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Trade Names:
Ergotrate
- Tablets 0.2 mg

Mechanism of Action

Pharmacology

Increases strength, duration, and frequency of uterine contractions and decreases uterine bleeding.

Pharmacokinetics

Onset

Produces a firm tetanic contraction of postpartum uterus within 6 to 15 min that, in the course of about 90 min, gradually changes to a series of clonic contractions that persist for 90 min or more.

Indications and Usage

Prevention and treatment of postpartum and postabortal hemorrhage caused by uterine atony.

Unlabeled Uses

Oxytocin challenge test.

Contraindications

Induction of labor; threatened spontaneous abortion; previous allergic or idiosyncratic reactions to drug.

Dosage and Administration

PO Immediate postpartum dose 0.2 mg. To minimize late postpartum bleeding, 0.2 to 0.4 mg 2 to 4 times daily (every 6 to 12 h) until danger of uterine atony has passed (usually 48 h).

General Advice

• Administer prescribed dose by mouth or sublingually.
• Administer without regard to meals but administer with food if GI upset occurs.

Storage/Stability

Store tablets at controlled room temperature (59° to 86°F).

Drug Interactions

Increased risk of ergot toxicity (eg, peripheral vasospasm, ischemia of extremities).

Possible hypertension caused by additive vasoconstriction.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Increased BP (sometimes extreme).

GI

Nausea, vomiting, cramping.

Miscellaneous

Allergy (including shock), ergotism.

Precautions

Pregnancy

Category X . Contraindicated during pregnancy.

Lactation

Ergot alkaloids are excreted in breast milk.

Labor and Delivery

Because of the high uterine tone produced, ergonovine is not recommended for routine use prior to the delivery of the placenta, unless the surgeon is familiar with the technique described by Davis and others and has adequate facilities and personnel at his or her disposal.

Special Risk Patients

Use with caution in patients with hypertension, heart disease, venoatrial shunts, mitral-valve stenosis, obliterative vascular disease, sepsis, hepatic or renal function impairment.

Calcium deficiency

Hypocalcemia may affect response to drug.

Duration

Avoid prolonged use and discontinue if symptoms of ergotism appear.

Ergotism

Closely monitor patient for signs and symptoms of ergotism (eg, intense vasoconstriction, coldness of the extremities, chest pain, gangrene). Immediately discontinue therapy and inform health care provider if noted or suspected.

Hypertension

Obtain baseline vital signs, with special attention to pulse and BP. Closely monitor BP during treatment. Notify health care provider immediately if BP becomes elevated. Be prepared to discontinue therapy and treat appropriately.

Severe cramping

This is evidence of effectiveness but may justify reduction in dosage. Monitor and document uterine response during and after administration. Notify health care provider if uterine contractions are not maintained or if cramping is severe. Note character and amount of vaginal bleeding.

Uterine effects

Hyperstimulation of uterus may lead to uterine tetany and impairment of uteroplacental blood flow, uterine rupture, cervical and perineal lacerations, amniotic fluid embolism, and trauma to infant (eg, intracranial hemorrhage).

Overdosage

Symptoms

Convulsions, gangrene, chest pain, diarrhea, dizziness, dyspnea, hypercoagulability, loss of consciousness, numbness and coldness of extremities, increase or decrease in BP, tingling, vomiting, weak pulse.

Patient Information

• Advise patient that medication will usually be administered by a health care professional in a medical setting.
• Advise patient to take prescribed dose either orally or sublingually as ordered.
• Caution patient not to change the dose or take for longer period than prescribed.
• Advise patient to stop taking the medication and notify health care provider immediately if any of the following occur: numbness, tingling, coldness, or paleness in the fingers or toes; muscle pain in arms or legs; weakness in the legs; chest pain, tightness, or pressure; changes in heart rate.
• Advise patient to report excessive or severe uterine cramping.