Ergonovine

Drug Levels and Effects:




Summary of Use during Lactation:


Ergonovine given in the immediate postpartum period lowers serum basal prolactin and possibly suckling-induced prolactin increases. It also appears to decrease the rate of breastfeeding. Ergonovine is probably best avoided in mothers who wish to nurse, relying instead on suckling-induced oxytocin release to hasten uterine involution. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.


Drug Levels:


Maternal Levels.

Relevant published information was not found as of the revision date.

Infant Levels.

Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:


Relevant published information was not found as of the revision date.


Possible Effects on Lactation:


In one study, a single oral dose of ergonovinemaleate0.2 mg in 12 nonbreastfeeding women on day 3 postpartum caused a 10 to 20% drop in average serum prolactin levels between 0.5 and 2.5 hours after the dose. The authors expressed concern that repeated doses of ergonovine could suppress lactation.[1]

Ten women who were given ergonovine 0.2 mg 3 times daily from day 1 to 7 postpartum were compared to 6 women who did not receive the drug. None of the women breastfed their infants. Serum prolactin levels were significantly lower in the treated women by day 2 postpartum and persisted through the 7 days of the study. Seven of the 10 treated women developed breast engorgement and had milk letdown and 3 had progressive inhibition of lactation. In 2 additional women who were nursing their infants, a single dose of 0.2 mg of ergonovine intravenously blunted the response of serum prolactin to suckling.[2]

In a nonrandomized study, 11 women with normal deliveries were given an intramuscular injection of either oxytocin 5 units plus ergonovine 0.5 mg (n = 5) or 5 units of oxytocin alone (n = 6). Serum prolactin levels were lower in the women given ergonovine from 0.5 to 2.5 hours.[3]

In a randomized, but nonblinded, controlled trial, women thought to be at low risk of postpartum hemorrhage were given either ergonovine 0.5 mg intravenously following birth of the infant (n = 197) or no drug (n = 135). Serum prolactin levels obtained in the period of 48 to 72 hours postpartum did not differ between the groups, but fewer of those who received ergonovine were still breastfeeding at 4 weeks postpartum than those who did not.[4]

In a randomized, but nonblinded, controlled trial, women thought to be at low risk of postpartum hemorrhage were given either ergonovine 0.5 mg intravenously following birth of the infant (n = 197) or no drug (n = 135). Serum prolactin levels obtained in the period of 48 to 72 hours postpartum did not differ between the groups, but fewer of those who received ergonovine were still breastfeeding at 4 weeks postpartum than those who did not.[4]

A retrospective review of obstetrical records of 18,165 records of mothers giving birth in Wales found that use of intravenous or intramuscular ergonovine during the third stage of labor as a uterotonic reduced the odds of the mother breastfeeding at 48 hours postpartum. The reduction was 36% in the overall sample and 49% for primiparous mothers.[5]


Alternate Drugs to Consider:


Methylergonovine


References:


1. Shane JM, Naftolin F. Effect of ergonovinemaleateon puerperal prolactin. Am J Obstet Gynecol. 1974;120:129-31. PMID:4602154
2. Canales ES, Garrido JT et al. Effect of ergonovine on prolactin secretion and milk let-down. Obstet Gynecol. 1976;48:228-9. PMID:940657
3. Symes JB. A study on the effect of ergometrine on serum prolactin levels following delivery. J Obstet Gynaecol. 1984;5:36-8.
4. Begley CM. The effect of ergometrine on breast feeding. Midwifery. 1990;6:60-72. PMID:2195299
5. 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;116:1622-32 . PMID:19735379



Substance Identification:




Substance Name:

Ergonovine

CAS Registry Number:

60-79-7

Drug Class:


  • Ergot Alkaloids

  • Oxytocics


  • Administrative Information:




    LactMed Record Number:


    457


    Last Revision Date:


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