Mitrotan (Ergometrine Maleate)

Ergometrine maleate is an ergot alkaloid uterotonic used in obstetric practice to promote uterine contraction.

• Postpartum hemorrhage: controls severe bleeding by inducing rapid uterine contraction after delivery.
• Uterine atony: restores tone in a relaxed uterus to prevent ongoing blood loss.
• Prophylactic third‑stage management: administered prophylactically during the third stage of labor to reduce the incidence of postpartum hemorrhage.

• Ergometrine maleate acts as a partial agonist at serotonin 5‑HT2 receptors and alpha‑adrenergic receptors on uterine smooth‑muscle cells. Stimulation of these receptors increases intracellular calcium and activates phosphoinositide pathways, leading to sustained contraction of the myometrium. These effects are rapid, occurring within minutes of intravenous or intramuscular administration, and are dose‑dependent, providing clinicians with a controllable means to manage obstetric bleeding.

Ergometrine maleate may be associated with a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea: mild to moderate nausea occurring shortly after injection.
• Vomiting: occasional emesis related to gastrointestinal irritation.
• Hypertension: transient elevation of blood pressure.
• Headache: mild headache reported by some patients.

Serious or Rare Side Effects

• Coronary artery spasm: severe chest pain due to vasospasm.
• Myocardial ischemia: reduced cardiac blood flow leading to angina or infarction.
• Anaphylactic reaction: severe allergic response requiring immediate treatment.

When using ergometrine maleate, careful assessment and monitoring are essential to minimize risks.

• Cardiovascular assessment: evaluate blood pressure and cardiac history before administration.
• Hypertension monitoring: observe for sudden increases in blood pressure during and after dosing.
• Caution in vascular disease: avoid use in patients with known coronary artery disease or peripheral vascular disorders.
• Hypersensitivity screening: discontinue if signs of allergic reaction appear.
• Use under obstetric supervision: ensure administration by qualified healthcare professionals in a setting equipped for emergency management.
• Store at ambient temperature: keep in original container, protect from moisture and light.

Ergometrine maleate can interact with several medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• MAO inhibitors: concurrent use may cause severe hypertension or vasospasm.
• Other ergot derivatives (e.g., bromocriptine): additive vasoconstrictive effects increase risk of ischemia.
• Strong CYP3A4 inhibitors (e.g., ketoconazole): may raise plasma concentrations, heightening adverse events.

Moderate Interactions (Monitor Closely)

• Antihypertensive agents: ergometrine may counteract blood‑pressure‑lowering effects.
• SSRIs or other serotonergic drugs: potential for enhanced serotonergic activity and vascular effects.