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Drug overview for METHYLERGONOVINE MALEATE (methylergonovine maleate):
Generic name: METHYLERGONOVINE MALEATE
Drug class: Abortifacients
Therapeutic class: Endocrine
Ergonovine maleate and methylergonovine maleate, which are amine ergot alkaloids, directly stimulate contractions of uterine smooth muscle.
Ergonovine maleate and methylergonovine maleate are used for the prevention and treatment of postpartum hemorrhage caused by uterine atony. The drugs appear to be equally effective for these purposes; however, many clinicians prefer methylergonovine to ergonovine because the former drug may produce hypertension less frequently than does the latter drug. Methylergonovine is a first-line agent for the treatment of postpartum hemorrhage; methylergonovine usually is given after oxytocin.
Administration of parenteral ergot alkaloids during the third stage of labor decreases mean blood loss and the incidence of postpartum blood loss of 500 mL or more. Ergonovine and methylergonovine should not be used for the induction or augmentation of labor. Ergonovine maleate has been used as a provocative test+ for the diagnosis of variant angina. The drug has been used to precipitate coronary artery spasm in patients with suspected variant angina.
Generic name: METHYLERGONOVINE MALEATE
Drug class: Abortifacients
Therapeutic class: Endocrine
Ergonovine maleate and methylergonovine maleate, which are amine ergot alkaloids, directly stimulate contractions of uterine smooth muscle.
Ergonovine maleate and methylergonovine maleate are used for the prevention and treatment of postpartum hemorrhage caused by uterine atony. The drugs appear to be equally effective for these purposes; however, many clinicians prefer methylergonovine to ergonovine because the former drug may produce hypertension less frequently than does the latter drug. Methylergonovine is a first-line agent for the treatment of postpartum hemorrhage; methylergonovine usually is given after oxytocin.
Administration of parenteral ergot alkaloids during the third stage of labor decreases mean blood loss and the incidence of postpartum blood loss of 500 mL or more. Ergonovine and methylergonovine should not be used for the induction or augmentation of labor. Ergonovine maleate has been used as a provocative test+ for the diagnosis of variant angina. The drug has been used to precipitate coronary artery spasm in patients with suspected variant angina.
DRUG IMAGES
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The following indications for METHYLERGONOVINE MALEATE (methylergonovine maleate) have been approved by the FDA:
Indications:
Postpartum hemorrhage
Prevention of uterine inertia
Professional Synonyms:
Postpartum bleeding
Prevention of uterine atony
Indications:
Postpartum hemorrhage
Prevention of uterine inertia
Professional Synonyms:
Postpartum bleeding
Prevention of uterine atony
The following dosing information is available for METHYLERGONOVINE MALEATE (methylergonovine maleate):
For the prevention and treatment of postpartum hemorrhage, the IM dose of ergonovine maleate is 0.2 mg; the dose can be repeated as necessary. The manufacturer states that it is rarely necessary to administer IM doses more frequently than every 2-4 hours.
Following IM administration, the drug can be given orally to minimize late postpartum bleeding. The usual oral dosage of ergonovine maleate to minimize late postpartum bleeding is 0.2-0.4
mg every 6-12 hours until uterine atony has passed (usually 48 hours). Severe uterine cramping may be reduced by decreasing dosage. Ergonovine maleate tablets also may be administered sublingually.
For the prevention and treatment of postpartum hemorrhage, the IM dose of methylergonovine maleate is 0.2 mg; the dose can be repeated as necessary every 2-4 hours. For excessive uterine bleeding or other emergency situations, the same dose may be given IV, but blood pressure and uterine contractions should be carefully monitored.
To control uterine bleeding during the puerperium, methylergonovine maleate can be administered orally in a dosage of 0.2 mg 3 or 4 times daily for a maximum of 1 week postpartum.
When used as a provocative test+ in the diagnosis of variant angina, ergonovine maleate has been administered IV in a dose of 0.1-0.4 mg.
Following IM administration, the drug can be given orally to minimize late postpartum bleeding. The usual oral dosage of ergonovine maleate to minimize late postpartum bleeding is 0.2-0.4
mg every 6-12 hours until uterine atony has passed (usually 48 hours). Severe uterine cramping may be reduced by decreasing dosage. Ergonovine maleate tablets also may be administered sublingually.
For the prevention and treatment of postpartum hemorrhage, the IM dose of methylergonovine maleate is 0.2 mg; the dose can be repeated as necessary every 2-4 hours. For excessive uterine bleeding or other emergency situations, the same dose may be given IV, but blood pressure and uterine contractions should be carefully monitored.
