Methylergometrine is a medicine that makes the uterus contract firmly and for a long time. It is given after childbirth (by mouth or injection) to treat bleeding caused by poor uterine contraction.
Also known as: Methergine, Metilergonovina
Methylergometrine (uterotonic) and salbutamol (beta-2 tocolytic) have directly opposing uterine effects: in preterm labour risk avoid methylergometrine; postpartum with salbutamol for asthma, watch for bleeding.
Salbutamol relaxes the myometrium (β2); methylergometrine increases uterine tone and contractions (ergot alkaloid); the combination may blunt postpartum uterine haemostasis or preterm tocolysis (Prontuário, obstetrics).
Blood loss, uterine tone, maternal heart rate (additive tachycardia).
Prolonged postpartum haemorrhage, attenuated contractions.
In preterm labour: tocolytics only (salbutamol/nifedipine); postpartum when salbutamol is necessary, monitor blood loss and uterine tone.
EMC-UK — Ergometrine Injection BP 0.05% w/v (hameln pharma), SmPC 4.3/4.4 (hypertension, vasospasm; tocolytic context): https://www.medicines.org.uk/emc/product/6265/smpc; INFARMED Prontuário Terapêutico (11th ed., 2012), Obstetrics (ergot alkaloids and β2 tocolytics).
Methylergometrine (vasoconstrictor) plus dopamine (vasopressor) adds peripheral and central vasoconstriction, with risk of hypertensive crisis, coronary/cerebral vasospasm and ischaemia.
Ergot alkaloids cause dose-dependent peripheral vasoconstriction ("overdose leads to peripheral vasoconstriction" — Prontuário); dopamine activates α/β-adrenergic receptors; the pressor sum can be severe.
Invasive BP, urine output, peripheral perfusion, ECG (ischaemia).
Sudden headache, chest pain, pale/cold extremities, seizures.
Avoid co-administration; if a uterotonic is needed in a vasopressor-dependent patient, prefer oxytocin alone and monitor invasive BP; taper the vasopressor gradually.
EMC-UK — Ergometrine Injection BP 0.05% w/v (hameln pharma), SmPC 4.4/4.5 (vasoconstriction, hypertension, angina/infarction): https://www.medicines.org.uk/emc/product/6265/smpc; INFARMED Prontuário Terapêutico (11th ed., 2012), Methylergometrine: peripheral vasoconstriction in overdose.
Methylergometrine plus noradrenaline adds intense α-adrenergic vasoconstriction, with risk of limb, myocardial and gut ischaemia and hypertensive crisis.
Noradrenaline is a potent α1 agonist (systemic vasoconstriction); ergot alkaloids add their own vasoconstriction (serotonergic/α) — the combination is proarrhythmic and ischaemic (EMC Ergometrine: contraindicated in occlusive vascular disease).
Invasive BP, peripheral perfusion (capillary refill), lactate, ECG.
Cold/mottled extremities, chest pain, ischaemic abdominal pain.
Avoid co-administration; in postpartum haemorrhagic/septic shock, prefer oxytocin; if use is unavoidable, invasive BP and distal perfusion monitoring.
EMC-UK — Ergometrine Injection BP 0.05% w/v (hameln pharma), SmPC 4.3 (occlusive vascular disease contraindicated) and 4.4 (vasoconstriction): https://www.medicines.org.uk/emc/product/6265/smpc
Methylergometrine is used IM/IV or in short oral courses postpartum; no food interaction is documented in the labels.
No dietary restrictions during use.
EMC-UK — Methylergometrine/Methylergonovine labels (no food interaction section).
Methylergometrine is contraindicated in hypertension and pre-eclampsia — intense vasoconstriction raises blood pressure further.
Measure blood pressure before each dose postpartum; alternatives: oxytocin.
Prontuário Terapêutico INFARMED, 7.2 (methylergometrine — contraindicated in hypertension, pre-eclampsia and occlusive vascular disease); site monograph.
Contraindicated in occlusive vascular disease — risk of vasospasm, angina and peripheral ischaemia.
Do not use in cardiac patients postpartum; prefer oxytocin.
EMC-UK — Ergometrine Injection BP (product/6265) § 4.3 (occlusive vascular disease, angina/MI).
Contraindicated during pregnancy before placental separation — causes tonic contractions and may harm the fetus.
Only after placental delivery (prevention/treatment of PPH).
Prontuário Terapêutico INFARMED, 7.2 (methylergometrine — pregnancy before separation).
Contraindicated before delivery of the fetus: it is an ergot alkaloid with a potent uterotonic effect — it causes tonic contractions that can lead to fetal distress, uterine rupture or miscarriage. The Prontuário assigns it risk factor C (pregnancy).
Contraindicated during pregnancy and for induction of labour; use only at the end of the 2nd stage of labour (after delivery of the baby's anterior shoulder) or immediately postpartum, under specialist supervision. Avoid in patients with eclampsia (Prontuário 7.2.1).
Excreted into breast milk; ergotamine (a related alkaloid) is contraindicated during breastfeeding (Prontuário, Annex 2) and ergot alkaloids are associated with neonatal toxicity (vomiting, diarrhoea, seizures, hypertension). Do not breastfeed for 12–24 hours after each dose.
Prontuário Terapêutico INFARMED — 7.2.1 (Oxytocics): methylergometrine, "Should only be used at the end of the second stage of labour but not for induction of labour... Avoid in patients with eclampsia"; Annex 1: risk factor C. EMC-UK (MHRA) — Methylergometrine SmPC (Methergin).
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Firm, long-acting ergot uterotonic used AFTER placental delivery; contraindicated before (risk of retained placenta and severe hypertension).
Partial agonist at myometrial alpha-1-adrenergic and 5-HT2 receptors: increased basal tone (sustained tetanic contraction) and contraction frequency; less vasopressor activity than other ergot alkaloids but retains coronary/peripheral vasoconstriction risk at high doses or in predisposed patients.
Oral: good absorption (~60–70%), peak 30–60 min, onset 5–15 min. IM: faster peak (onset 2–5 min). IV (rare, diluted): immediate — risk of severe hypertension.
Extensive hepatic hydroxylation (CYP3A4) and conjugation; the absorbed fraction undergoes significant first-pass (oral bioavailability ~60%). CYP3A4 inhibitors (macrolides, azoles) raise exposure — ergotism risk.
3.4 h (IV); apparent 8–12 h orally (absorption/prolonged uterine effect).
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
