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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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Methylergonovine (Methylergometrine) - Uses, Dose, Side effects, MOA

Methylergonovine is a semi-synthetic ergot alkaloid. It is used primarily to treat and prevent bleeding after childbirth (postpartum hemorrhage) due to its ability to stimulate the smooth muscles of the uterus, leading to increased tone and contractions. This helps to reduce bleeding after the placenta has been delivered.

Methylergonovine (Methylergometrine) is available as oral, IM, and IV formulation. It causes the contraction of uterine smooth muscles and is used during the third stage of labor to control uterine bleeding.

Methylergonovine Uses:

After the placenta has been delivered, it is utilized to treat uterine atony, hemorrhage, and subinvolution of the uterus.
After the anterior shoulder has been delivered during the second stage of labor, it may be utilized to reduce uterine haemorrhage.

Methylergonovine Dose in Adults

Methylergonovine (Methylergometrine) Dose in the Prevention of hemorrhage:

Taking by Mouth (Oral):

Take a 0.2 mg pill 3 to 4 times a day after giving birth.
Only take it for up to 7 days.

Injection (IM, IV):

Get a 0.2 mg shot after the baby's head and shoulders are out, after the placenta is delivered, or after birth.
If needed, you can get another shot every 2 to 4 hours.
A direct injection into a vein (IV) should only be used in really serious situations.

Use in Children:

Not indicated.

Pregnancy Risk Factor X

Methylergonovine is a medicine given after the baby's shoulders come out, after the placenta is delivered, or just after birth.
It shouldn't be used during pregnancy.
It's used when an extra medicine to help the uterus tighten is needed, but it's not the first choice because it can have side effects for the mother.

Methylergonovine use during breastfeeding:

Methylergonovine can be found in breast milk, and when we calculate how much of it gets into a baby's body through breastfeeding, it's about 3.9% of what the mother takes as a dose.
In general, it's considered safe for breastfeeding when this amount is less than 10%.
The amount of methylergonovine in breast milk was measured at 1.3 ng/mL after mothers took 0.125 mg three times a day for five days.
This resulted in an estimated daily dose for a baby through breast milk of 195 ng/kg/day.
However, some babies may experience side effects like fussiness, diarrhea, high or low blood pressure, seizures, fast or slow heartbeat, or vomiting.
Methylergonovine might also affect a mother's milk production.
Some manufacturers recommend not breastfeeding during treatment or for 12 hours after the last dose because of these possible side effects, but other sources say it might still be okay to breastfeed while taking it.

Dose in Kidney Disease:

The manufacturer doesn't give any special dose recommendations for people with kidney problems.
So, if someone has issues with their kidneys, they should be extra careful when using this medicine.

Dose in Liver disease:

The manufacturer doesn't provide specific dosing instructions for people with liver issues.

Side effects of Methylergonovine (Methylergometrine):

Cardiovascular:
- Cerebrovascular Accident
- Chest Pain
- Hypotension
- Local Thrombophlebitis
- Coronary Artery Vasospasm
- Paresthesia
- Tachycardia
- Hypertension
- Angina Pectoris
- Atrioventricular Block
- Bradycardia
- Ventricular Fibrillation
- Myocardial Infarction
- Palpitations
- Vasospasm
Central Nervous System:
- Headache
- Dizziness
- Hallucination
- Seizure
Endocrine & Metabolic:
- Water Intoxication
Dermatologic:
- Diaphoresis
- Skin Rash
Gastrointestinal:
- Abdominal Pain
- Diarrhea
- Nausea
- Unpleasant Taste
- Vomiting
Genitourinary:
- Hematuria
Neuromuscular & Skeletal:
- Leg Cramps
Otic:
- Tinnitus
Hypersensitivity:
- Anaphylaxis
Respiratory:
- Dyspnea
- Nasal Congestion

Contraindication to Methylergonovine Include:

People shouldn't take methylergonovine if:

They're allergic to it or any of its ingredients.
They have high blood pressure.
They have preeclampsia (a condition in pregnancy involving high blood pressure).
They are currently pregnant.

Warnings and precautions

Coronary artery disease

People with heart artery disease or those at risk for it might have a higher chance of heart problems like blocked or narrowed arteries after taking methylergonovine.
This is because methylergonovine can cause blood vessels to tighten.

Ergotism:

Taking medicines from the "ergot" family, like methylergonovine, can cause a condition called "ergotism." This means the blood vessels tighten too much, which can reduce blood flow and potentially harm body parts, even leading to tissue death.
This usually happens if someone takes too much of the medicine or uses it for a long time.
It's essential to follow the recommended dose and not use it for extended periods to avoid this.

Retroperitoneal and pleural fibrosis

There have been a few cases where people who took medicines similar to methylergonovine for a long time every day developed tissue scarring in the lining of the lungs and the area behind the stomach and intestines.
It's a rare but serious side effect.

Hepatic impairment

If someone has liver problems, they should be extra careful when using this medicine.

Labor

Be careful using this medicine during the second part of giving birth.

Renal impairment

If someone has kidney problems, they should be extra careful when using this medicine.

Sepsis:

If someone has a severe infection (sepsis), they should be careful when using this medicine and should talk to a doctor before taking it.

Vascular disease

If someone has a disease that's blocking or narrowing their blood vessels, they should be careful when using this medicine.

