ergonovine maleate
Ergotrate Maleate

Available forms
Available by prescription only
Injection: 0.2-mg/ml ampules

Indications and dosages
 Prevention or treatment of postpartum and postabortion hemorrhage caused by uterine atony or subinvolution. Adults: 0.2 mg I.M. q 2 to 4 hours, maximum five doses. Or, 0.2 mg I.V. (only for severe uterine bleeding or other life-threatening emergency) over 1 minute while blood pressure and uterine contractions are monitored. I.V. dose may be diluted to 5 ml with normal saline injection.
 Diagnosis of coronary artery spasm (Prinzmetal’s angina) ◇ . Adults: 0.1 to 0.4 mg I.V. for one dose.

Pharmacodynamics
Oxytocic action: Ergonovine maleate stimulates contraction of uterine and vascular smooth muscle. It produces intense uterine contractions followed by periods of relaxation. The drug produces vasoconstriction of primarily capacitance blood vessels, causing an increased CVP and elevated blood pressure. The clinical effect is secondary to contraction of the uterine wall around bleeding vessels, producing hemostasis.

Pharmacokinetics
Absorption: Rapid with I.M. route.
Distribution: Unknown.
Metabolism: Metabolized in the liver.
Excretion: Probably primarily nonrenal elimination in feces.

Contraindications and precautions
Contraindicated in patients sensitive to ergot preparations; in threatened spontaneous abortion, induction of labor, or before delivery of placenta because captivation of placenta may occur; and in those with history of allergic or idiosyncratic reactions to drug.
 Because of the potential for adverse CV effects, use cautiously in patients with hypertension, toxemia, sepsis, occlusive vascular disease, or hepatic, renal, or cardiac disease.

Interactions
Drug-drug. Cardiac glycosides: Enhances vasoconstriction. Avoid use together.
Local anesthetics with vasoconstrictors (lidocaine with epinephrine): Enhances vasoconstriction. Use cautiously.
Other ergot alkaloids and sympathomimetic amines: Enhances vasoconstrictor potential. Monitor patient carefully.
Drug-lifestyle. Smoking: Enhances vasoconstriction. Discourage smoking.

Adverse reactions
CNS: headache, confusion, dizziness, ringing in ears.
CV: chest pain, weakness in legs (peripheral vasospasm), hypertension, thrombophlebitis, shock.
GI: nausea, vomiting, diarrhea, cramping.
Musculoskeletal: pain in arms, legs, or lower back.
Respiratory: shortness of breath.
Other: itching; sweating; hypersensitivity reactions.

Effects on lab test results
• May decrease serum prolactin levels.

Overdose and treatment
Signs and symptoms of overdose include seizures, nausea, vomiting, diarrhea, dizziness, fluctuations in blood pressure, weak pulse, chest pain, tingling, and numbness and coldness in the limbs. Rarely, gangrene has occurred.
 Treat seizures with anticonvulsants and hypercoagulability with heparin; give vasodilators to improve blood flow. Gangrene may require amputation.

Special considerations
• Contractions begin immediately after I.V. injection. May continue for up to 45 minutes after I.V. injection.
• Discontinue drug if hypertension or allergic reactions occur.
• Hypocalcemia may decrease patient response; I.V. administration of calcium salts may be needed.
 ALERT High doses during delivery may cause uterine tetany and possible infant hypoxia or intracranial hemorrhage.
• Drug has been used as a diagnostic agent for angina pectoris.
• Monitor blood pressure, pulse rate, uterine response, and character and amount of vaginal bleeding. Watch for sudden changes in vital signs and frequent periods of uterine relaxation.
Pregnant patients
• High doses during delivery may cause uterine tetany and possible infant hypoxia or intracranial hemorrhage.
Breast-feeding patients
• Ergot alkaloids inhibit lactation. Drug appears in breast milk, and ergotism has been reported in breast-fed infants of women given other ergot alkaloids. Use cautiously.

Patient education
• Tell patient not to smoke while taking drug.
• Advise patient of possible adverse reactions.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use