Can we give Methergine (methylergonovine) to a patient?

Methylergonovine (Methergine) Administration Guidelines

Methylergonovine should not be administered to patients with coronary artery disease, risk factors for coronary artery disease, or during pregnancy due to the risk of severe cardiovascular complications including vasospasm, myocardial ischemia, and infarction. 1

Contraindications

• Methylergonovine is contraindicated in patients with coronary artery disease or risk factors for coronary artery disease (smoking, obesity, diabetes, high cholesterol) due to increased susceptibility to myocardial ischemia and infarction 1
• Should not be administered intravenously routinely due to risk of sudden hypertensive and cerebrovascular accidents 1
• Contraindicated with concomitant use of medications that could create serious/life-threatening adverse events through inhibition of metabolism, including:
  • Astemizole, terfenadine, dihydroergotamine, ergotamine, ergonovine 2
  • Cisapride, midazolam, triazolam, ergot derivatives, St. John's Wort 2
  • Flecainide, propafenone, pimozide, lovastatin, simvastatin 2

Special Populations

• Pregnancy: Methylergonovine should not be used during pregnancy due to the risk of teratogenicity and potential for causing intrauterine growth restriction, prematurity, and morphological/functional cardiac changes 2
• Breastfeeding mothers should not breastfeed during treatment with methylergonovine and should wait at least 12 hours after the last dose before resuming breastfeeding 1
• Use with caution in patients with impaired hepatic or renal function 1

Clinical Applications

• Methylergonovine is primarily used for prevention of postpartum hemorrhage after delivery of the placenta 2, 3
• When administered in combination with oxytocin during cesarean delivery, methylergonovine reduces the need for additional uterotonic agents and improves uterine tone 3
• Can provide greater hemodynamic stability compared to oxytocin alone during cesarean section under spinal anesthesia 4

Administration Guidelines

• If administration is essential as a lifesaving measure, methylergonovine should be given slowly over a period of no less than 60 seconds with careful blood pressure monitoring 1
• Intra-arterial or periarterial injection must be strictly avoided 1
• For postpartum care, slow IV infusion of oxytocin (<2 U/min) is preferred over methylergonovine to prevent maternal hemorrhage after placental delivery 2
• Methylergonovine should be stored separately from medications intended for neonatal administration to prevent accidental neonatal exposure 1

Adverse Effects and Monitoring

• Serious cardiovascular side effects can include:
  • Hypertension and cerebrovascular accidents 1
  • Sinus bradycardia (may occur up to 70 minutes after administration) 5
  • Chest pain and myocardial ischemia 1, 5
• While the absolute risk is low, large database studies suggest methylergonovine exposure may result in up to 5 additional cases of acute coronary syndrome per 100,000 exposed patients 6
• Close monitoring of vital signs is required even in young, healthy patients due to potential for delayed serious side effects 5

Storage and Safety Precautions

• Methylergonovine should be stored separately from medications intended for neonatal administration 1
• Resuscitation equipment should be readily available when administering methylergonovine due to potential cardiovascular complications 1
• Careful monitoring of blood pressure is essential, particularly when IV administration is necessary 1

Remember that while methylergonovine can be effective for preventing postpartum hemorrhage, its significant cardiovascular risks require careful patient selection and monitoring.