Is Ergometrine Maleate compatible with breastfeeding? Do we have alternatives for Ergometrine Maleate?

Ergometrine Maleate

February 22, 2018 (High Risk)

Ergot derivative which is used in the prevention and treatment of postpartum hemorrhage.

It has frequent and serious side effects (nausea, vomiting, headache, hypertension, arrhythmias, angina and infarction) that do not occur with oxytocin, so the latter is preferable to reduce the risk of postpartum hemorrhage.
They have occurred serious poisonings in infants when giving it intramuscularly due to confusion with other medication for newborn (Dargaville 1998).

Data on excretion into breast milk is lacking; the excretion of another product of the same family and similar chemical structure, Methylergometrine, has been shown to be negligible.

It may cause shortening of the duration of breastfeeding (Jordan 2009, Begley 1990) by decreasing the concentration of prolactin and inhibiting lactation (Canales 1976, Shane 1974). These effects have been demonstrated to be much more intense that in the case of Methylergometrine.

Until there is more published data on this drug in relation to breastfeeding, safer known alternatives may be preferable, especially during the neonatal period and in case of prematurity.

The limited use of ergot derivatives should not cause problems in infants (Hale 2017 p.337). It is advisable to use the lowest effective dose and avoid prolonged use.

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Ergobasine Maleate
  • Ergonovine Maleate
  • Ergostetrine Maleate
  • Ergotocine Maleate

Writings

  • Εργομετρίνη μηλεϊνική (Greek)
  • Эргометрина Малеат (Cyrillic)
  • エルゴメトリンマレイン酸塩 (Japanese)
  • C19H23N3O2,C4H4O4 (Molecular formula)

Drug trade names

References

  1. Pfizer. Ergometrine. Drug Summary. 2017 Full text (in our servers)
  2. Brown A, Jordan S. Active management of the third stage of labor may reduce breastfeeding duration due to pain and physical complications. Breastfeed Med. 2014Abstract
  3. Jordan S, Emery S, Watkins A, Evans JD, Storey M, Morgan G. Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG. 2009Abstract
  4. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  5. Moretti ME, Lee A, Ito S. Which drugs are contraindicated during breastfeeding? Practice guidelines. Can Fam Physician. 2000Abstract Full text (link to original source) Full text (in our servers)
  6. Dargaville PA, Campbell NT. Overdose of ergometrine in the newborn infant: acute symptomatology and long-term outcome. J Paediatr Child Health. 1998Abstract
  7. de Groot AN, van Dongen PW, Vree TB, Hekster YA, van Roosmalen J. Ergot alkaloids. Current status and review of clinical pharmacology and therapeutic use compared with other oxytocics in obstetrics and gynaecology. Drugs. 1998Abstract
  8. Carroli G, Grant A. The effect of ergometrine on breast feeding. Midwifery. 1990Abstract
  9. Begley CM. The effect of ergometrine on breast feeding. Midwifery. 1990Abstract
  10. Jolivet A, Robyn C, Huraux-Rendu C, Gautray JP. [Effect of ergot alkaloid derivatives on milk secretion in the immediate postpartum period]. J Gynecol Obstet Biol Reprod (Paris). 1978Abstract
  11. Canales ES, Garrido JT, Zárate A, Mason M, Soria J. Effect of ergonovine on prolactin secretion and milk let-down. Obstet Gynecol. 1976Abstract
  12. Shane JM, Naftolin F. Effect of ergonovine maleate on puerperal prolactin. Am J Obstet Gynecol. 1974Abstract