To control uterine bleeding during the puerperium, methylergonovine maleate can be administered orally in a dosage of 0.2 mg 3 or 4 times daily for a maximum of 1 week postpartum.
When used as a provocative test+ in the diagnosis of variant angina, ergonovine maleate has been administered IV in a dose of 0.1-0.4 mg.
Ergonovine maleate or methylergonovine maleate may be administered orally or by IM or IV injection. IV use of methylergonovine should be limited to patients with severe uterine bleeding or other life-threatening emergency situations. IV doses of methylergonovine should be given over a period of not less than 1 minute.
Some clinicians recommend diluting the IV dose to a volume of 5 mL with 0.9% sodium chloride injection before administration.
Some clinicians recommend diluting the IV dose to a volume of 5 mL with 0.9% sodium chloride injection before administration.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| METHYLERGONOVINE 0.2 MG/ML AMP | Maintenance | Adults inject 1 milliliter (0.2 mg) by intramuscular route every 2-4 hours as needed, not to exceed a total of 5 doses |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| METHYLERGONOVINE 0.2 MG/ML AMP | Maintenance | Adults inject 1 milliliter (0.2 mg) by intramuscular route every 2-4 hours as needed, not to exceed a total of 5 doses |
The following drug interaction information is available for METHYLERGONOVINE MALEATE (methylergonovine maleate):
There are 8 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| 5-HT1D Agonists/Ergot Alkaloids SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The 5-HT1D agonists and ergot alkaloids can produce vasospastic reactions. CLINICAL EFFECTS: Concurrent therapy may produce additive vasospastic effects. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer states that sumatriptan should not be used within 24 hours of an ergotamine-containing or ergotamine-like medication (such as dihydroergotamine or methysergide).(1,2) The Australian(3) and UK(4,5) manufacturers state that 24 hours should elapse before sumatriptan is administered following an ergotamine-containing preparation and 6 hours should elapse before an ergotamine-containing preparation is administered following sumatriptan. The US manufacturer states that zolmitriptan should not be used within 24 hours of an ergotamine-containing or ergotamine-like medication.(6) The UK manufacturer states that zolmitriptan should not be used within 6 hours of an ergotamine-containing or ergotamine-like medication.(7) The The Australian manufacturer states that 24 hours should elapse before zolmitriptan is administered following an ergotamine-containing preparation and 6 hours should elapse before an ergotamine-containing medication is administered following zolmitriptan.(8) The US manufacturer states that the use of rizatriptan within 24 hours of an ergotamine-containing or ergot-type medication is contraindicated.(9) The US manufacturer states that the use of naratriptan within 24 hours of an ergotamine-containing or ergot-type medication is contraindicated.(10) The Australian manufacturer states that concurrent use of naratriptan and ergotamine or ergotamine derivatives is not recommended.(11) The US manufacturer states that the use of eletriptan within 24 hours of an ergotamine-containing or ergot-type medication is contraindicated.(12) The UK manufacturer states that the use of eletriptan within 24 hours of an ergotamine-containing or ergot-type medication is not recommended.(13) DISCUSSION: Because of the theoretical risk of additive vasospastic effects, the US manufacturer states that the use of sumatriptan within 24 hours of an ergotamine-containing or ergotamine-like medication is contraindicated.(1,2) The Australian(3) and UK(4,5) manufacturer states that 24 hours should elapse before sumatriptan is administered following an ergotamine-containing preparation and 6 hours should elapse before an ergotamine-containing medication is administered following sumatriptan. Although the pharmacokinetics of zolmitriptan were not affected by ergotamine, the UK manufacturer of zolmitriptan recommends that 6 hours should elapse between the administration of zolmitriptan and an ergotamine preparation.