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Methylergonovine Maleate Injection USP 0.2mg/1ml in Prefilled syringe Taj Pharma

DESCRIPTION

Methylergonovine maleate is a semi-synthetic

ergot alkaloid used for the prevention and control of postpartum hemorrhage.

Methylergonovine maleate is available in sterile vials of 1 mL, containing 0.2 mg methylergonovine maleate for intramuscular or intravenous injection.

Prefilled Syringe, 1 mL, clear, colorless solution.

Active Ingredient: methylergonovine maleate, USP, 0.2 mg.

Inactive Ingredients: maleic acid, 0.10 mg; sodium chloride, 7.0 mg; water for injection, qs to 1 mL.

Chemically, methylergonovine maleate is designated as ergoline-8-carboxamide, 9,10-didehydro-N-[1­ (hydroxymethyl)propyl]-6-methyl-,[8b(S)]-,   (Z)-2­ butenedioate (1:1) (salt).

C20H25N3O2 · C4H4O4
Mol. wt. – 455.51

CLINICAL PHARMACOLOGY

Methylergonovine maleate acts directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of rhythmic contractions. Thus, it induces   a rapid and sustained tetanic uterotonic effect which shortens the third stage of labor and reduces blood loss. The onset of action after I.V. administration is immediate; after I.M. administration, 2 to 5 minutes, and after oral administration, 5 to 10 minutes.

Pharmacokinetic studies following an I.V. injection have shown that methylergonovine is rapidly distributed from plasma to peripheral tissues within 2 to 3 minutes or less. The bioavailability after oral administration was reported to be about 60% with no accumulation after repeated doses. During delivery, with intramuscular injection, bioavailability increased to 78%. Ergot alkaloids are mostly eliminated by hepatic metabolism and excretion, and the decrease in bioavailability following oral administration is probably a result of first- pass metabolism in the liver.

Bioavailability studies conducted in fasting healthy female volunteers have shown that oral absorption    of a 0.2 mg methylergonovine Prefilled syringe  was fairly rapid with a mean peak plasma concentration of 3243 ± 1308  pg/mL observed  at  1.12  ±  0.82  hours.   For a

0.2 mg intramuscular injection, a mean peak plasma concentration of 5918 ±  1952 pg/mL was observed  at 0.41 ± 0.21 hours. The extent of absorption of the Prefilled syringe , based upon methylergonovine plasma concentrations, was found to be equivalent to that of the I.M. solution given orally, and the extent of oral absorption of the I.M. solution was proportional to the dose following administration of 0.1, 0.2, and 0.4 mg. When given intramuscularly, the extent of absorption of methylergonovine maleate solution was about 25% greater than the  Prefilled syringe .  The volume  of  distribution (Vdss/F) of methylergonovine was calculated to be 56.1± 17.0 liters, and the plasma clearance (CLp/F) was calculated to be 14.4 ± 4.5 liters per hour. The plasma level decline was biphasic with a mean elimination half- life of 3.39 hours (range 1.5 to 12.7 hours). A delayed gastrointestinal absorption (Tmax about 3 hours) of Methylergonovine Maleate Prefilled syringe  might be observed in postpartum women during continuous treatment with this oxytocic agent.

INDICATIONS AND USAGE

For routine management after delivery of the placenta; postpartum atony and hemorrhage; subinvolution. Under full obstetric supervision, it may be given in the second stage of labor following delivery of the anterior shoulder.

CONTRAINDICATIONS

Hypertension; toxemia; pregnancy; and hypersensitivity.

WARNINGS

This drug should not be administered I.V. routinely because of the possibility of inducing sudden hypertensive and cerebrovascular accidents. If I.V. administration is considered essential as a lifesaving measure, methylergonovine maleate should be given slowly over a period of no less than 60 seconds with careful monitoring of blood pressure. Intra-arterial or periarterial injection should be strictly avoided.

PRECAUTIONS

General

Caution should be exercised in the presence of sepsis, obliterative vascular disease, hepatic or renal involvement. Also use with caution during the second stage of labor. The necessity for manual removal of a retained placenta should occur only rarely with proper technique and adequate allowance of time for its spontaneous separation.

Drug Interactions

CYP 3A4 Inhibitors (e.g., Macrolide Antibiotics and Protease Inhibitors)

There have been rare reports of serious adverse events in connection with the coadministration of certain ergot alkaloid drugs (e.g., dihydroergotamine and ergotamine) and potent CYP 3A4 inhibitors, resulting in vasospasm leading to cerebral ischemia and/or ischemia of the extremities. Although there have been no reports of such interactions with methylergonovine alone, potent CYP 3A4 inhibitors should not be coadministered with methylergonovine. Examples of some of the more potent CYP 3A4 inhibitors include macrolide antibiotics (e.g., erythromycin, troleandomycin, clarithromycin), HIV protease or  reverse  transcriptase  inhibitors (e.g., ritonavir, indinavir, nelfinavir, delavirdine) or azole antifungals (e.g., ketoconazole, itraconazole, voriconazole). Less potent CYP 3A4  inhibitors  should be administered with caution. Less potent inhibitors include saquinavir, nefazodone, fluconazole, grapefruit juice, fluoxetine, fluvoxamine, zileuton, and clotrimazole. These lists are not exhaustive, and the prescriber should consider the effects on CYP 3A4 of other agents being considered for concomitant use with methylergonovine.

