Version May 2024
Treatment/prevention of postpartum or postabortion hemorrhage: IM, IV (IV should be reserved for emergency use only): 0.2 mg, may repeat dose every 2 to 4 hours if needed, up to maximum of 5 total doses. A 0.25 mg dose may also be used for the treatment of postpartum hemorrhage (Ref).
Intracoronary provocation testing for vasospastic angina (off-label use): Intracoronary (off-label route): 20 to 60 mcg (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Frequency not defined:
Cardiovascular: Bradycardia, chest pain, palpitations, thrombophlebitis
Dermatologic: Diaphoresis
Endocrine & metabolic: Water intoxication
Gastrointestinal: Abdominal pain, diarrhea, nausea, unpleasant taste, vomiting
Genitourinary: Hematuria
Nervous system: Dizziness, hallucination, headache, vertigo
Otic: Tinnitus
Respiratory: Dyspnea, nasal congestion
Postmarketing:
Cardiovascular: Acute myocardial infarction (Tsui 2001), collapse (Valentine 1977), complete atrioventricular block (Wang 2017), coronary artery vasospasm (Bamrah 1984), increased serum creatine kinase, sick sinus syndrome (Wang 2017)
Hepatic: Abnormal hepatic function tests
Neuromuscular & skeletal: Muscle spasm
Ophthalmic: Eye movement disorder
Respiratory: Bronchospasm (Crawford 1980)
Hypersensitivity to ergonovine, other ergot preparations, or any component of the formulation; induction of labor, threatened spontaneous abortion, toxemia; hypertension; breastfeeding (if >1 dose is administered); concomitant use of HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors (Note: the product labeling for other potent CYP3A4 inhibitors [eg, azole antifungals, some macrolide antibiotics] contraindicates concomitant use with ergot derivatives.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Concerns related to adverse effects:
• Ergotism: Prolonged therapy may lead to gangrene and other signs of ergotism.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with cardiovascular disease; coronary vasoconstriction may occur.
• Hypocalcemia: Uterine response may be insufficient in calcium deficient patients. Responsiveness may be restored with cautious use of IV calcium.
Other warnings/precautions:
• IV administration: Use with extreme caution when administering IV; risk of inducing sudden hypertensive and cerebrovascular accidents.
• General anesthesia: May cause nausea/vomiting; use caution when administered to patients undergoing general anesthesia.
Not available in the US
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Injection:
Generic: 0.25 mg/mL (1 mL)
IV or IM: May be administered by IV or IM injection. IV use should be limited to patients with severe uterine bleeding or other life-threatening emergency situations. IV doses should be administered over a period of ≥1 minute.
Intracoronary (off-label use/route): For provocation testing during coronary angiography, mix in normal saline and inject slowly over 2 to 5 minutes into left coronary artery; perform coronary angiography 1 to 2 minutes after completion of injection. If negative result, proceed with right coronary artery provocation in a similar fashion over 2 to 5 minutes (Ref).
Hazardous agent (NIOSH 2016 [group 3]).
Use appropriate precautions for receiving, handling, administration, and disposal. Gloves (single) should be worn during receiving, unpacking, and placing in storage.
NIOSH recommends double gloving, a protective gown, ventilated engineering controls (a class II biological safety cabinet or a compounding aseptic containment isolator), and closed system transfer devices (CSTDs) for preparation. Double gloving, a gown, and (if dosage form allows) CSTDs are required during administration (NIOSH 2016). Assess risk to determine appropriate containment strategy (USP-NF 2017).
Note: Not approved in the US
Postpartum or postabortion hemorrhage: Prevention and treatment of postpartum and postabortion hemorrhage caused by uterine atony
Vasospastic angina (diagnostic identification)
Health Canada-approved labeling includes a boxed warning. See Warnings/Precautions section for a concise summary of this information. For verbatim wording of the boxed warning, consult the product labeling.