(7) The US manufacturer of zolmitriptan states under contraindications that zolmitriptan should not be used within 24 hours of an ergotamine-containing or ergot-type medication.(6) The Australian manufacturer states that 24 hours should elapse before zolmitriptan is administered following an ergotamine-containing preparation and 6 hours should elapse before an ergotamine-containing medication is administered following zolmitriptan.(8) Because of the additive risk of prolonged vasospastic reactions, the manufacturers of rizatriptan(9) and naratriptan(10) in the US state that the use of ergotamine-containing or ergot-type medications and these agents is contraindicated. The Australian manufacturer states that concurrent use of naratriptan and ergotamine or ergotamine derivatives is not recommended.(11) Administration of oral ergotamine one and two hours after eletriptan resulted in additive increases in blood pressure.(13) |
ALMOTRIPTAN MALATE, ELETRIPTAN HBR, FROVA, FROVATRIPTAN SUCCINATE, IMITREX, MAXALT, MAXALT MLT, MIGRANOW, NARATRIPTAN HCL, ONZETRA XSAIL, RELPAX, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN SUCC-NAPROXEN SOD, SUMATRIPTAN SUCCINATE, SYMBRAVO, TOSYMRA, TREXIMET, ZEMBRACE SYMTOUCH, ZOLMITRIPTAN, ZOLMITRIPTAN ODT, ZOMIG |
| Ergot Alkaloids/Selected Macrolide Antibiotics SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The macrolides may inhibit the hepatic metabolism of ergot alkaloids by inhibition of CYP3A4.(1) CLINICAL EFFECTS: Concurrent use may result in increased levels of ergot alkaloids, which may result in clinical signs of ergotism, including vasospasm, dysesthesia, renal ischemia, and peripheral ischemia. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of ergotamine(2) and dihydroergotamine (3) state that the concurrent use of these agents with clarithromycin, erythromycin, or troleandomycin is contraindicated. The US manufacturer of methylergonovine states that methylergonovine should not be administered with potent CYP3A4 inhibitors such as the macrolide antibiotics clarithromycin, erythromycin, and troleandomycin.(4) The US manufacturer of clarithromycin states that concurrent administration of ergotamine or dihydroergotamine is contraindicated.(5) It would be prudent to avoid the concurrent use of all ergot alkaloids and macrolide antibiotics that inhibit CYP3A4. Patients receiving concurrent therapy with macrolides and ergot alkaloids should be monitored for clinical signs of ergotism. One or both agents may need to be discontinued. Patients should be treated symptomatically for ergotism. DISCUSSION: Three case reports have documented clinical signs of ergotism following concomitant therapy with erythromycin and ergotamine. Symptoms included vasospasm, dysesthesia, renal ischemia, and peripheral ischemia. Symptoms occurred within one to seven days of concurrent therapy and with small doses of ergotamine.(6-8) Five case reports have documented peripheral vasospasm following the concurrent administration of ergotamine and troleandomycin. Ergotamine dosages ranged from single dose to long term therapy.(9-12) A similar interaction was reported for ergotamine and troleandomycin(13) and ergotamine and clarithromycin.(14) Other case reports document similar interactions between dihydroergotamine and erythromycin(15-19), troleandomycin(16-19), and ponsinomycin(20). One or more of the drug pairs linked to this monograph have been included in a list of interactions that should be considered "high-priority" for inclusion and should not be inactivated in EHR systems. This DDI subset was vetted by an expert panel commissioned by the U.S. Office of the National Coordinator (ONC) for Health Information Technology. |
CLARITHROMYCIN, CLARITHROMYCIN ER, E.E.S. 200, E.E.S. 400, ERY-TAB, ERYPED 200, ERYPED 400, ERYTHROCIN LACTOBIONATE, ERYTHROCIN STEARATE, ERYTHROMYCIN, ERYTHROMYCIN ESTOLATE, ERYTHROMYCIN ETHYLSUCCINATE, ERYTHROMYCIN LACTOBIONATE, LANSOPRAZOL-AMOXICIL-CLARITHRO, OMECLAMOX-PAK, VOQUEZNA TRIPLE PAK |
