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Ergonovine (United States: Not available): Drug information

Ergonovine (United States: Not available): Drug information
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For additional information see "Ergonovine (United States: Not available): Patient drug information"

For abbreviations, symbols, and age group definitions show table
Pharmacologic Category
  • Ergot Derivative;
  • Oxytocic Agent
Dosing: Adult
Treatment/prevention of postpartum or postabortion hemorrhage

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

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.

Adverse Reactions

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)

Contraindications

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.

Warnings/Precautions

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.

Product Availability

Not available in the US

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Injection:

Generic: 0.25 mg/mL (1 mL)

Administration: Adult

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 Drugs Handling Considerations

Ergonovine was removed from the NIOSH list of hazardous drugs in health care settings with the 2024 update because ergonovine was never approved for use in humans by the US Food and Drug Administration (NIOSH 2024); however, ergonovine may meet the criteria for a hazardous drug. Ergonovine may cause reproductive toxicity and has a structural/toxicity profile similar to existing hazardous agents.

Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2023, NIOSH 2024, USP-NF 2020).

Note: Facilities may perform risk assessment of some hazardous drugs to determine if appropriate for alternative handling and containment strategies (USP-NF 2020). Refer to institution-specific handling policies/procedures.

Use: Labeled Indications

Note: Not approved in the US

Postpartum or postabortion hemorrhage: Prevention and treatment of postpartum and postabortion hemorrhage caused by uterine atony

Use: Off-Label: Adult

Vasospastic angina (diagnostic identification)

Medication Safety Issues
ALERT: Canadian Boxed Warning:

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.

Metabolism/Transport Effects

Substrate of CYP3A4 (Major with inhibitors), CYP3A4 (Minor with inducers); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;

Drug Interactions

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 drug interactions program by clicking on the “Launch drug interactions program” link above.

Alpha-/Beta-Agonists: Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates) may increase vasoconstricting effects of Alpha-/Beta-Agonists. Risk X: Avoid

Alpha1-Agonists: Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates) may increase vasoconstricting effects of Alpha1-Agonists. Risk X: Avoid

Aprepitant: May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

Beta-Blockers: May increase vasoconstricting effects of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

Bromocriptine: Ergot Derivatives may increase adverse/toxic effects of Bromocriptine. Risk X: Avoid

Chloroprocaine (Systemic): May increase hypertensive effects of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor

CYP3A4 Inhibitors (Moderate): May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

CYP3A4 Inhibitors (Strong): May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid

Dihydroergotamine: Ergot Derivatives may increase vasoconstricting effects of Dihydroergotamine. Risk X: Avoid

Erythromycin (Systemic): May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid

Esketamine (Injection): May increase adverse/toxic effects of Ergonovine. Risk X: Avoid

Fosamprenavir: May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid

Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification

Grapefruit Juice: May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

Itraconazole: May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid

Lenacapavir: May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid

Letermovir: May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid

Lisuride: May increase adverse/toxic effects of Ergot Derivatives. Risk X: Avoid

Metergoline: Ergot Derivatives may increase adverse/toxic effects of Metergoline. Management: Combined use of metergoline with other ergot alkaloids after birth and during the postpartum period is specifically not recommended. Risk D: Consider Therapy Modification

Methysergide: Ergot Derivatives may increase vasoconstricting effects of Methysergide. Risk X: Avoid

Nefazodone: May increase serotonergic effects of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). This could result in serotonin syndrome. Nefazodone may increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid

Nicotine: May increase vasoconstricting effects of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

Nitroglycerin: Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates) may decrease vasodilatory effects of Nitroglycerin. Nitroglycerin may increase 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 increase adverse/toxic effects of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

Reboxetine: May increase hypertensive effects of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

Reverse Transcriptase Inhibitors (Non-Nucleoside): May increase 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

Roxithromycin: May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid

Serotonergic Agents (High Risk): Ergot Derivatives may increase serotonergic effects 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

Serotonin 5-HT1D Receptor Agonists (Triptans): May increase vasoconstricting effects of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid

Sulprostone: May increase vasoconstricting effects of Ergot Derivatives. Risk C: Monitor

Tipranavir: May increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid

Pregnancy Considerations

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]).

Breastfeeding Considerations

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.

Monitoring Parameters

Postpartum hemorrhage: Heart rate, BP, blood loss, temperature (FIGO [Escobar 2022]).

Mechanism of Action

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.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: IM: 2 to 5 minutes; IV: Immediate