Substrate of CYP3A4 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alpha-/Beta-Agonists: Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates) may enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Risk X: Avoid combination
Alpha1-Agonists: Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates) may enhance the vasoconstricting effect of Alpha1-Agonists. Risk X: Avoid combination
Aprepitant: May increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor therapy
Beta-Blockers: May enhance the vasoconstricting effect of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor therapy
Bromocriptine: Ergot Derivatives may enhance the adverse/toxic effect of Bromocriptine. Risk X: Avoid combination
Chloroprocaine (Systemic): May enhance the hypertensive effect of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor therapy
Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid combination
Delavirdine: May increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid combination
Dihydroergotamine: Ergot Derivatives may enhance the vasoconstricting effect of Dihydroergotamine. Risk X: Avoid combination
Erythromycin (Systemic): May increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid combination
Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination
Fosamprenavir: May increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid combination
Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination
Lenacapavir: May increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid combination
Letermovir: May increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid combination
Lisuride: May enhance the adverse/toxic effect of Ergot Derivatives. Risk X: Avoid combination
Lorcaserin (Withdrawn From US Market): May enhance the adverse/toxic effect of Ergot Derivatives. Specifically, use of these drugs together may increase the risk of developing valvular heart disease. Lorcaserin (Withdrawn From US Market) may enhance the serotonergic effect of Ergot Derivatives. This could result in serotonin syndrome. Risk X: Avoid combination
Methysergide: Ergot Derivatives may enhance the vasoconstricting effect of Methysergide. Risk X: Avoid combination
Nefazodone: May enhance the serotonergic effect of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). This could result in serotonin syndrome. Nefazodone may increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid combination
Nitroglycerin: Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates) may diminish the vasodilatory effect of Nitroglycerin. Nitroglycerin may increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Management: Avoid the use of ergot derivatives in patients receiving nitroglycerin for angina (or in any angina patient) if possible. If combined, monitor for decreased effects of nitroglycerin and increased adverse effects of the ergot derivative (eg, ergotism). Risk D: Consider therapy modification
Pergolide: May enhance the adverse/toxic effect of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor therapy
Reboxetine: May enhance the hypertensive effect of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor therapy
Reverse Transcriptase Inhibitors (Non-Nucleoside): May increase the serum concentration of Ergonovine. Specifically, this would be most likely with delavrdine, while other Non-Nucleoside Reverse Transcriptase Inhibitors may be more likely to decrease the concentration of Ergonovine. Risk X: Avoid combination
Roxithromycin: May increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid combination
Serotonergic Agents (High Risk): Ergot Derivatives may enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor therapy
Serotonin 5-HT1D Receptor Agonists (Triptans): May enhance the vasoconstricting effect of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid combination
Tipranavir: May increase the serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid combination
Ergonovine is used in the third stage of labor for the prevention or treatment of postpartum hemorrhage and should not be used prior to delivery of the placenta. Prior to administration, the placenta should be delivered and the possibility of twin pregnancy ruled out. Ergonovine is not the preferred agent for the prevention of postpartum hemorrhage due to an increased risk of adverse maternal events (SOGC [Robinson 2022]). Rule out hypertensive disorders prior to use (FIGO [Escobar 2022]).
Ergonovine may suppress prolactin secretion leading to decreased breastfeeding rates (Jordan 2009). May cause ergotism in breastfeeding infants. According to the manufacturer, breastfeeding is contraindicated when more than a single dose of ergonovine is administered to the postpartum mother. Administration of a single dose of ergonovine does not preclude a mother from nursing.
Postpartum hemorrhage: Heart rate, BP, blood loss, temperature (FIGO [Escobar 2022]).
Similar smooth muscle actions as seen with ergotamine; however, it affects primarily uterine smooth muscles producing sustained contractions and thereby shortens the third stage of labor. Has slight alpha-adrenergic blocking activity and produces less vasoconstriction than ergotamine.
Onset of action: IM: 2 to 5 minutes; IV: Immediate
Duration: IM: Uterine effect: ≥3 hours; IV: ~45 minutes
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