Methylergonovine maleate Methergine, Mergotrex Classification: Oxytocic Ordered Dose: 1 amp given IM at left deltoid area Suggested Dose:

Adults IM: 0.2 mg after delivery of the placenta, after the delivery of the anterior shoulder, or during puerperium. May be repeated q2-4 hr. IV: Same dosage as IM; infuse slowly over at least 60 seconds. Monitor BP very carefully as severe hypertensive reaction can occur. Oral 0.2 mg PO tid or qid daily in the puerperium for up to 1 week. Suggested Dose: Adults IM: 0.2 mg after delivery of the placenta, after the delivery of the anterior shoulder, or during puerperium. May be repeated q2-4 hr. IV: Same dosage as IM; infuse slowly over at least 60 seconds. Monitor BP very carefully as severe hypertensive reaction can occur. Oral 0.2 mg PO tid or qid daily in the puerperium for up to 1 week. Mode of Action: A partial agonist or antagonist at alpha receptors; as a result, it increases the strength, duration, and frequency of uterine contractions. Indication: Routine management after delivery of the placenta. Treatment of postpartum atony and hemorrhage; subinvolution of the uterus. Uterine stimulation during the second stage of labor following the delivery of the anterior shoulder, under strict medical supervision. Contraindication: Contraindicated with allergy to methylergonovine, hypertension, toxemia, lactation, pregnancy. Use cautiously with sepsis; oblirterative vascular disease, hepatic or renal impairment. Drug Interaction: Drug-drug: Risk of severe hypertension, vasoconstriction, MI if combined with vasoconstrictors, ergot alkaloids, use extreme caution. Avoid use with potent CYP3A4 inhibitors. Side Effects: CNS: dizziness, headache, tinnitus, diaphoresis.

 CV: Transient hypertension, palpitations, chest pain, dyspnea GI: Nausea, vomiting

Nursing Responsibilities: Administer by IM injection or orally unless emergency requires IV use. Complications are more frequent with IV use. Monitor postpartum women for BP changes and amount and character of vaginal bleeding. Discontinue if signs of toxicity occur. Avoid prolonged use of the drug. Monitor prolactin levels and assess for decreased breast milk production. Assess for ergotism (overdose): nausea, vomiting, weakness, muscular pain, insensitivity to cold and paresthesia to determine dose adjustments or drug withdrawal.