| Protease Inhibitors/Ergot Alkaloids SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The protease inhibitors may inhibit the metabolism of the ergot alkaloids by CYP3A4, including dihydroergotamine, ergotamine, ergonovine, and methylergonovine. (1-13) CLINICAL EFFECTS: The concurrent administration of a protease inhibitor with an ergot alkaloid may result in elevated levels, clinical effects, and adverse effects of the ergot alkaloids.(1-13) Signs of ergotism may include peripheral vasospasm and ischemia. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The concurrent administration of ergot alkaloids with amprenavir,(1) atazanavir,(2,3) darunavir,(4) fosamprenavir,(5) indinavir, (6) the combination of lopinavir and ritonavir,(7) nelfinavir,(8) nirmatrelvir coadministered with ritonavir,(25) ritonavir, (12) saquinavir,(9,10) and tipranavir coadministered with ritonavir(11) is contraindicated. The US manufacturer of methylergonovine states that methylergonovine should not be administered with potent CYP3A4 inhibitors such as protease inhibitors.(13) Protease inhibitors linked include: amprenavir, atazanavir, darunavir, fosamprenavir, indinavir, lopinavir, nelfinavir, nirmatrelvir, ritonavir, saquinavir, and tipranavir. DISCUSSION: There have been several case reports of ergotism developing in patients receiving concurrent ergotamine derivatives with indinavir,(14) nelfinavir,(15) or ritonavir.(16-23) One or more of the drug pairs linked to this monograph have been included in a list of interactions that should be considered "high-priority" for inclusion and should not be inactivated in EHR systems. This DDI subset was vetted by an expert panel commissioned by the U.S. Office of the National Coordinator (ONC) for Health Information Technology. |
APTIVUS, ATAZANAVIR SULFATE, DARUNAVIR, EVOTAZ, FOSAMPRENAVIR CALCIUM, KALETRA, LOPINAVIR-RITONAVIR, PAXLOVID, PREZCOBIX, PREZISTA, REYATAZ, SYMTUZA, VIRACEPT |
| Ergot Alkaloids/Posaconazole; Voriconazole SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Posaconazole(1,2) and voriconazole(3,4) may inhibit the metabolism of the ergot alkaloids by CYP3A4. CLINICAL EFFECTS: The concurrent use of posaconazole(1,2) or voriconazole (3,4) and ergot alkaloids may result in elevated levels of the ergot alkaloids and ergotism. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The UK(1) and US(2) manufacturers of posaconazole state that the concurrent use of ergot alkaloids is contraindicated. The manufacturer of voriconazole states that the concurrent use of voriconazole and ergot alkaloids is contraindicated.(3) The US manufacturer of methylergonovine states that methylergonovine should not be administered with potent CYP3A4 inhibitors such as voriconazole.(4) DISCUSSION: Posaconazole has been shown to inhibit the CYP3A4 mediated metabolism of midazolam by 83%.(1) Voriconazole (400 mg every 12 hours for one day, then 200 mg every 12 hours for 8 days) increased the maximum concentration (Cmax) and area-under-curve (AUC) of a single dose of sirolimus (2 mg) by 7-fold and 11-fold, respectively. Ergot alkaloids are metabolized by the same isoenzyme system.(3) One or more of the drug pairs linked to this monograph have been included in a list of interactions that should be considered "high-priority" for inclusion and should not be inactivated in EHR systems. This DDI subset was vetted by an expert panel commissioned by the U.S. Office of the National Coordinator (ONC) for Health Information Technology. |
NOXAFIL, POSACONAZOLE, VFEND, VFEND IV, VORICONAZOLE, VORICONAZOLE (HPBCD) |
