Source: Medicines & Healthcare Products Regulatory Agency (GB) Revision Year: 2018 Publisher: Hameln pharmaceuticals ltd, Gloucester, UK
Pharmacotherapeutic group: Ergot alkaloids
ATC code: G02AB03
Ergometrine produces sustained tonic uterine contraction via agonist or partial agonist effects at myometrial 5-HT2 receptors and alpha-adrenergic receptors. Both upper and lower uterine segments are stimulated to contract in a tetanic manner. Unlike oxytocin ergometrine has an effect on the non-pregnant uterus. Ergometrine inhibits prolactin secretion and in turn can reduce lactation. Uterine stimulation occurs within 7 minutes of intramuscular injection and almost immediately following intravenous injection. The sustained uterine contractions produced by ergometrine are effective in controlling uterine haemorrhage.
Ergometrine has weak antagonist actions at dopaminergic receptors in certain blood vessels. Compared with other ergot alkaloids, effects of ergometrine on cardiovascular and central nervous system are less pronounced. It has a partial agonist action in blood vessels (less than ergotamine) and has little or no antagonist action at α-adrenergic receptors.
Ergometrine is rapidly absorbed after administration by mouth or by intramuscular injection. Uterotonic effect can be observed within 10 minutes following oral administration and within 7 minutes of intramuscular injection.
The average steady state volume of distribution of ergometrine in healthy man is reported to be 1.04 L/kg. The plasma protein binding of ergometrine is unknown. Ergometrine is known to cross the placenta and its clearance from the foetus is slow. Concentrations of ergometrine achieved in foetus are not known. Ergometrine is also expected to be excreted in the breast milk and to reduce milk secretion.
Ergometrine is mainly metabolised in the liver by hydroxylation and glucuronic acid conjugation and possibly N-demethylation. Like other ergot alkaloids it is a substrate for CYP3A4 enzymes.
The plasma half life of ergometrine is reported to be in the range of 30-120 min. When administered orally, the drug is mainly eliminated with the bile into the faeces as 12-hydroxyergometrine glucuronide. It is eliminated unchanged in the urine and can be detected up to 8 h after injection.
There are no pre-clinical data of relevance to the prescriber which are additional to those already included in other sections of the Summary of Product Characteristics.
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