Methylergonovine

INTRODUCTION

Indications

Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution.

Action

Directly stimulates uterine and vascular smooth muscle. Therapeutic Effects: Uterine contraction.

Adverse Reactions/Side Effects

CNS: dizziness, headache. EENT: tinnitus. Resp: dyspnea. CV: HYPERTENSION, arrhythmias, chest pain, palpitations. GI: nausea, vomiting. GU: cramps. Derm: diaphoresis. Misc: allergic reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report increased BP (hypertension) to the physician immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, difficulty breathing, fainting, and fatigue/weakness.

• Assess dizziness that affects gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess any abdominal or pelvic pain and cramping. Notify physician if pain/cramping does not subside or continues to worsen.

Interventions

• Because of the risk of hypertension and arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, respiration, fatigue levels), and terminate exercise immediately if any untoward responses occur (see Appendix L).

Patient/Client-Related Instruction

• Instruct patient to report other troublesome side effects such as severe or prolonged headache, ringing/buzzing in the ears, sweating, or GI problems (nausea, vomiting).

Pharmacokinetics

Absorption: Well absorbed following oral or IM administration.

Distribution: Unknown. Enters breast milk in small quantities.

Metabolism and Excretion: Probably metabolized by the liver.

Half-life: 30–120 min.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Should not be used to induce labor.

Use Cautiously in: Hypertensive or eclamptic patients (more susceptible to hypertensive and arrhythmogenic side effects); Severe hepatic or renal disease; Sepsis.

Exercise Extreme Caution in: 3rd stage of labor.

Interactions

Drug-Drug: Excessive vasoconstriction may result when used with heavy cigarette smoking (nicotine) or other vasopressors such as dopamine.

Route/Dosage

PO (Adults): 200–400 mcg (0.4–0.6 mg) q 6–12 ...