| Ergot Alkaloids/Itraconazole; Ketoconazole SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Itraconazole(1,2) and ketoconazole(3-5) may inhibit the metabolism of ergot alkaloids by CYP3A4. CLINICAL EFFECTS: Concurrent use may result in increased levels of ergot alkaloids, which may result in clinical signs of ergotism, including vasospasm, dysesthesia, renal ischemia, and peripheral ischemia. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturers of itraconazole(1) and ketoconazole(5) state that concurrent administration with ergot alkaloids metabolized by CYP3A4 is contraindicated. The US manufacturer of itraconazole also states that concurrent administration of ergot alkaloids is contraindicated during and two weeks after itraconazole treatment.(1) The manufacturers of dihydroergotamine(3) and ergotamine(4) state that the concurrent use of these agents with strong inhibitors of CYP3A4 such as itraconazole, ketoconazole, or levoketoconazole is contraindicated. The US manufacturer of methylergonovine states that methylergonovine should not be administered with potent CYP3A4 inhibitors such as itraconazole, ketoconazole, or levoketoconazole.(2) DISCUSSION: Coadministration of dihydroergotamine(3) and ergotamine(4) with potent inhibitors of CYP3A4 such as clarithromycin, erythromycin, indinavir, nelfinavir, ritonavir, and troleandomycin has resulted in ergotism, characterized by vasospasm and ischemia of the extremities. One or more of the drug pairs linked to this monograph have been included in a list of interactions that should be considered "high-priority" for inclusion and should not be inactivated in EHR systems. This DDI subset was vetted by an expert panel commissioned by the U.S. Office of the National Coordinator (ONC) for Health Information Technology. |
ITRACONAZOLE, ITRACONAZOLE MICRONIZED, KETOCONAZOLE, SPORANOX, TOLSURA |
| Selected CYP3A4 Substrates/Mifepristone SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Mifepristone is an inhibitor of CYP3A4 and may increase levels and effects of drugs metabolized by this enzyme.(1) CLINICAL EFFECTS: Lovastatin, simvastatin and CYP3A4 substrates with a narrow therapeutic window such as alprazolam, cyclosporine, dihydroergotamine, ergotamine, pimozide, quinidine, sirolimus, and tacrolimus or CYP3A4 substrates with a high first pass effect such as oral midazolam, sildenafil, and triazolam are particularly susceptible to significant toxicity.(1,2) PREDISPOSING FACTORS: Due to the need for continuous therapy and mifepristone's long half-life of 85 hours(1) which leads to accumulation, patients with endogenous Cushing's syndrome may be at an increased risk for toxicity. With pimozide, the risk of anticholinergic toxicities including cognitive decline, delirium, falls and fractures is increased in geriatric patients using more than one medicine with anticholinergic properties.(3) PATIENT MANAGEMENT: The US manufacturer of mifepristone for hypercortisolism due to endogenous Cushing's syndrome states use with lovastatin, simvastatin, CYP3A4 substrates with a narrow therapeutic range, or CYP3A4 substrates with a high first pass effect is contraindicated.(1) DISCUSSION: Administration of mifepristone 1200 mg daily for 10 days followed by a single dose of simvastatin 80 mg led to an increase of simvastatin and simvastatin acid (active metabolite) area-under-curve (AUC) of 10.4-fold and 15.7-fold, respectively. |
KORLYM, MIFEPREX, MIFEPRISTONE |
| Ergot Alkaloids/Selected Strong CYP3A4 Inhibitors SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Strong inhibitors of CYP3A4 may inhibit the hepatic metabolism of ergot alkaloids.(1-4) CLINICAL EFFECTS: Concurrent use may result in increased levels of ergot alkaloids, which may result in clinical signs of ergotism, including vasospasm, dysesthesia, renal ischemia, and peripheral ischemia. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The concurrent use of dihydroergotamine,(1,2) ergotamine,(2,3) or methylergonovine(2,4) and strong inhibitors of CYP3A4 is contraindicated. It would be prudent to avoid the concurrent use of all ergot alkaloids and strong inhibitors of CYP3A4. Patients receiving concurrent therapy should be monitored for clinical signs of ergotism. One or both agents may need to be discontinued. Patients should be treated symptomatically for ergotism. DISCUSSION: Case reports have documented clinical signs of ergotism following concomitant therapy with various ergot alkaloids and strong inhibitors of CYP3A4 such as clarithromycin, erythromycin, indinavir, nelfinavir, ritonavir, and troleandomycin. Selected strong CYP3A4 inhibitors linked include: adagrasib, ceritinib, cobicistat, grapefruit, idelalisib, josamycin, levoketoconazole, lonafarnib, mibefradil, nefazodone, ribociclib, and tucatinib. |
