Ergot uterotonic Pregnancy: Contraindicated during pregnancy and during induction/first and second stage labour prior to delivery of the anterior shoulder (potent uterotonic activity). Ergometrine derivatives are excreted in breast milk (amounts unknown) and can suppress lactation - repeated use should be avoided.

Ergometrine maleate

Brand names: various

Ergometrine maleate is an ergot alkaloid uterotonic used in the management of the third stage of labour and the treatment of postpartum haemorrhage.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 500 micrograms of ergometrine maleate IM (active management of the third stage of labour)

Route: Intramuscular (recommended); intravenous by slow injection in emergencies only

Frequency: Single dose (following delivery of the anterior shoulder or immediately after delivery)

Doses are expressed as ergometrine maleate (product: Ergometrine Injection BP 0.05% w/v). Active management of the third stage of labour: 500 micrograms IM (often combined with synthetic oxytocin 5 units) following delivery of the anterior shoulder or at the latest immediately after delivery of the baby. Prevention and treatment of postpartum haemorrhage: 200-500 micrograms IM following expulsion of the placenta or when bleeding occurs. In emergencies (severe haemorrhage due to uterine atony): 250-500 micrograms IV by slow injection only. Use under medical supervision only. Contraindicated in severe hepatic or renal impairment; caution in mild or moderate hepatic/renal impairment. Not for use before delivery is completed (contraindicated in pregnancy/labour prior to delivery of the anterior shoulder).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or any excipient
Pregnancy and labour (induction, first and second stage prior to delivery of the anterior shoulder)
Primary or secondary uterine inertia
Severe hypertension, pre-eclampsia, eclampsia
Severe cardiac disorders; severe hepatic or renal impairment; occlusive vascular disease (e.g. Raynaud's); sepsis

Side effects

Nausea, vomiting, abdominal pain
Headache, dizziness
Hypertension, vasoconstriction
Cardiac arrhythmias, palpitations, bradycardia, chest pain, coronary arteriospasm (very rare myocardial infarction)
Dyspnoea, pulmonary oedema; anaphylactic/anaphylactoid reactions

Interactions

Strong CYP3A4 inhibitors (macrolides e.g. erythromycin, clarithromycin; HIV protease/reverse transcriptase inhibitors e.g. ritonavir; azole antifungals e.g. ketoconazole, itraconazole): avoid - risk of ergot toxicity (vasospasm, ischaemia)
Other vasoconstrictors / other ergot alkaloids: caution; concurrent vasoconstrictors after delivery during anaesthesia may cause severe postpartum hypertension
Triptans (5HT1B/1D agonists), sympathomimetics (including in local anaesthetics), beta-blockers: enhanced vasoconstrictor/vasopressor effect
Prostaglandins and their analogues: caution when used alone or in combination for postpartum atonic uterine haemorrhage

Clinical monograph

How it works

Produces sustained tonic contraction of uterine smooth muscle mainly through alpha-adrenergic and serotonergic receptor agonism, compressing uterine vessels to reduce bleeding.

Prescribing in practice

Contraindicated in pre-eclampsia, eclampsia and hypertension and in severe cardiac disease because it can cause marked vasoconstriction and a rise in blood pressure.
It is not used for induction or augmentation of labour and must not be given before delivery of the baby.
Avoid combining with strong vasoconstrictors and certain interacting drugs that potentiate ergot toxicity.

Monitoring

Monitor blood pressure, uterine tone and blood loss closely after administration.

Counselling the patient

Nausea and vomiting may occur after the injection.
The medicine is given by clinicians to help the womb contract and reduce bleeding after birth.
Tell the team about any history of high blood pressure or heart disease.

Evidence & guidelines

Ergometrine is an established uterotonic in third-stage and postpartum haemorrhage management as reflected in WHO and RCOG guidance.

Reference: RCOG GTG 52 (PPH); MBRRACE; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways