factor C (Monitor therapy).
Antiemetics (5HT3 Antagonists)	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
Antipsychotic Agents	Antipsychotic Agents may have a greater adverse/toxic effect if they are regulated with serotonin modulators. Serotonin modulators can increase dopamine blockade and, therefore, may increase the risk of developing neuroleptic malignant syndrome. Serotonin modulators may have a serotonergic effect that is enhanced by antipsychotic agents. This could lead to serotonin syndrome.
Aprepitant	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Chloroprocaine	May increase the hypertensive effects of Ergot Derivatives.
Clofazimine	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Moderate CYP3A4 inhibitors	Might decrease metabolism of CYP3A4 substrates (High Risk with Inhibitors).
Duvelisib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Erdafitinib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Fosaprepitant	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Fosnetupitant	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Larotrectinib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Metaxalone	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
Methylphenidate	Can increase the toxic/adverse effects of Serotonin Modulators. In particular, there may be an increase in the risk of serotonin syndrome and serotonin toxicities.
Metoclopramide	The adverse/toxic effects of Metoclopramide may be exacerbated by Serotonin Modulators. This could manifest as serotonin syndrome, neuroleptic malignant syndrome, or other symptoms.
Netupitant	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Opioid Agonists	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
Palbociclib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Reboxetine	May increase the hypertensive effects of Ergot Derivatives.
Serotonin Modulators	This may increase the toxic/adverse effects of other Serotonin Activators. Serotonin syndrome can develop. Exceptions: Nicergoline; Tedizolid.
Simeprevir	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Tedizolid	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
TraMADol	The adverse/toxic effects of TraMADol may be exacerbated by Serotonin Modulators. Seizures may increase. TraMADol could increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
Risk Factor D (Regard therapy modification)
Anti-Parkinson Agents (Monoamine Oxidase Inhibitor)	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome. Selegiline, rasagiline or safinamide can be combined with a serotonin modator to monitor for symptoms and signs of serotonin syndrome. It is not recommended to use transdermal selegiline in combination with serotonin modators.
Beta-Blockers	May increase the vasoconstricting effects of Ergot Derivatives.
Strong CYP3A4 inhibitors	Might decrease metabolism of CYP3A4 substrates (High Risk with Inhibitors).
Linezolid	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome. Management: Serotonin syndrome/serotonin toxicemia can occur if serotonin modulators are stopped 2 weeks before linezolid is administered. Stop using serotonin modators immediately if you need to initiate linezolid immediately.
Antibiotics with Macrolide	Could increase serum concentrations of Ergot Derivatives. Cabergoline, Clarithromycin and Fidaxomicin may interact. Refer to the specific monograph for more details. Azithromycin (Systemic); Fidaxomicin, Spiramycin are exceptions.
MiFEPRIStone	High risk of Inhibitors causing an increase in serum concentrations of CYP3A4 substrates. Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid dihydroergotamine and ergotamine.
Stiripentol	High risk of Inhibitors causing an increase in serum concentrations of CYP3A4 substrates. Management: Avoid stiripentol use with CYP3A4 Substrates that have a narrow therapeutic Index. This is to avoid adverse effects and toxicities. Monitoring of any CYP3A4 substrate that is used with stiripentol should be closely done.
Risk Factor X (Avoid Combination)
Alpha-/Beta Agonists	Alpha-/BetaAgonists' hypertensive effects may be enhanced by Ergot Derivatives. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists.
Alpha1-Agonists	Alpha1-Agonists' hypertensive effects may be enhanced by Ergot Derivatives. Alpha1-Agonists' vasoconstricting effects may be enhanced by using Ergot Derivatives.
Antihepaciviral Combination Products	May increase serum concentrations of Ergot Derivatives.
Conivaptan	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Dapoxetine	Can increase the toxic/adverse effects of Serotonin Activators.
Fusidic Acid (Systemic).	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Idelalisib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Itraconazole	May increase serum Ergonovine concentrations
Ketoconazole (Systemic)	May increase serum Ergonovine concentrations
Letermovir	May increase serum concentrations of Ergot Derivatives.
Lorcaserin	Could increase the toxic/adverse effects of Ergot Derivatives. Particularly, the combination of these drugs may increase your risk of developing valvular disease. Lorcaserin could increase the serotonergic effects of Ergot Derivatives. This could lead to serotonin syndrome.
Methylene Blue	This may increase the serotonergic effects of Serotonin Activators. This could lead to serotonin syndrome.
Nitroglycerin	Ergot derivatives can decrease the vasodilatory effects of Nitroglycerin. This is especially important for patients with angina. The serum concentrations of Ergot Derivatives may be increased by Nitroglycerin.
Posaconazole	May increase serum Ergonovine concentrations
Protease inhibitors	May increase serum concentrations of Ergot Derivatives.
Reverse Transcriptase inhibitors (Non-Nucleoside).	Could increase serum Ergonovine concentration. This would occur most commonly with delavrdine. Other Non-Nucleoside Reverse Transcriptase Inhibitors might be more likely to lower the concentration of Ergonovine.
Roxithromycin	May increase serum concentrations of Ergot Derivatives.
Serotonin 5-HT1D Receptor Agonists	The vasoconstricting effects of Serotonin 5-HT1D Receptor Aggonists may be enhanced by Ergot Derivatives. The vasoconstricting effects of Ergot Derivatives could be enhanced by Serotonin 5-HT1D Receptor Aggonists.
Voriconazole	May increase serum Ergonovine concentrations

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:

Ergometrine Maleate Tablets 2 mg in Pakistan
Migranil	Polyfine Chempharma (Pvt) Ltd.