GENVOYA, KISQALI, KRAZATI, NEFAZODONE HCL, PREZCOBIX, RECORLEV, STRIBILD, TUKYSA, TYBOST, ZOKINVY, ZYDELIG, ZYKADIA |
| Ergot Alkaloids/Letermovir SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Letermovir, a moderate inhibitor of CYP3A4, may inhibit the hepatic metabolism of ergot alkaloids.(1) CLINICAL EFFECTS: Concurrent use may result in increased levels of the ergot alkaloid, which may result in clinical signs of ergotism, including vasospasm, dysesthesia, renal ischemia, and peripheral ischemia. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The concurrent use of ergotamine derivatives and letermovir is contraindicated.(1) It would be prudent to avoid the concurrent use of all ergot alkaloids and letermovir. Patients receiving concurrent therapy should be monitored for clinical signs of ergotism. One or both agents may need to be discontinued. Patients should be treated symptomatically for ergotism. DISCUSSION: Letermovir is a moderate inhibitor of CYP3A4. In a study, concurrent administration of letermovir (240 mg once daily) increased the area-under-the curve (AUC), and C24hr of midazolam (1 mg single dose intravenous, a CYP3A4 substrate) by 1.47-fold and 2.74-fold.(1) |
PREVYMIS |
There are 4 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Ergot Alkaloids/Sympathomimetics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of ergot alkaloids and sympathomimetics may result in additive or synergistic effect on peripheral blood vessels. CLINICAL EFFECTS: Concurrent use of ergot alkaloids and sympathomimetics may result in increased blood pressure due to peripheral vasoconstriction. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: When possible, avoid the concurrent use of ergot alkaloids and sympathomimetics. If concurrent use is warranted, monitor blood pressure and for signs of vasoconstriction. Decreasing the dose of one or both drugs may be necessary. DISCUSSION: There have been reports of severe vasoconstriction resulting in gangrene in patients receiving intravenous ergonovine with dopamine or norepinephrine. |
ADDERALL, ADDERALL XR, ADRENALIN, ADVAIR DISKUS, ADVAIR HFA, ADZENYS XR-ODT, AIRDUO DIGIHALER, AIRSUPRA, AKOVAZ, ALBUTEROL SULFATE, ALBUTEROL SULFATE HFA, AMPHETAMINE ER ODT, AMPHETAMINE SULFATE, ANORO ELLIPTA, APTENSIO XR, ARFORMOTEROL TARTRATE, ARTICADENT DENTAL, ARTICAINE-EPINEPHRINE, ARTICAINE-EPINEPHRINE BIT, AZSTARYS, BENZPHETAMINE HCL, BEVESPI AEROSPHERE, BIORPHEN, BREO ELLIPTA, BREYNA, BREZTRI AEROSPHERE, BROMFED DM, BROMPHENIRAMINE-PSEUDOEPHED-DM, BROVANA, BUDESONIDE-FORMOTEROL FUMARATE, BUFFERED LIDOCAINE-EPINEPHRINE, BUPIVACAINE HCL-EPINEPHRINE, BUPIVACAINE-DEXAMETH-EPINEPHRN, CARBOCAINE WITH NEO-COBEFRIN, CITANEST FORTE DENTAL, CLARINEX-D 12 HOUR, COMBIVENT RESPIMAT, CONCERTA, COTEMPLA XR-ODT, DAYTRANA, DESOXYN, DEXEDRINE, DEXMETHYLPHENIDATE HCL, DEXMETHYLPHENIDATE HCL ER, DEXTROAMPHETAMINE SULFATE, DEXTROAMPHETAMINE SULFATE ER, DEXTROAMPHETAMINE-AMPHET ER, DEXTROAMPHETAMINE-AMPHETAMINE, DIETHYLPROPION HCL, DIETHYLPROPION HCL ER, DOBUTAMINE HCL, DOBUTAMINE HCL-D5W, DOPAMINE HCL, DOPAMINE HCL IN 5% DEXTROSE, DROXIDOPA, DUAKLIR PRESSAIR, DULERA, DYANAVEL XR, EMERPHED, EPHEDRINE HCL, EPHEDRINE SULFATE, EPHEDRINE SULFATE-0.9% NACL, EPHEDRINE SULFATE-NACL, EPINEPHRINE, EPINEPHRINE BITARTRATE, EPINEPHRINE HCL-0.9% NACL, EPINEPHRINE HCL-D5W, EPINEPHRINE-0.9% NACL, EPINEPHRINE-D5W, EVEKEO, FINTEPLA, FLUTICASONE-SALMETEROL, FLUTICASONE-SALMETEROL HFA, FLUTICASONE-VILANTEROL, FOCALIN, FOCALIN XR, FORMOTEROL FUMARATE, HYDROXYAMPHETAMINE HBR, IMMPHENTIV, IPRATROPIUM-ALBUTEROL, ISOMETHEPTENE MUCATE, ISOPROTERENOL HCL, ISUPREL, JORNAY PM, LEVALBUTEROL CONCENTRATE, LEVALBUTEROL HCL, LEVALBUTEROL TARTRATE HFA, LEVOPHED, LIDOCAINE HCL-EPINEPHRINE, LIDOCAINE HCL-EPINEPHRINE-NACL, LIDOCAINE-EPINEPHRINE, LIGNOSPAN