Ritonavir
Contraindicated
Database
Ergotism: vasospasm, gangrene
Absolute contraindication in HIV patients on PIs.
Source: DDInter
Drug reference
Methylergometrine
Ergot alkaloid uterotonic agent · Obstetric agent, Postpartum hemorrhage management
Also known as Methylergonovine, Methergine
START
Ensure delivery is complete (retained placenta is contraindication). Check BP (contraindicated if hypertensive/preeclamptic). IV oxytocin is first-line for PPH; reserve methylergometrine for oxytocin failure or as second-line.
TYPICAL MAX
5 x 0.2mg IM doses (1mg total). Do not exceed—risk of severe hypertension and vasoconstriction.
STOP IF
Severe hypertension (SBP >160 or DBP >110), chest pain, severe headache, signs of peripheral vasospasm (cold, pale extremities), uterine tetany.
WATCH
BP monitoring every 15 minutes after IM injection. NEVER give IV (risk of severe hypertension, stroke, death)—IM or PO only. Contraindicated in preeclampsia/eclampsia due to hypertensive effect. Oxytocin is preferred first-line uterotonic; methylergometrine is second-line.
CDSCO approvedSchedule HJan AushadhiATC G02AB03
KDIGO 2024 + manufacturer label
- ONSET
- 5min · IM onset 2-5 minutes
- PEAK
- 30min · IM peak 30 minutes
- t½
- 3.4h · t½ ~3.4 hours
- DURATION
- 3h · 2-4 hours (IM)
EXCRETION
Fecal/biliary as metabolites (~90%)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated during pregnancy before delivery—causes uterine contractions and fetal distress. Safe for postpartum use.
FDA category + note
Top interactionssee all 12 →
- RitonavirContraindicatedDatabaseDDInter
- AlmotriptanSevereDatabaseDDInter
- AmprenavirSevereDatabaseDDInter
- AtazanavirSevereDatabaseDDInter
Available in India
78 branded formulations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Direct agonist at 5-HT2A serotonin and alpha-adrenergic receptors on uterine smooth muscle, causing sustained tetanic uterine contractions. Also has partial agonist/antagonist activity at dopamine D2 receptors. Contracts uterine fundus and mid-zone more than lower segment.
Indications
Prevention and treatment of postpartum hemorrhage (PPH) due to uterine atonyIncomplete abortion (after uterine evacuation)Subinvolution of the uterusUterine atony following cesarean section
Dosing
- Adult
- PPH prevention/treatment: 0.2mg IM q2-4h after delivery (max 5 doses). OR 0.2mg PO TID-QID x 2-7 days. Uterine subinvolution: 0.2mg PO TID x up to 7 days.
- Pediatric
- Not used in children.
- Renal adjustment
- Avoid in severe renal impairment (reduced clearance, increased toxicity).
- Hepatic adjustment
- Avoid in hepatic impairment (extensively hepatically metabolized).
- Geriatric
- Not applicable (postpartum use only).
- Max dose
- 1mg/day (5 x 0.2mg IM); 0.8mg/day PO
Pharmacokinetics
Onset
IM: uterine contraction within 2-5 minutes; PO: 5-10 minutes
Peak effect
IM: peak in 30 minutes; PO: Tmax 30-120 minutes
Duration
IM: 2-4 hours; PO: 3-4 hours
Half-life
~3.4 hours (plasma); biological effects persist longer
Bioavailability
~60% (oral)
Protein binding
~50%
Metabolism
Extensive hepatic via CYP3A4 (major) and CYP2D6 to inactive metabolites
Excretion
~90% biliary/fecal (metabolites); ~5% renal (unchanged)
Contraindications
- Pregnancy (before delivery—causes uterine contractions and fetal distress)
- Hypersensitivity to ergot alkaloids
- Hypertension or preeclampsia/eclampsia
- Peripheral vascular disease
- Coronary artery disease
- Hepatic or renal impairment
- Sepsis
- Concomitant CYP3A4 inhibitors (ergotism risk)
Side effects
Common
Nausea and vomitingAbdominal crampingHypertension / vasoconstrictionHeadacheDizzinessDiaphoresis
Serious
- Severe hypertension (cerebrovascular accident risk)
- Ergotism (peripheral vasospasm, gangrene—rare with therapeutic doses)
- Myocardial ischemia / infarction
- Seizures
- Thrombosis
- Uterine tetany / rupture (rare)
Pregnancy & lactation
Pregnancy
Contraindicated during pregnancy before delivery—causes uterine contractions and fetal distress. Safe for postpartum use.
Lactation
Excreted in breast milk; may cause GI upset, weakness, and poor feeding in infants. Use lowest effective dose for shortest duration; monitor infant.
Drug interactions
Almotriptan
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amprenavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Atazanavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Boceprevir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Bromocriptine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Ceritinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Clarithromycin
Severe
Database
Ergotism
Avoid. Use alternative uterotonic.
Source: DDInter
Cobicistat
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Conivaptan
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Darunavir
Severe
Database
Clinical effect not specified
Source: DDInter
Delavirdine
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Abnormal uterine bleeding
FOGSI · Obstetrics & Gynaecology · 2016
Blood transfusion in obstetrics and gynaecology
FOGSI · Obstetrics & Gynaecology · 2024
Postpartum haemorrhage
FOGSI · Obstetrics & Gynaecology · 2024
Stroke and TIA — secondary prevention
AHA · Neurology · 2021
Tobacco-related cancer prevention
ICMR · Oncology · 2021
Ask House about Methylergometrine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19