Methylergometrine
Clinical data
Trade namesMethergine
Other namesMethylergonovine; methylergobasin; Methylergobasine; Methylergobrevin; d-Lysergic acid 1-butanolamide; N-[(2S)-1-Hydroxybutan-2-yl]-6-methyl-9,10-didehydroergoline-8β-carboxamide
AHFS/Drugs.comInternational Drug Names
MedlinePlusa601077
Pregnancy
category
  • Contraindicated
Routes of
administration		Oral
ATC code
Legal status
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetic data
MetabolismLiver
Elimination half-life30–120 minutes
ExcretionMostly bile
Identifiers
  • (6aR,9R)-N-[(2S)-1-hydroxybutan-2-yl]-7-methyl-6,6a,8,9-tetrahydro-4H-indolo[4,3-fg]quinoline-9-carboxamide
CAS Number
PubChem CID
IUPHAR/BPS
ChemSpider
UNII
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.003.661
Chemical and physical data
FormulaC20H25N3O2
Molar mass339.439 g·mol−1
3D model (JSmol)
Melting point172 °C (342 °F)
Solubility in waterInsoluble mg/mL (20 °C)
  • CC[C@@H](CO)NC(=O)[C@@H]2/C=C1/c3cccc4N\C=C(\C[C@H]1N(C)C2)c34
  • InChI=1S/C20H25N3O2/c1-3-14(11-24)22-20(25)13-7-16-15-5-4-6-17-19(15)12(9-21-17)8-18(16)23(2)10-13/h4-7,9,13-14,18,21,24H,3,8,10-11H2,1-2H3,(H,22,25)/t13-,14+,18-/m1/s1 ☒N
  • Key:UNBRKDKAWYKMIV-QWQRMKEZSA-N ☒N
 ☒NcheckY (what is this?)  (verify)

Methylergometrine, also known as methylergonovine and sold under the brand name Methergine, is a medication of the ergoline and lysergamide groups which is used as an oxytocic in obstetrics and in the treatment of migraine. It reportedly produces psychedelic effects similar to those of lysergic acid diethylamide (LSD) at high doses.

It is on the World Health Organization's List of Essential Medicines.[1]

Medical uses

Obstetric use

Methylergometrine is a smooth muscle constrictor that mostly acts on the uterus. It is most commonly used to prevent or control excessive bleeding following childbirth and spontaneous or elective abortion, and also to aid in expulsion of retained products of conception after a missed abortion (miscarriage in which all or part of the fetus remains in the uterus) and to help deliver the placenta after childbirth. It is available as tablets or injection (IM or IV) or in liquid form to be taken orally.[2][3][4]

Migraine

Methylergometrine is sometimes used for both prevention[5] and acute treatment[6] of migraine. It is an active metabolite of methysergide.[7] In the treatment of cluster headaches, methylergometrine has been initiated at a dose of 0.2 mg/day, rapidly increased to 0.2 mg three times per day, and increased to a maximum of 0.4 mg three times per day.[7]

Contraindications

Methylergometrine is contraindicated in patients with hypertension and pre-eclampsia.[2] It is also contraindicated in HIV positive patients taking protease inhibitors, delavirdine, and efavirenz (which is also an agonist at the 5-HT2A–mGlu2 receptor protomer and increases the chances of a patient experiencing hallucinations during methylergometrine therapy).[8]

Side effects

Adverse effects include:[2]

  • Nausea, vomiting, and diarrhea
  • Dizziness
  • Pulmonary hypertension
  • Coronary artery vasoconstriction
  • Severe systemic hypertension (especially in patients with pre-eclampsia)
  • Convulsions

In excessive doses, methylergometrine can also lead to cramping, respiratory depression and coma.[2]

Interactions

Methylergometrine likely interacts with drugs that inhibit the liver enzyme CYP3A4, such as azole antifungals, macrolide antibiotics and many HIV drugs. It can also increase constriction of blood vessels caused by sympathomimetic drugs and other ergot alkaloids.[2]

Pharmacology

Pharmacodynamics

Methylergometrine is an agonist or antagonist to serotonin, dopamine, and α-adrenergic receptors. Its specific binding and activation pattern on these receptors leads to a highly, if not completely, specific contraction of smooth uterus muscle via serotonin 5-HT2A receptors,[9] while blood vessels are affected to a lesser extent compared to other ergot alkaloids.[2] It has been found to interact with the serotonin 5-HT1A, 5-HT1B, 5-HT1E, 5-HT1F, 5-HT2A, 5-HT2B, 5-HT2C, 5-HT5A, and 5-HT7 receptors.[10][11][12][13]

Methylergometrine is a synthetic analogue of ergometrine, a psychedelic alkaloid found in ergot, and many species of morning glory. Methylergometrine is a member of the ergoline family and chemically similar to LSD, ergine, ergometrine, and lysergic acid. According to Jonathan Ott, methylergometrine produces LSD-like psychedelic effects at doses of 2 mg and above.[14] This can be attributed to due to its agonistic action at the 5-HT2A–mGlu2 receptor protomers. Clinical efficacy occurs around 200 µg, ten times lower than the hallucinogenic threshold.[14]

Methylergometrine is an agonist of the serotonin 5-HT2B receptor and is maybe linked to cardiac valvulopathy.[15]

Activities of methylergometrine at various sites[10][11][16][17][12][18][19]
Site Affinity (Ki [nM]) Efficacy (Emax [%]) Action
5-HT1A 1.5–2.0  ? Full agonist
5-HT1B 251  ? Full agonist
5-HT1D 0.86–2.9 70 Partial agonist
5-HT1E 89  ? Full agonist
5-HT1F 31  ? Full agonist
5-HT2A 0.35–1.1  ? Full agonist
5-HT2B 0.46–2.2  ? Full or partial agonist
5-HT2C 4.6–43.7  ? Full agonist
5-HT3  ? – –
5-HT5A  ? 24.4[13] Full agonist[13]
5-HT6  ?  ? Full agonist
5-HT7 11–52  ? Full agonist
Notes: All sites are human except 5-HT1B (rat) and 5-HT7 (guinea pig).[10][11]

Chemistry

Methylergometrine, also known as d-lysergic acid 1-butanolamide, is a derivative of the ergoline and lysergamide classes and is structurally related to ergometrine (d-lysergic acid β-propanolamide) and lysergic acid diethylamide.