STANDARD, LISDEXAMFETAMINE DIMESYLATE, LOMAIRA, MARCAINE-EPINEPHRINE, METADATE CD, METADATE ER, METHAMPHETAMINE HCL, METHYLIN, METHYLPHENIDATE, METHYLPHENIDATE ER, METHYLPHENIDATE ER (LA), METHYLPHENIDATE HCL, METHYLPHENIDATE HCL CD, METHYLPHENIDATE HCL ER (CD), MIDODRINE HCL, MIRABEGRON ER, MYDAYIS, MYRBETRIQ, NOREPINEPHRINE BITAR-0.9% NACL, NOREPINEPHRINE BITARTRAT-WATER, NOREPINEPHRINE BITARTRATE, NOREPINEPHRINE BITARTRATE-D5W, NORTHERA, ORABLOC, OXYMETAZOLINE HCL, PERFOROMIST, PHENDIMETRAZINE TARTRATE, PHENDIMETRAZINE TARTRATE ER, PHENTERMINE HCL, PHENTERMINE-TOPIRAMATE ER, PHENYLEPHRINE HCL, PHENYLEPHRINE HCL-0.9% NACL, PHENYLEPHRINE HCL-NACL, PHENYLEPHRINE HCL-WATER, PROAIR DIGIHALER, PROAIR RESPICLICK, PROCENTRA, PROMETHAZINE VC, PROMETHAZINE-PHENYLEPHRINE HCL, PSEUDOEPHEDRINE HCL, QSYMIA, QUILLICHEW ER, QUILLIVANT XR, R.E.C.K.(ROPIV-EPI-CLON-KETOR), RACEPINEPHRINE HCL, RELEXXII, RESPA A.R., REZIPRES, RITALIN, RITALIN LA, SENSORCAINE-EPINEPHRINE, SENSORCAINE-MPF EPINEPHRINE, SEPTOCAINE, SEREVENT DISKUS, STIOLTO RESPIMAT, STRIVERDI RESPIMAT, SYMBICORT, TERBUTALINE SULFATE, TETRAHYDROZOLINE HCL, TRELEGY ELLIPTA, UMECLIDINIUM-VILANTEROL, VAZCULEP, VENTOLIN HFA, VIVACAINE, VYVANSE, WIXELA INHUB, XELSTRYM, XOPENEX HFA, XYLOCAINE DENTAL-EPINEPHRINE, XYLOCAINE WITH EPINEPHRINE, XYLOCAINE-MPF WITH EPINEPHRINE, XYLOMETAZOLINE HCL, ZENZEDI |
| Ergot Alkaloids/Nitrates SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Decreased first-pass metabolism of ergot alkaloids. Ergot alkaloids may precipitate angina pectoris. CLINICAL EFFECTS: Increased standing systolic blood pressure and angina attacks may occur. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid administration of ergot alkaloids to patients receiving nitroglycerin for angina. When it is necessary to give this combination, monitor the patient for increased effects of the ergot alkaloid. Reduce the dose of ergot alkaloid as necessary. DISCUSSION: Dihydroergotamine has been reported to precipitate angina pectoris. Nitroglycerin administration to patients receiving dihydroergotamine increased the plasma dihydroergotamine level and area under the plasma concentration-time curve. An increase in the mean standing systolic blood pressure was measured. |
AMYL NITRITE, BIDIL, GONITRO, ISORDIL, ISORDIL TITRADOSE, ISOSORBIDE, ISOSORBIDE DINIT-HYDRALAZINE, ISOSORBIDE DINITRATE, ISOSORBIDE MONONITRATE, ISOSORBIDE MONONITRATE ER, NITRO-BID, NITRO-DUR, NITRO-TIME, NITROGLYCERIN, NITROGLYCERIN IN D5W, NITROGLYCERIN PATCH, NITROLINGUAL, NITROMIST, NITROSTAT, RECTIV |
| Ergot Alkaloids/Stiripentol SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Stiripentol may inhibit the metabolism of ergot alkaloids by CYP3A4.(1) CLINICAL EFFECTS: Concurrent use of stiripentol may result in elevated levels of ergot alkaloids, which may result in ergotism with the possibility of necrosis of the extremities.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The UK manufacturer of stiripentol states that concurrent use of ergot alkaloids should be avoided unless strictly necessary.(1) DISCUSSION: Stiripentol has been shown to inhibit CYP3A4. In a pediatric study, concurrent administration of stiripentol and clobazam (a CYP3A4 substrate) increased clobazam plasma levels by approximately 2- to 3-fold.(1) |
DIACOMIT |
| Ergot Alkaloids/Moderate CYP3A4 Inhibitors SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Moderate CYP3A4 inhibitors may inhibit the metabolism of ergot alkaloids. CLINICAL EFFECTS: Concurrent use of a moderate CYP3A4 inhibitor may result in increased levels of the ergot alkaloid, which may result in clinical signs of ergotism, including vasospasm, dysesthesia, renal ischemia, and peripheral ischemia. PREDISPOSING FACTORS: Patients receiving the maximum recommended (or higher than recommended) dosages of ergot alkaloids may be at a higher risk of adverse effects from this combination. PATIENT MANAGEMENT: When possible, avoid the concurrent use of moderate CYP3A4 inhibitors in patients taking ergot alkaloids. If concurrent use is warranted, consider