Methergine 0.2mg Tablets
It is used to stop or treat bleeding that happens after a birth. If you have been given this drug for some other reason, talk with your doctor for more information.
Drug Class
Uterotonic
Pharmacologic Class
Ergot alkaloid
Pregnancy Category
Category X
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Methergine is a medication used after childbirth to help your uterus contract and stop heavy bleeding. It works by making the muscles in your uterus tighten up.
How to Use This Medicine
Taking Your Medication Correctly
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided with your medication and follow the instructions closely. Do not take this medication for more than 1 week unless your doctor advises you to do so.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your doctor or pharmacist. If you have questions about disposing of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs available in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for a missed dose.
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided with your medication and follow the instructions closely. Do not take this medication for more than 1 week unless your doctor advises you to do so.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your doctor or pharmacist. If you have questions about disposing of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs available in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for a missed dose.
Lifestyle & Tips
- Avoid smoking, as it can worsen blood vessel constriction.
- Avoid grapefruit and grapefruit juice during treatment, as it can increase drug levels and side effects.
- Report any unusual symptoms immediately to your doctor.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
0.2 mg orally every 6-8 hours for a maximum of 1 week
Dose Range:
0.2 - 0.2 mg
Condition-Specific Dosing:
postpartum_atony_hemorrhage:
0.2 mg orally every 6-8 hours for a maximum of 1 week (after initial parenteral administration if needed)
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment recommended, use with caution
Moderate:
Use with caution, monitor for adverse effects
Severe:
Contraindicated due to increased risk of ergotism and hypertension
Dialysis:
Not recommended, monitor closely if used
Hepatic Impairment:
Mild:
No specific adjustment recommended, use with caution
Moderate:
Use with caution, monitor for adverse effects
Severe:
Contraindicated due to increased risk of ergotism and hypertension
Confidence:
Medium
Pharmacology
Mechanism of Action
Methylergonovine is an ergot alkaloid that acts as a partial agonist and antagonist on adrenergic, dopaminergic, and serotonergic receptors. Its primary uterotonic effect is due to direct stimulation of uterine and vascular smooth muscle, leading to rapid and sustained tonic contraction of the uterus, which helps to decrease blood loss by compressing intramyometrial blood vessels.
Pharmacokinetics
Absorption:
Bioavailability:
60% (oral)
Tmax:
0.5-2 hours (oral)
FoodEffect:
Not significantly affected by food
Distribution:
Vd:
56 L
ProteinBinding:
80%
CnssPenetration:
Limited
Elimination:
HalfLife:
0.5-2 hours
Clearance:
Not available
ExcretionRoute:
Primarily renal (metabolites), some biliary
Unchanged:
Not available
Pharmacodynamics
OnsetOfAction:
5-10 minutes (oral)
PeakEffect:
Not available
DurationOfAction:
3 hours or more (oral)
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high or low blood pressure, including:
+ Severe headache
+ Dizziness
+ Passing out
+ Changes in eyesight
Neurological symptoms, such as:
+ Weakness on one side of the body
+ Trouble speaking or thinking
+ Changes in balance
+ Drooping on one side of the face
+ Blurred eyesight
Seizures
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Headache
Stomach pain
* Upset stomach or vomiting
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high or low blood pressure, including:
+ Severe headache
+ Dizziness
+ Passing out
+ Changes in eyesight
Neurological symptoms, such as:
+ Weakness on one side of the body
+ Trouble speaking or thinking
+ Changes in balance
+ Drooping on one side of the face
+ Blurred eyesight
Seizures
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Headache
Stomach pain
* Upset stomach or vomiting
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe headache
- Blurred vision
- Chest pain or tightness
- Numbness, tingling, or coldness in fingers or toes
- Nausea or vomiting that is severe or persistent
- Severe abdominal pain or cramping
- Signs of allergic reaction (rash, itching, swelling, severe dizziness, trouble breathing)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have high blood pressure, including preeclampsia (high blood pressure during pregnancy).
Any medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. Certain medications, such as those used to treat HIV, infections, and depression, may interact with this medication and should not be taken together. Your doctor or pharmacist can help you identify potential interactions.
If you are pregnant or think you may be pregnant. Do not take this medication if you are pregnant.
* If you are breastfeeding. You should not breastfeed for at least 12 hours after receiving this medication.
This is not an exhaustive list of all potential interactions or health concerns related to this medication. Therefore, it is crucial to discuss all your medications, health problems, and concerns with your doctor and pharmacist to ensure safe treatment. Always check with your doctor before starting, stopping, or changing the dose of any medication to avoid potential interactions or complications.
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have high blood pressure, including preeclampsia (high blood pressure during pregnancy).
Any medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. Certain medications, such as those used to treat HIV, infections, and depression, may interact with this medication and should not be taken together. Your doctor or pharmacist can help you identify potential interactions.
If you are pregnant or think you may be pregnant. Do not take this medication if you are pregnant.
* If you are breastfeeding. You should not breastfeed for at least 12 hours after receiving this medication.
This is not an exhaustive list of all potential interactions or health concerns related to this medication. Therefore, it is crucial to discuss all your medications, health problems, and concerns with your doctor and pharmacist to ensure safe treatment. Always check with your doctor before starting, stopping, or changing the dose of any medication to avoid potential interactions or complications.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
If you have risk factors for heart disease, such as high blood pressure, high cholesterol, being overweight, having high blood sugar or diabetes, smoking cigarettes, being a male over 40 years old, having a family history of early heart disease, or being a female who has gone through menopause, exercise caution and discuss your individual situation with your doctor.
