Methergine (Methylergonovine) Dosage and Administration for Postpartum Hemorrhage
Critical Safety Warning
Methylergonovine is contraindicated in patients with hypertension or cardiovascular disease due to a >10% risk of severe vasoconstriction and hypertension. 1 The drug can cause coronary vasospasm leading to myocardial ischemia, arrhythmias, heart block, or cardiac arrest, even when administered intramuscularly. 2
Standard Dosing Regimen
For postpartum hemorrhage management, methylergonovine is administered at 0.2 mg intramuscularly as a second-line uterotonic agent after oxytocin. 3
Administration Details:
- Route: Intramuscular injection (1 mL of 0.2 mg solution) 3
- Timing: Given after placental delivery when oxytocin alone is insufficient 4, 3
- Combination therapy: Should be used alongside slow intravenous oxytocin infusion (<2 U/min) 1
Clinical Efficacy Evidence
Methylergonovine demonstrates superior efficacy compared to carboprost as a second-line uterotonic, with reduced hemorrhage-related morbidity. 4
- When combined prophylactically with oxytocin during cesarean delivery, methylergonovine reduces the need for additional uterotonics from 55% to 20% (RR 0.4,95% CI 0.2-0.6) 3
- Significantly improves uterine tone (80% vs 41% satisfactory tone) 3
- Reduces mean quantitative blood loss by 348 mL compared to oxytocin alone 3
- Decreases blood transfusion requirements from 23% to 5% (RR 0.2,95% CI 0.1-0.6) 3
Absolute Contraindications
Do not administer methylergonovine in the following situations:
- Hypertension or pre-eclampsia (>10% risk of severe hypertensive crisis) 1
- Cardiovascular disease, including coronary artery disease, valvular heart disease, or structural heart disease 1
- Conditions requiring avoidance of increased pulmonary artery pressure 1
Alternative in Contraindicated Patients:
- Use prostaglandin F analogues instead, unless pulmonary artery pressure elevation is undesirable 1
- Consider tranexamic acid 1g IV over 10 minutes (must be within 3 hours of birth) 5
Monitoring Requirements
After methylergonovine administration, monitor for:
- Blood pressure elevation and signs of hypertensive emergency 1
- Chest pain or cardiac symptoms (coronary vasospasm) 2
- Uterine tone and ongoing bleeding 3
- Hemodynamic stability for at least 24 hours postpartum 1
Clinical Pitfalls to Avoid
- Never use intravenous methylergonovine routinely - the intramuscular route is standard and safer 3
- Screen all patients for hypertension and cardiovascular disease before administration - even mild hypertension is a contraindication 1
- Have sublingual nitroglycerin immediately available to treat potential coronary vasospasm 2
- Oral methylergonovine for delayed/secondary PPH has minimal evidence and constitutes <1% of prescriptions 6