ERGOT ALKALOIDS

The amine alkaloid ergometrine and its semi synthetic analogue methylergometrine have prominent uterine action and are used in obstetrics. They increase force, frequency and duration of contraction. Gravid uterus is more sensitive, specially at term and in early puerparium.The vasoconstrictor and uterotonic actionof ergot alkaloids is believed to result from partial agonistic action and adrenergic and 5 HT receptors.

Indications

Active management of 3rd stage of labour. Uterine atony/haemorrhage during and after third stage of labour, in association with ceasarean section, following abortion, subinvolution of the uterus, lochiometra, puerperal bleeding.

Dosage

Active management of 3rd stage of labour: 0.1 to 0.2 mg slowly i.v. Uterine atony/haemorrhage: 0.2 mg i.m. or 0.1 to 0.2 mg i.v. may be repeated at intervals of not less than 2 hrs. Subinvolution, lochiometra, puerperal bleeding : 0.125 to 0.25 mg orally or 0.1-0.2 mg s.c. or i.m., upto 3 times daily in lactating women preferably not longer than 3 days.

Contra-Indications

Severe hypertension, pregna-ncy, first stage of labour, second stage of labour be-fore crowning of head; hypertensive toxaemia; occlusive vascular disease,sepsis.Hypersensitivity.

Special Precautions

Donot give drug before delivery of child (last child in multiple pregnancies). Breach presentation. Hepatic or renal impairment, toxaemia of pregnancy,pelvic sepsis,obliterative vascular diseases. Pregnancy: Treatment only during third stage of labour. Lactation: Should not be used.

Side Effects

Nausea, vomiting, rise in BP, decreased milk secretion, gangrene.

Drug Interactions

Smoking, beta blockers, and methylsergide increases risk of Vascular occulsion. Simultaneous use of Oral contraceptives increase risk of thrombosis. Erythromycin increases plasm concentration of Ergotamine.