This medication may cause high blood pressure. To monitor your condition, follow your doctor's instructions for regular blood pressure checks.
Additionally, if you regularly consume grapefruit juice or eat grapefruit, consult with your doctor to discuss any potential interactions with this medication.
If you have risk factors for heart disease, such as high blood pressure, high cholesterol, being overweight, having high blood sugar or diabetes, smoking cigarettes, being a male over 40 years old, having a family history of early heart disease, or being a female who has gone through menopause, exercise caution and discuss your individual situation with your doctor.
This medication may cause high blood pressure. To monitor your condition, follow your doctor's instructions for regular blood pressure checks.
Additionally, if you regularly consume grapefruit juice or eat grapefruit, consult with your doctor to discuss any potential interactions with this medication.
Overdose Information
Overdose Symptoms:
- Nausea
- Vomiting
- Abdominal pain
- Numbness, tingling, and pain in the extremities
- Peripheral ischemia (cold, pale, painful limbs)
- Respiratory depression
- Hypotension or hypertension
- Convulsions
- Coma
What to Do:
Seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Treatment is symptomatic and supportive, including maintaining vital signs and managing vasoconstriction.
Drug Interactions
Contraindicated Interactions
- Potent CYP3A4 inhibitors (e.g., macrolide antibiotics like erythromycin, clarithromycin; protease inhibitors like ritonavir, indinavir, nelfinavir; azole antifungals like ketoconazole, itraconazole, voriconazole)
- Other ergot alkaloids (e.g., ergotamine, dihydroergotamine)
- Triptans (e.g., sumatriptan, zolmitriptan)
- Vasoconstrictors (e.g., dopamine, dobutamine, epinephrine, other sympathomimetics)
Major Interactions
- Beta-blockers (may enhance vasoconstrictive effects)
- Bromocriptine (additive vasoconstriction)
- Grapefruit juice (CYP3A4 inhibition)
Moderate Interactions
- SSRIs (potential for serotonin syndrome, though less common)
- Nicotine (may increase vasoconstriction)
Monitoring
Baseline Monitoring
Blood Pressure
Rationale: Methylergonovine can cause significant hypertension.
Timing: Prior to administration
Uterine Tone and Vaginal Bleeding
Rationale: To assess the effectiveness of the drug in controlling postpartum hemorrhage.
Timing: Prior to administration
Routine Monitoring
Blood Pressure
Frequency: Every 15-30 minutes initially, then as clinically indicated
Target: Individualized, maintain within safe limits
Action Threshold: Systolic BP >140 mmHg or Diastolic BP >90 mmHg, or significant increase from baseline
Uterine Tone and Vaginal Bleeding
Frequency: Regularly throughout treatment
Target: Firm uterine fundus, minimal vaginal bleeding
Action Threshold: Boggy uterus, excessive bleeding
Signs of Ergotism (e.g., numbness, tingling, cold extremities)
Frequency: Daily
Target: Absence of symptoms
Action Threshold: Presence of symptoms
Symptom Monitoring
- Headache
- Nausea
- Vomiting
- Abdominal pain (cramping)
- Dizziness
- Hypertension
- Chest pain
- Palpitations
- Numbness or tingling in fingers/toes
- Cold or pale extremities
Special Patient Groups
Pregnancy
Contraindicated during pregnancy. It is used postpartum to prevent or treat uterine atony and hemorrhage. Its potent uterotonic effects can cause fetal hypoxia, bradycardia, and death if used before delivery.
Trimester-Specific Risks:
First Trimester:
Contraindicated (risk of abortion)
Second Trimester:
Contraindicated (risk of fetal distress, premature labor)
Third Trimester:
Contraindicated (risk of fetal distress, premature labor, uterine rupture)
Lactation
Methylergonovine is excreted in breast milk and may cause adverse effects in the nursing infant (e.g., vomiting, diarrhea, weak pulse, unstable blood pressure, convulsions). It may also suppress lactation. Breastfeeding is generally not recommended during treatment and for at least 12 hours after the last dose. Consult with a healthcare provider.
Infant Risk:
Moderate to High (L3)
Pediatric Use
Safety and efficacy not established in pediatric patients. Not indicated for use in this population.
Geriatric Use
Use with caution in elderly patients due to increased risk of hypertension and cardiovascular events. Start with lower doses and monitor closely.
Clinical Information
Clinical Pearls
- Methylergonovine is a potent uterotonic; always confirm the patient is postpartum before administration to avoid severe adverse effects on the fetus.
- Monitor blood pressure closely, especially in patients with pre-existing hypertension or preeclampsia, as methylergonovine can cause significant increases.
- The oral form is typically used for continued management after initial parenteral administration (IM or IV) for acute postpartum hemorrhage.
- Counsel patients on the importance of avoiding grapefruit juice and certain medications (e.g., macrolide antibiotics, protease inhibitors) due to serious drug interactions.
- Educate patients on symptoms of ergotism (e.g., numbness, tingling, cold extremities) and to seek immediate medical attention if they occur.
Alternative Therapies
- Oxytocin (Pitocin)
- Carboprost tromethamine (Hemabate)
- Misoprostol (Cytotec)
- Tranexamic acid (Lysteda, Cyklokapron)
Cost & Coverage
Average Cost:
$20 - $50 per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (generic), Tier 3 (brand)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.