Methylergometrine (other names include
methylergonovine, methylergobasin, methergine, and
d-lysergic acid 1-butanolamide) is a synthetic analogue of
ergonovine, a psychedelic alkaloid found in ergot, and many
species of morning glory. It is a member of the ergoline family
and chemically similar to LSD, ergine, ergometrine, and
lysergic acid. Due to its oxytocic properties, it has a medical
use in obstetrics. According to Jonathan
methylergonovine has LSD-like actions above
milligrams[citation needed]. Clinical dosages are ten times lower.
Methylergometrine maleate is marketed under the trade
name Methergine.
[edit] Obstetric use
Methylergometrine is a blood vessel constrictor and smooth
muscle agonist most commonly used to prevent or control
excessive bleeding following childbirth and spontaneous or
elective abortion. It also causes uterine contractions to aid in
expulsion of retained products of conception after a missed
abortion (miscarriage in which all or part of the fetus remains
in the uterus) and to help deliver the placenta after childbirth.
It is available as tablets or injection (IM or IV) or in liquid
form to be taken orally.
Methylergonovine Maleate is an oral and parenteral
semisynthetic derivative of ergonovine, an ergot
alkaloid. Methylergonovine Maleate and ergonovine
are preferentially used over the other ergot alkaloids
in contemporary obstetric practice to prevent
postpartum uterine atony and hemorrhage because
they are most active of the ergot alkaloids on uterine
tissues. Additionally, methylergonovine Maleate and
ergonovine are less likely than other ergot alkaloids
to cause ergot-related toxicity with repeated oral
dosing and a limited duration of normal prescription
use. Methylergonovine Maleate is occasionally used
off-label following first trimester abortion curettage
to reduce blood loss. Historically, the therapeutic
actions of ergot-infested grain during pregnancy and
childbirth were documented as early as the Middle
Ages, well before the specific causative agent was
known.
Methylergonovine Maleate’s innovator is Novartis-
Global and appears world-wide under the brand
names: Methergin and Methylergometrine.
 
The pharmacologic properties of the ergot alkaloids are
complex; some of the pharmacologic actions are unrelated to
each other; some actions are even mutually antagonistic.
Methylergonovine Maleate is a selective and potent
antagonist of serotonin receptors in various smooth muscles,
a partial agonist of serotonin receptors in human umbilical
and placental blood vessels, and a partial agonist and
antagonist in some areas of the CNS. Although all ergot
alkaloids exhibit the ability to produce uterine contractions,
methylergonovine Maleate and its parent compound,
ergonovine, are the most active of the ergot alkaloids on
uterine smooth muscle. The normal response of the coronary
arteries in response to the ergot alkaloids is coronary
vasospasm and a resultant decrease in luminal diameter.
Methylergonovine Maleate is a weak antagonist of dopamine
in certain blood vessels, and a partial agonist and antagonist
of dopamine receptors in the CNS.
Ott,
2
Clinically, methylergonovine Maleate increases the strength,
duration, and frequency of uterine contractions and
decreases uterine bleeding. Methylergonovine Maleate is
considered a second-line agent for uterine atony, used when
massage and therapy with oxytocin has failed. While oxytocin
stimulates contractions of the upper uterine segment,
methylergonovine Maleate stimulates the upper and lower
segments for stronger uterine tone. Endpoints of therapeutic
effect include the onset of uterine contractions and the
cessation of hemorrhaging following obstetric delivery.
What is the most important information I should
know about ferrous fumarate?
Before using this medication, tell your doctor if you are
allergic to any drugs, or if you have iron overload syndrome,
hemolytic anemia (a lack of red blood cells), porphyria (a
genetic enzyme disorder that causes symptoms affecting the
skin or nervous system), thalassemia (a genetic disorder of
red blood cells), kidney or liver disease, if you are an
alcoholic, or if you receive regular blood transfusions.
Seek emergency medical attention if you think you have used
too much of this medicine, or if anyone has accidentally
swallowed it. An overdose of iron can be fatal, especially in a
young child.
Overdose symptoms may include drowsiness, severe nausea
or stomach pain, vomiting, bloody diarrhea, coughing up
blood or vomit that looks like coffee grounds, shallow
breathing, weak and rapid pulse, cold or clammy skin, blue
lips, and seizure (convulsions).
Take ferrous fumarate on an empty stomach, at least 1 hour
before or 2 hours after a meal. Avoid taking antacids or
antibiotics within 2 hours before or after taking ferrous
fumarate .
Ferrous fumarate is only part of a complete program of
treatment that may also include a special diet. It is very
important to follow the diet plan created for you by your
doctor or nutrition counselor. You should become very
familiar with the list of foods you should eat to make sure you
get enough iron from both your diet and your medication.
Ferrous fumarate side effects
Get emergency medical help if you have any of these signs of
an allergic reaction: hives; difficulty breathing; swelling of
your face, lips, tongue, or throat. Call your doctor if you have
serious side effects such as:
 bright red blood in your stools; or
 pain in your chest or throat when swallowing a
ferrous fumarate tablet.
Less serious side effects may include:

 constipation, diarrhea;
 nausea, vomiting, heartburn;
 stomach pain, upset stomach;
 black or dark-colored stools or urine; or
 temporary staining of the teeth.

Perineal care during daily bath or shower and after every

voiding or BM.

Wash hands. Remove perineal pad from front to back. Clean

washcloth with soap and water are to be used. Wash from
front to back. Rinse the area allowing water to flow from front
to back. Pat dry.