Evina (Ergometrine)

Uses

Active management of the third stage of labour, Treatment and prophylaxis of postpartum haemorrhage, Excessive uterine bleeding, Postpartum and post-abortion bleeding

Evina (Ergometrine) is also used to associated treatment for these conditions: Hemorrhage, Vasospastic Angina

How Evina (Ergometrine) works

Ergonovine directly stimulates the uterine muscle to increase force and frequency of contractions. With usual doses, these contractions precede periods of relaxation; with larger doses, basal uterine tone is elevated and these relaxation periods will be decreased. Contraction of the uterine wall around bleeding vessels at the placental site produces hemostasis. Ergonovine also induces cervical contractions. The sensitivity of the uterus to the oxytocic effect is much greater toward the end of pregnancy. The oxytocic actions of ergonovine are greater than its vascular effects. Ergonovine, like other ergot alkaloids, produces arterial vasoconstriction by stimulation of alpha-adrenergic and serotonin receptors and inhibition of endothelial-derived relaxation factor release. It is a less potent vasoconstrictor than ergotamine. As a diagnostic aid (coronary vasospasm), ergonovine causes vasoconstriction of coronary arteries.

Dosage

Evina (Ergometrine) dosage

Intramuscular (Adult)-

• Active management of the third stage of labour: 0.5 mg given with 5 units of oxytocin after delivery of the anterior shoulder of the infant or immediately after delivery.
• Treatment and prophylaxis of postpartum haemorrhage: 0.2 mg, may repeat in severe bleeding every 2-4 hr as needed.

Intravenous(Adult)-

• Excessive uterine bleeding: 0.2 mg via IV inj over at least 1 minute. May follow with oral doses of 0.2 to 0.4 mg 2-4 times daily until the danger of atony or haemorrhage has passed (usually 48 hr).

Oral(Adult)-

• Postpartum and post-abortion bleeding:0.2 to 0.4 mg 2-4 times daily until danger of uterine atony and haemorrhage has passed (usually 48 hr). Max duration: 1 wk postpartum.

Side Effects

Nausea, vomiting, abdominal pain, diarrhoea; headache, dizziness; tinnitus; chest pain, palpitation, bradycardia, transient hypertension and other cardiac arrhythmias; dyspnoea, sometimes rashes, shock

Toxicity

The principal symptoms of overdose are convulsions and gangrene. Other symptoms include bradycardia, confusion, diarrhoea, dizziness, dyspnoea, drowsiness, fast and/or weak pulse, miosis, hypercoagulability, loss of consciousness, nausea and vomiting, numbness and coldness of the extremities, pain in the chest, peripheral vasoconstriction, respiratory depression, rise or fall in blood pressure, severe cramping of the uterus, tachycardia, tingling, and unusual thirst.

Precaution

Breech and abnormal foetal presentation; hypertension; chronic anaemia; hepatic, renal, respiratory or cardiac impairment; toxemia; lactation; hypocalcaemia. Monitor BP, pulse and uterine response.

Interaction

Halothane causes relaxation of uterine muscle and may interfere with ergometrine action. Enhanced uterotonic effect with prostaglandins and oxytocin. Concurrent admin with CYP3A4 inhibitors may lead to vasospasm, cerebral ischaemia and/or ischaemia of extremities.

Food Interaction

Elimination Route

Absorption is rapid and complete after oral or intramuscular administration.

Half Life

t_{1/2 α}=10 minutes; t_{1/2 β}=2 hours

Elimination Route

Thought to be eliminated by non-renal mechanisms (i.e. hepatic metabolism, excretion in feces)

Pregnancy & Breastfeeding use

Pregnancy Category X. Studies in animals or human beings have demonstrated foetal abnormalities or there is evidence of foetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.

Contraindication

Pregnancy, 1st and 2nd stage of labour, patients with preeclampsia, eclampsia or threatened spontaneous abortion; porphyria.

Acute Overdose

Symptoms include peripheral vasoconstriction, encephalopathy, convulsions, respiratory failure, acute renal failure and temporary lactose intolerance. Treatment is supportive.

Storage Condition

Intramuscular: Active management of the third stage of labour: Refrigerate at 2-8°C.

Intravenous: Refrigerate at 2-8°C.

Oral: Store below 25°C.

Innovators Monograph

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