reducing the dose of the ergot alkaloid during concurrent therapy. Patients receiving concurrent therapy should be monitored for and instructed to report any signs of ergotism. DISCUSSION: Coadministration of dihydroergotamine and ergotamine with potent inhibitors of CYP3A4 such as clarithromycin, erythromycin, indinavir, nelfinavir, ritonavir, and troleandomycin has resulted in ergotism, characterized by vasospasm and ischemia of the extremities. Inhibition of ergot alkaloid metabolism by moderate inhibitors would also be expected, but to a lesser degree. Moderate CYP3A4 inhibitors linked to this monograph are aprepitant, avacopan, berotralstat, clofazimine, conivaptan, crizotinib, diltiazem, dronedarone, duvelisib, fedratinib, fluconazole, fluvoxamine, fosnetupitant, imatinib, isavuconazonium, lenacapavir, netupitant, nilotinib, nirogacestat, rilzabrutinib, schisandra, tofisopam, treosulfan and verapamil. |
AKYNZEO, APONVIE, APREPITANT, CARDIZEM, CARDIZEM CD, CARDIZEM LA, CARTIA XT, CINVANTI, CLOFAZIMINE, CONIVAPTAN-D5W, COPIKTRA, CRESEMBA, DANZITEN, DIFLUCAN, DILT-XR, DILTIAZEM 12HR ER, DILTIAZEM 24HR ER, DILTIAZEM 24HR ER (CD), DILTIAZEM 24HR ER (LA), DILTIAZEM 24HR ER (XR), DILTIAZEM HCL, DILTIAZEM HCL-0.7% NACL, DILTIAZEM HCL-0.9% NACL, DILTIAZEM HCL-NACL, DILTIAZEM-D5W, EMEND, FLUCONAZOLE, FLUCONAZOLE-NACL, FLUVOXAMINE MALEATE, FLUVOXAMINE MALEATE ER, GLEEVEC, GRAFAPEX, IMATINIB MESYLATE, IMKELDI, INREBIC, MATZIM LA, MULTAQ, NILOTINIB HCL, NILOTINIB TARTRATE, OGSIVEO, ORLADEYO, SUNLENCA, TASIGNA, TAVNEOS, TIADYLT ER, TIAZAC, TRANDOLAPRIL-VERAPAMIL ER, VAPRISOL-5% DEXTROSE, VERAPAMIL ER, VERAPAMIL ER PM, VERAPAMIL HCL, VERAPAMIL SR, WAYRILZ, XALKORI, YEZTUGO |
There are 0 moderate interactions.
The following contraindication information is available for METHYLERGONOVINE MALEATE (methylergonovine maleate):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 3 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Acute myocardial infarction |
| Hypertension |
| Pregnancy |
There are 5 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Arteriosclerosis obliterans |
| Cerebrovascular accident |
| Coronary artery disease |
| Mitral stenosis |
| Sepsis |
There are 3 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Disease of liver |
| Kidney disease with reduction in glomerular filtration rate (GFr) |
| Seizure disorder |
The following adverse reaction information is available for METHYLERGONOVINE MALEATE (methylergonovine maleate):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 19 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. | None. |
| Rare/Very Rare |
|---|
|
Acute myocardial infarction Anaphylaxis Angina Atrioventricular block Bradycardia Cardiac arrest Cerebrovascular accident Chest pain Coronary artery spasm Dyspnea Hypotension Paresthesia Peripheral vasoconstriction Seizure disorder Severe uncontrolled hypertension Ventricular arrhythmias Ventricular fibrillation Ventricular tachycardia Water intoxication |
There are 16 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Uterine cramps |
Diarrhea Dizziness Headache disorder Hyperhidrosis Nausea Vomiting |
| Rare/Very Rare |
|---|
|
Cramps in legs Dysgeusia Hallucinations Hematuria Nasal congestion Palpitations Skin rash Thrombophlebitis Tinnitus |
The following precautions are available for METHYLERGONOVINE MALEATE (methylergonovine maleate):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
No enhanced Pregnancy information available for this drug.
No enhanced Lactation information available for this drug.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for METHYLERGONOVINE MALEATE (methylergonovine maleate):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for METHYLERGONOVINE MALEATE (methylergonovine maleate)'s list of indications:
| Postpartum hemorrhage | |
| O72 | Postpartum hemorrhage |
| O72.1 | Other immediate postpartum hemorrhage |
| Prevention of uterine inertia | |
| O62.0 | Primary inadequate contractions |
| O62.1 | Secondary uterine inertia |
| O62.2 | Other uterine inertia |
Formulary Reference Tool