Methylergonovine (Methylergometrine): Drug Interaction

Risk Factor C (Monitor therapy)
Aprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Chloroprocaine	May enhance the hypertensive effect of Ergot Derivatives.
Clofazimine	May increase CYP3A4 substrates' serum concentration (High risk with Inhibitors).
CYP3A4 Inhibitors (Moderate)	May slow down CYP3A4 substrate metabolism (High risk with Inhibitors).
Duvelisib	May increase CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Erdafitinib	May raise the serum level of CYP3A4 substrates (High risk with Inhibitors).
Fosaprepitant	CYP3A4 Substrates' serum levels may rise (High risk with Inhibitors).
Fosnetupitant	May raise serum levels of CYP3A4 substrates (High risk with Inhibitors).
Larotrectinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Netupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Palbociclib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Reboxetine	May enhance the hypertensive effect of Ergot Derivatives.
Serotonergic Agents (High Risk)	Serotonergic agents' serotonergic effects may be enhanced by ergot derivatives (High Risk). Serotonin syndrome could occur from this. When these medications are used together, it is important to watch out for any signs and symptoms of serotonin syndrome or serotonin poisonings, such as hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, and changes in mental state. Nefazodone is an exception.
Simeprevir	May increase CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Risk Factor D (Consider therapy modification)
Beta-Blockers	Ergot derivatives ability to constrict blood vessels could be improved.
CYP3A4 Inhibitors (Strong)	May slow down CYP3A4 substrate metabolism (High risk with Inhibitors). Risk
Macrolide Antibiotics	Ergot derivatives' serum levels can rise. Clarithromycin and cabergoline may interact; detailed information is available in the relevant monograph. Exceptions: Fidaxomicin, Spiramycin, and systemic azithromycin.
MiFEPRIStone	May increase CYP3A4 substrates' serum concentration (High risk with Inhibitors). Management: During and two weeks after mifepristone treatment, reduce dosages of CYP3A4 substrates and keep an eye out for elevated amounts of toxicity. Fentanyl, pimozide, quinidine, sirolimus, and tacrolimus should all be avoided. Cyclosporine should also be avoided.
Stiripentol	May increase CYP3A4 substrates' serum concentration (High risk with Inhibitors). Management: Due to the increased potential for side effects and toxicity, stiripentol should not be used with CYP3A4 substrates that are thought to have a narrow therapeutic index. The use of stiripentol with any CYP3A4 substrate necessitates cautious observation.
Risk Factor X (Avoid combination)
Alpha-/Beta-Agonists	Alpha-/BetaAgonists' hypertensive effects may be enhanced by ergot derivatives. Alpha-/Beta-Agonists' vasoconstrictive effects may be strengthened by ergot derivatives.
Alpha1-Agonists	Alpha1-Agonists' ability to cause hypertension may be increased by ergot derivatives. Alpha1-Agonists may have a greater vasoconstrictive impact when combined with ergot derivatives.
Antihepaciviral Combination Products	Ergot derivatives' serum levels can rise.
Cobicistat	Methylergonovine serum levels could rise.
Conivaptan	May increase CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Fusidic Acid (Systemic)	May raise the serum level of CYP3A4 substrates (High risk with Inhibitors).
Idelalisib	CYP3A4 Substrates' serum levels may rise (High risk with Inhibitors).
Itraconazole	May raise the level of methylergonovine in the blood.
Ketoconazole (Systemic)	The serum level of methylergonovine could rise.
Letermovir	Might raise the serum level of ergot derivatives.
Lorcaserin	Ergot derivatives' harmful or poisonous effects might be increased. More specifically, taking these medications concurrently may make you more likely to develop valvular heart disease. The serotonergic action of ergot derivatives may be enhanced by lorcaserin. Serotonin syndrome could occur from this.
Nefazodone	The serotonergic activity of nefazodone may be strengthened by ergot derivatives. Serotonin syndrome could occur from this. The serum levels of ergot derivatives may rise after using nefazodone.
Nitroglycerin	Nitroglycerin's ability to dilate blood vessels may be lessened by ergot derivatives. For patients receiving angina treatment, this is very concerning. The concentration of ergot derivatives in the serum may rise while using nitroglycerin.
Posaconazole	May raise the level of methylergonovine in the blood.
Protease Inhibitors	Might make ergot derivatives more concentrated in the blood.
Roxithromycin	May raise the serum level of ergot derivatives.
Serotonin 5-HT1D Receptor Agonists (Triptans)	The vasoconstrictive effects of serotonin 5-HT1D receptor antagonists may be enhanced by ergot derivatives (Triptans). Ergot derivatives' ability to constrict blood vessels may be enhanced by serotonin 5-HT1D receptor antagonists (triptans).
Voriconazole	May raise the level of methylergonovine in the blood.

Monitoring parameters:

Blood Presssure
ECG

How to administer Methylergonovine (Methylergometrine)?

IV (into the vein):

Give it slowly, over at least 1 minute.
Watch the blood pressure closely when giving it.
Don't use this method often because it can cause very high blood pressure and possibly a stroke.
Use this way only in very serious situations.

IM (into the muscle):

It's okay to give it as a shot into the muscle.

By Mouth:

There are pills available to take by mouth.

Mechanism of action of Methylergonovine (Methylergometrine):

It makes the muscles of the womb work harder and more efficiently.
This helps to finish the last part of giving birth faster and reduces bleeding.

How fast it works:

When taken by mouth, it starts working in 5-10 minutes, by injection into a muscle in 2-5 minutes, and immediately when injected directly into a vein.

How long it lasts: