ergometrine maleate: clinical use

Prescribing considerations

• Use only with medical and expert obstetric supervision.
• Assess blood pressure, cardiovascular and peripheral vascular history, hepatic and renal function, infection and interacting medicines.
• Use caution in mild or moderate hypertension and mild or moderate cardiac, hepatic or renal disease.
• Patients with coronary artery disease may be particularly susceptible to vasospastic myocardial ischaemia.
• If bleeding persists, assess for retained placental tissue, genital-tract trauma or a coagulation disorder before further uterotonic treatment.
• Avoid accidental neonatal administration.

Contraindications and cautions

• Hypersensitivity to ergometrine maleate or an excipient.
• Pregnancy, induction and labour before delivery of the anterior shoulder.
• Primary or secondary uterine inertia.
• Severe hypertension, pre-eclampsia or eclampsia.
• Severe cardiac disease or severe hepatic or renal impairment.
• Occlusive vascular disease, including Raynaud’s disease or phenomenon.
• Sepsis.

Monitoring

• Monitor blood pressure, pulse, uterine response and ongoing blood loss.
• Watch for chest pain, arrhythmia, peripheral ischaemia, severe headache, dyspnoea, pulmonary oedema and hypersensitivity.
• Evaluate alternative causes promptly if postpartum bleeding is not controlled.

Clinical pharmacology

An ergot alkaloid with agonist or partial agonist activity at myometrial 5-HT2 and alpha-adrenergic receptors. It produces sustained tonic uterine contraction, is mainly metabolised hepatically and is a CYP3A4 substrate.

Formulation and product differences

• The selected product is a sterile injection in clear glass ampoules for intramuscular or intravenous administration.
• Intravenous administration must be slow and is limited to severe haemorrhage due to uterine atony.
• Avoid mixing with other medicines in the same syringe; dilution with sodium chloride injection is permitted where intravenous administration requires it.
• Store refrigerated and protected from light; controlled storage outside refrigeration is permitted under product-specific conditions.

Injection

Route: Parenteral

Strengths: 0.05% w/v