Duration: IM: Uterine effect: ≥3 hours; IV: ~45 minutes

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AR) Argentina: Ergonovina drawer;
  • (BR) Brazil: Ergotrate;
  • (GB) United Kingdom: Ergometrin | Ergometrine;
  • (LT) Lithuania: Ergometrin;
  • (LV) Latvia: Ergometrin;
  • (MX) Mexico: Ergotrate;
  • (MY) Malaysia: DBL Ergometrine Maleate;
  • (NZ) New Zealand: Ergometrine maleat;
  • (PL) Poland: Ergometrin;
  • (RU) Russian Federation: Ergometrin
  1. Bamrah VS, Schuchard GJ. Refractory coronary artery spasm. J Am Coll Cardiol. 1984;4(3):635-639. doi:10.1016/s0735-1097(84)80114-x [PubMed 6470347]
  2. Crawford JS. Bronchospasm following ergometrine. Anaesthesia. 1980;35(4):397-398. doi:10.1111/j.1365-2044.1980.tb05138.x [PubMed 7435910]
  3. de Groot AN, van Dongen PW, Vree TB, et al, “Ergot Alkaloids. Current Status and Review of Clinical Pharmacology and Therapeutic Use Compared With Other Oxytocics in Obstetrics and Gynaecology,” Drugs, 1998, 56(4):523-35. [PubMed 9806101]
  4. Ergonovine maleate injection [product monograph]. Mississauga, Ontario, Canada: Teligent Canada Inc; June 2020.
  5. Escobar MF, Nassar AH, Theron G, et al; FIGO Safe Motherhood and Newborn Health Committee. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet. 2022;157(suppl 1):3-50. doi:10.1002/ijgo.14116 [PubMed 35297039]
  6. Fuster V, Topol EJ, and Nabel EG, eds, Atherothrombosis and Coronary Artery Disease, 2nd ed, Philadelphia, PA: Lippincott Williams & Wilkens, 2004.
  7. Hodson L, Ovesen J, Couch J, et al; US Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Managing hazardous drug exposures: information for healthcare settings, 2023. https://doi.org/10.26616/NIOSHPUB2023130. Updated April 2023. Accessed December 27, 2024.
  8. JCS Joint Working Group. Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina). Circ J. 2014;78(11):2779-2801. doi: 10.1253/circj.cj-66-0098 [PubMed 25273915]
  9. Jordan S, Emery S, Watkins A, et al. Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG. 2009;116(12):1622-1629. doi:10.1111/j.1471-0528.2009.02256.x [PubMed 19735379]
  10. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. doi: 10.1093/eurheartj/eht296 [PubMed 23996286]
  11. Ovesen JL, Sam­mons D, Connor TH, et al; US Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. NIOSH list of hazardous drugs in healthcare settings, 2024. https://doi.org/10.26616/NIOSHPUB2025103. Updated December 18, 2024. Accessed December 20, 2024.
  12. Previtali M, Ardissino D, Barberis P, Panciroli C, Chimienti M, Salerno JA. Hyperventilation and ergonovine tests in Prinzmetal's variant angina pectoris in men. Am J Cardiol. 1989;63(1):17-20. [PubMed 2909157]
  13. Robinson D, Basso M, Chan C, Duckitt K, Lett R. Guideline no. 431: postpartum hemorrhage and hemorrhagic shock. J Obstet Gynaecol Can. 2022;44(12):1293-1310.e1. doi:10.1016/j.jogc.2022.10.002 [PubMed 36567097]
  14. Song JK, Park SW, Kang DH, Hong MK, Kim JJ, Lee CW, Park SJ. Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm. J Am Coll Cardiol. 2000;35(7):1850-1856. [PubMed 10841234]
  15. Soriano D, Dulitzki M, Schiff E, et al, “A Prospective Cohort Study of Oxytoxin Plus Ergometrine Compared With Oxytocin Alone for Prevention of Postpartum Heamorrhage,” Br J Obstet Gynaecol, 1996, 103(11):1068-73. [PubMed 8916990]
  16. Sueda S, Kohno H, Fukuda H, Ochi N, Kawada H, Hayashi Y, Uraoka T. Induction of coronary artery spasm by two pharmacological agents: comparison between intracoronary injection of acetylcholine and ergonovine. Coron Artery Dis. 2003;14(6):451-457. [PubMed 12966266]
  17. Sueda S, Kohno H, Fukuda H, Ochi N, Kawada H, Hayashi Y, Uraoka T. Clinical impact of selective spasm provocation tests: comparisons between acetylcholine and ergonovine in 1508 examinations. Coron Artery Dis. 2004;15(8):491-497. [PubMed 15585990]
  18. Takagi Y, Yasuda S, Takahashi J, et al; Japanese Coronary Spasm Association. Clinical implications of provocation tests for coronary artery spasm: safety, arrhythmic complications, and prognostic impact: multicentre registry study of the Japanese Coronary Spasm Association. Eur Heart J. 2013;34(4):258-267. [PubMed 22782943]
  19. Tsui BC, Stewart B, Fitzmaurice A, Williams R. Cardiac arrest and myocardial infarction induced by postpartum intravenous ergonovine administration. Anesthesiology. 2001;94(2):363-364. doi:10.1097/00000542-200102000-00033 [PubMed 11176106]
  20. United States Pharmacopeia. <800> Hazardous Drugs—Handling in Healthcare Settings. In: USP-NF. United States Pharmacopeia; July 1, 2020. Accessed January 16, 2025. doi:10.31003/USPNF_M7808_07_01
  21. Valentine BH, Martin MA, Phillips NV. Collapse during operation following i.v. ergometrine. A case report. Br J Anaesth. 1977;49(1):81-82. doi:10.1093/bja/49.1.81 [PubMed 831748]
  22. Wang HT, Liu WH, Chen YL. Transient sick sinus syndrome with complete atrioventricular block associated with ergonovine intake: a case report. Medicine (Baltimore). 2017;96(44):e8559. doi:10.1097/MD.0000000000008559 [PubMed 29095320]
  23. Yamada T, Okamoto M, Sueda T, Hashimoto M, Matsuura H, Kajiyama G. Ergonovine-induced alterations in coronary flow velocity preceding onset of occlusive spasm in patients without significant coronary artery stenoses. Am J Cardiol. 1998;81(6):688-693. [PubMed 9527075]
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