From the Guidelines
Ergot alkaloids are strictly contraindicated during pregnancy due to their potential to cause severe uterine contractions, placental abruption, and fetal distress. Medications such as ergotamine (found in Cafergot), methylergonovine (Methergine), and ergometrine should never be used by pregnant women at any stage of pregnancy, as stated in the study 1. These drugs act on serotonin, dopamine, and adrenergic receptors, causing powerful vasoconstriction and uterine muscle stimulation that can compromise blood flow to the placenta and potentially induce premature labor or miscarriage. Even a single dose can be harmful.
The US Food and Drug Administration classification, as mentioned in the study 1, categorizes drugs based on their safety during pregnancy, with Category X being the most dangerous. Ergot alkaloids would fall under this category due to their potential to cause fetal abnormalities.
Some key points to consider when managing pregnancy include:
- Ergot alkaloids are contraindicated in patients with hypertension, coronary artery disease, peripheral vascular disease, sepsis, renal or hepatic impairment, and in those taking potent CYP3A4 inhibitors like macrolide antibiotics or protease inhibitors.
- For migraine treatment during pregnancy, safer alternatives include acetaminophen, certain NSAIDs (in early pregnancy only), and non-pharmacological approaches.
- For postpartum hemorrhage management, oxytocin is the preferred first-line agent, with ergot derivatives reserved only for specific situations when benefits clearly outweigh risks and no safer alternatives exist, as supported by the study 1 and 1.
It is essential to prioritize the safety of both the mother and the fetus when managing pregnancy, and ergot alkaloids should be avoided due to their potential risks.
From the FDA Drug Label
Use of Methergine is contraindicated during pregnancy because of its uterotonic effects. Use of methylergonovine maleate is contraindicated during pregnancy because of its uterotonic effects.
The contraindications of ergot alkaloids in pregnancy are due to their uterotonic effects.
- Ergot alkaloids should not be used during pregnancy because they can cause the uterus to contract, which may lead to fetal harm or other complications.
- The specific contraindication is the use of ergot alkaloids, such as methylergonovine, during pregnancy due to their uterotonic effects 2 3.
From the Research
Contraindications of Ergot Alkaloids in Pregnancy
- Ergot alkaloids are contrcontraindicated in patients with hypertension, severe cardiovascular disease, and those with a history of ergot alkaloid-induced adverse effects 4, 5
- The use of ergot alkaloids is also discouraged in patients with essential menorrhagia due to the availability of alternative treatments with fewer adverse effects 4
- Bromocriptine, an ergot alkaloid, is contraindicated in patients with uncontrolled hypertension, severe cardiovascular disease, and those with a history of bromocriptine-induced adverse effects 4
- Ergot alkaloids should not be used prophylatically in obstetrics or gynaecology, but may be used therapeutically in the third stage of labour to reduce blood loss 4, 6, 7
- The oral route of administration of ergot alkaloids is not recommended due to the lack of evidence on its effectiveness and safety 6, 7
Adverse Effects of Ergot Alkaloids in Pregnancy
- Ergot alkaloids can cause adverse effects such as elevated blood pressure, pain after birth requiring analgesia, vomiting, and nausea 6, 7
- The use of ergot alkaloids can also increase the risk of retained placenta or manual removal of the placenta 6, 7
- Ergot alkaloids can cause severe cardiovascular incidents, uterine hyperstimulation with fetal asphyria, and uterine rupture 8