Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Drugline nr 16972

Publicerat 2000-11-06

Question

Is methylergometrine compatible with breast-feeding? What is the background to the recommendation in FASS that treatment should not exceed three days in nursing mothers? General information is requested.

Answer

Methylergometrine is an ergot alkaloid derivative that causes uterine contractions and is used to treat or prevent post partum hemorrhage. A question concerning methylergometrine and breast-feeding has previously been answered in Drugline. It is stated that small amounts of methylergometrine passes over to milk, but that no adverse effects in breast-fed children have been reported in the literature (1). The warning in FASS, not to exceed three days of treatment, is based on unpublished, single cases known to the manufacturer: increased blood pressure, bradycardia, tachycardia, vomiting, diarrhea and clonic seizures in nursing children whose mothers took methylergometrine for several days (1). Renewed contact with the manufacturer has not revealed any further data (2).

Methylergometrine also has adverse effects on lactation. In 444 mothers treated with 0.375 mg methylergometrine daily for four weeks the mean milk production was 563 g daily, compared to 880 g in 436 placebo treated controls (3). Decreased prolactin and milk production and reduced nursing frequency in the first seven days post partum has also been shown in several studies, according to an earlier Drugline document (4). Ninety-four percent of untreated mothers or mothers given less than 2 mg methylergometrine were nursing their newborn infants when leaving the hospital, compared to 84 percent of the mothers treated with 2 mg or more (5).

Conclusion

The recommendation not to exceed three days of methylergometrine treatment in nursing mothers is based on unpublished cases, known to the manufacturer, of adverse effects in the infants. This recommendation is also supported by well documented inhibiting effects of methylergometrine on lactation.

Böttiger Y

References

  1. Drugline no12180 (year 1995, enclosed)
  2. Personal communication with representative, Novartis
  3. Arabin B, Ruttgers H, Kubli F: Effects of routine administration of methylergometrin during puerperium on involution, maternal morbidity and lactation. (German) Geburtshilfe-Frauenheilkunde 1986; 46: 215-20
  4. Drugline no 01856 (year 1979)
  5. Dorner G, Faber G, Tabatt K, Wurzbach A: Lactation inhibition by the early postpartum administration of Methylergobrevin. (German) Zentralbl Gynakol 1979; 101: 25-8

Senast ändrad 2018-09-20