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

Methylergometrine Maleate

September 19, 2016 (Low Risk)

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

It is not excreted into breast milk in clinically significant amount (Erkkola 1978) and, besides the information offered by the manufacturer, no reliable publications were found about problems in infants whose mothers were treated.

There is a controversy on an antiprolactin effect and its ability to decrease milk production found by some authors (Peters 1979, Döner 1979, Weiss 1975).
Some have published an association with a decreased in duration of breastfeeding though not in the percentage of initiation (Brown 2014, Jordan 2009) nor a decrease in weight gaining (Arabin 1986).
Others did not find a decrease in prolactin level (Javier del Castillo 1985, Del Pozo 1975), nor difference in the rate of exclusive breastfeeding or monthly weight gain (González1984), considering that the treatments limited to the first week postpartum that use a low dose do not affect lactation or the infant.

It has frequent side effects (nausea, vomiting, headache, hypertension) that do not occur with oxytocin, so the latter is preferable to reduce the risk of postpartum hemorrhage. There are insufficient data to know whether immediate breastfeeding is effective for this type of prevention (Chelmow 2011).
They have occurred serious poisonings in infants when giving directly both orally or intramuscularly due to confusion with other medication for newborns (Aeby 2003).

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

  • Methylergobasine Maleate
  • Methylergonovine Maleate

Writings

  • Метилэргометрина Малеат (Cyrillic)
  • メチルエルゴメトリンマレイン酸塩 (Japanese)
  • C20H25N3O2,C4H4O4 (Molecular formula)

Drug trade names

References

  1. AEMPS. Metilergometrina. Ficha técnica. 2015 Full text (in our servers)
  2. [No authors listed] Methylergometrine: adverse effects in breastfed infants. Prescrire Int. 2014Abstract
  3. 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
  4. Groupe de Travail Reproduction, Grossesse et Allaitement (ANSM). METHERGIN (Méthylergométrine) et allaitement. Document GT252013013. 2013Abstract Full text (link to original source) Full text (in our servers)
  5. FDA. Methylergonovine Maleate. Drug Summary. 2012 Full text (in our servers)
  6. Chelmow D. Postpartum haemorrhage: prevention. BMJ Clin Evid. 2011Abstract
  7. Vogel D, Burkhardt T, Rentsch K, Schweer H, Watzer B, Zimmermann R, Von Mandach U. Misoprostol versus methylergometrine: pharmacokinetics in human milk. Am J Obstet Gynecol. 2004Abstract
  8. Aeby A, Johansson AB, De Schuiteneer B, Blum D. Methylergometrine poisoning in children: review of 34 cases. J Toxicol Clin Toxicol. 2003Abstract
  9. 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)
  10. 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
  11. Arabin B, Rüttgers H, Kubli F. [Effects of routine administration of methylergometrin during puerperium on involution, maternal morbidity and lactation]. Geburtshilfe Frauenheilkd. 1986Abstract
  12. Malanetto C, Pomiato S, Armellino F, Contino B, Ragusa S, Falabella A, Spina A, Splendido M, Vidano E, Nubola S, et al. [Methylergometrine in early puerperium. Comparative research on its effects at the uterine level and on lactation]. Minerva Ginecol. 1986Abstract
  13. González P, Gayán P, Pineda G, Herrera R, Leyton M. [Plasma prolactin in the puerperium and its relation to the use of methylergonovine maleate]. Rev Chil Obstet Ginecol. 1984Abstract
  14. Scapin F, Calistri D, Tronconi G, Pellicciotta G, Bareggi SR, Pontiroli AE. Inhibition of puerperal lactation by metergoline: interactions with methylergobasine maleate. Gynecol Obstet Invest. 1983Abstract
  15. Javier del Castillo F, Ramírez BM, Díaz-Infante Ibarra A. [Effect of methylergovine on the secretion of prolactin in childbirth and the puerperium]. Ginecol Obstet Mex. 1980Abstract
  16. Dörner G, Faber G, Tabatt K, Wurzbach A. [Lactation inhibition by the early postpartum administration of Methylergobrevin]. Zentralbl Gynakol. 1979Abstract
  17. Peters F, Lummerich M, Breckwoldt M. Inhibition of prolactin and lactation by methylergometrine hydrogenmaleate. Acta Endocrinol (Copenh). 1979Abstract
  18. Erkkola R, Kanto J, Allonen H, Kleimola T, Mäntylä R. Excretion of methylergometrine (methylergonovine) into the human breast milk. Int J Clin Pharmacol Biopharm. 1978Abstract
  19. 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
  20. Weiss G, Klein S, Shenkman L, Kataoka K, Hollander CS. Effect of methylergonovine on puerperal prolactin secretion. Obstet Gynecol. 1975Abstract
  21. Perez-Lopez FR, Delvoye P, Denayer P, L'Hermite M, Roncero MC, Robyn C. Effect of methylergobasine maleate on serum gonadotrophin and prolactin in humans. Acta Endocrinol (Copenh). 1975Abstract
  22. Del Pozo E, Brun Del Re R, Hinselmann M. Lack of effect of methyl-ergonovine on postpartum lactation. Am J Obstet Gynecol. 1975Abstract
  23. Del Pozo E, Brun del Re R, Hinselmann M, Wyss H. [Effect of methergine, oxytocin, pyridoxine (vitamin B 6) and quinestrol on prolactin and milk secretion in puerperium]. Arch Gynakol. 1975Abstract