References

  1. ↑ World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl:10665/345533. WHO/MHP/HPS/EML/2021.02.
  2. 1 2 3 4 5 6 Jasek W, ed. (2007). Austria-Codex (in German) (62nd ed.). Vienna: Österreichischer Apothekerverlag. pp. 5193–5. ISBN 978-3-85200-181-4.
  3. ↑ Mutschler E, Schäfer-Korting M (2001). Arzneimittelwirkungen (in German) (8th ed.). Stuttgart: Wissenschaftliche Verlagsgesellschaft. p. 447. ISBN 3-8047-1763-2.
  4. ↑ "Methergin". Fachinformation des Arzneimittel-Kompendium der Schweiz (in German).
  5. ↑ Koehler PJ, Tfelt-Hansen PC (November 2008). "History of methysergide in migraine". Cephalalgia. 28 (11): 1126–1135. doi:10.1111/j.1468-2982.2008.01648.x. PMID 18644039. S2CID 22433355.
  6. ↑ Niño-Maldonado AI, Caballero-García G, Mercado-Bochero W, Rico-Villademoros F, Calandre EP (November 2009). "Efficacy and tolerability of intravenous methylergonovine in migraine female patients attending the emergency department: a pilot open-label study". Head & Face Medicine. 5 (21): 21. doi:10.1186/1746-160X-5-21. PMC 2780385. PMID 19895705.
  7. 1 2 Lambru G, Matharu M (April 2011). "Serotonergic agents in the management of cluster headache". Current Pain and Headache Reports. 15 (2): 108–117. doi:10.1007/s11916-011-0176-4. PMID 21271306. S2CID 34063682.
  8. ↑ "Methylergonovine Maleate Monograph for Professionals - Drugs.com". drugs.com. Archived from the original on 2016-09-20.
  9. ↑ Pertz H, Eich E (1999). "Ergot Alkaloids and their Derivatives as Ligands for Serotoninergic, Dopaminergic, and Adrenergic Receptors". In Křen V, Cvak L (eds.). Ergot: the genus Claviceps. CRC Press. pp. 411–440. ISBN 978-905702375-0.
  10. 1 2 3 "PDSP Database - UNC". pdsp.unc.edu. Archived from the original on 16 April 2021. Retrieved 15 January 2022.
  11. 1 2 3 "PDSP Database - UNC". pdsp.unc.edu. Archived from the original on 16 April 2021. Retrieved 15 January 2022.
  12. 1 2 Olivier B, van Wijngaarden I, Soudijn W (10 July 1997). Serotonin Receptors and their Ligands. Elsevier. pp. 149–. ISBN 978-0-08-054111-2.
  13. 1 2 3 Zhang S, Chen H, Zhang C, Yang Y, Popov P, Liu J, et al. (July 2022). "Inactive and active state structures template selective tools for the human 5-HT5A receptor". Nature Structural & Molecular Biology. 29 (7): 677–687. doi:10.1038/s41594-022-00796-6. PMC 9299520. PMID 35835867.
  14. 1 2 Ott J, Neely P (1980). "Entheogenic (hallucinogenic) effects of methylergonovine". Journal of Psychedelic Drugs. 12 (2): 165–166. doi:10.1080/02791072.1980.10471568. PMID 7420432.
  15. ↑ Cavero I, Guillon JM (2014). "Safety Pharmacology assessment of drugs with biased 5-HT(2B) receptor agonism mediating cardiac valvulopathy". Journal of Pharmacological and Toxicological Methods. 69 (2): 150–161. doi:10.1016/j.vascn.2013.12.004. PMID 24361689.
  16. ↑ Rothman RB, Baumann MH, Savage JE, Rauser L, McBride A, Hufeisen SJ, Roth BL (December 2000). "Evidence for possible involvement of 5-HT(2B) receptors in the cardiac valvulopathy associated with fenfluramine and other serotonergic medications". Circulation. 102 (23): 2836–2841. doi:10.1161/01.cir.102.23.2836. PMID 11104741.
  17. ↑ Guzman M, Armer T, Borland S, Fishman R, Leyden M (April 2020). "Novel Receptor Activity Mapping of Methysergide and its Metabolite, Methylergometrine, Provides a Mechanistic Rationale for both the Clinically Observed Efficacy and Risk of Fibrosis in Patients with Migraine" (PDF). Neurology. 94 (15 Supplement). doi:10.1212/WNL.94.15_supplement.2663. S2CID 266103427. 2663.
  18. ↑ Leff P (10 April 1998). Receptor - Based Drug Design. CRC Press. pp. 181–182. ISBN 978-1-4200-0113-6.
  19. ↑ Pertz H, Eich E (1999). "Ergot Alkaloids and their Derivatives as Ligands for Serotoninergic, Dopaminergic, and Adrenergic Receptors" (PDF). Ergot. pp. 432–462. doi:10.1201/9780203304198-21. ISBN 9780429219764. Archived from the original (PDF) on 2021-04-16.
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