No pharmacokinetic interactions involving other cytochrome P450 isoenzymes are known.

Caution should be exercised when methylergonovine maleate is used concurrently with other vasoconstrictors or ergot alkaloids.

Carcinogenesis, Mutagenesis, Impairment of Fertility

No long-term studies have been performed in animals to evaluate carcinogenic potential. The effect of the drug on mutagenesis or fertility has not been determined.

Pregnancy

Category C. Animal reproductive studies have not been conducted with methylergonovine maleate. It is also not known whether methylergonovine maleate can cause fetal harm or can affect reproductive capacity. Use of methylergonovine maleate is contraindicated during pregnancy because of its uterotonic effects. (See INDICATIONS AND USAGE.)

Labor and Delivery

The uterotonic effect of methylergonovine maleate is utilized after delivery to assist involution and decrease hemorrhage, shortening the third stage of labor.

Nursing Mothers

Methylergonovine maleate may be administered orally for a maximum of 1 week postpartum to control uterine bleeding. Recommended dosage is 1 Prefilled syringe  (0.2 mg) 3 or 4 times daily. At this dosage level a small quantity of drug appears in mothers’ milk.  Caution should be exercised when methylergonovine maleate is administered to a nursing woman.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Geriatric Use

Clinical studies of methylergonovine maleate did not include sufficient number of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in response between the elderly and younger patients. In general dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

ADVERSE REACTIONS

The most common adverse reaction is hypertension associated in several cases with seizure and/or headache. Hypotension has also been reported. Nausea and vomiting have occurred occasionally. Rarely observed reactions have included: acute myocardial infarction, transient chest pains, arterial spasm (coronary and peripheral), bradycardia, tachycardia, dyspnea, hematuria, thrombophlebitis, water intoxication, hallucinations, leg cramps, dizziness, tinnitus, nasal congestion, diarrhea, diaphoresis, palpitation, rash, and foul taste.1

There have been rare isolated reports of anaphylaxis, without a proven causal relationship to the drug product.

DRUG ABUSE AND DEPENDENCE

Methylergonovine maleate has not been associated with drug abuse or dependence of either a physical or psychological nature.

OVERDOSAGE

Symptoms of acute overdose may include: nausea, vomiting, abdominal pain, numbness, tingling of the extremities, rise in blood pressure, in severe cases followed by hypotension, respiratory depression, hypothermia, convulsions, and coma.

Because reports of overdosage with methylergonovine

maleate are infrequent, the lethal dose in  humans has not been established. The oral LD50  (in mg/kg)   for the mouse is 187, the rat 93, and the rabbit 4.5.2 Several cases of accidental methylergonovine maleate injection in newborn infants have been reported, and in such cases 0.2 mg represents an overdose of great magnitude. However, recovery occurred in all but one case following a period of respiratory depression, hypothermia, hypertonicity with jerking movements, and, in one case, a single convulsion.

Treatment of acute overdosage is symptomatic and includes the usual procedures of:

  • removal of offending drug by inducing emesis, gastric lavage, catharsis, and supportive diuresis.
  • maintenance of adequate pulmonary ventilation, especially if convulsions or coma
  • correction of hypotension with pressor drugs as needed.
  • control of convulsions with standard anticonvulsant agents.
  • control of peripheral vasospasm with warmth to the extremities if

DOSAGE AND ADMINISTRATION

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.

Intramuscularly

1 mL, 0.2 mg, after delivery of the anterior shoulder, after delivery of the placenta, or during the puerperium. May be repeated as required, at intervals of 2 to 4 hours.

Intravenously

Dosage same as intramuscular. (See WARNINGS.) Orally

One Prefilled syringe, 0.2 mg, 3 or 4 times daily in the puerperium for a maximum of 1 week.

HOW SUPPLIED

Prefilled Syringe

1 mL fill size.

Store and Dispense

Prefilled Syringe : Store in refrigerator, 2ºC to 8ºC (36ºF to 46ºF). Protect from light. Use carton to protect contents until used. Administer only if solution is clear and colorless.

MANUFACTURED IN INDIA BY:
TAJ PHARMACEUTICALS LTD.
Mumbai, India
Unit No. 214.Old Bake House,
Maharashtra chambers of  Commerce Lane,
Fort, Mumbai – 400001
at:Gujarat, INDIA.
Customer Service and Product Inquiries:
1-800-TRY-FIRST (1-800-222-434 & 1-800-222-825)
Monday through Saturday 9:00 a.m. to 7:00 p.m. EST
E-mail: tajgroup@tajpharma.com