Although other methods have been proposed, histamine, adrenalin, dopamine, dobutamine, atrial stimulation and exercise, the administration of intracoronary methylergonovine
is the most sensitive and specific diagnostic method to be performed safely for the patient (Yasue 2008).
provocation testing resulted in near-total spasm of the right coronary artery after administration of only 5 [micro]g methylergonovine
into the right coronary artery [Figure 1]d.
The IV oxytocin at the prescribed dose is running wide open, extra personnel are summoned to help, the first doses of methylergonovine
are given, and the misoprostol tablets are stored in the nearby drawer as prescribed by the institution's protocol.
maleate (Methergine) is sometimes used to treat uterine atony but should not be used in women with hypertension because of vasoconstrictive properties (King & Brucker, 2011).
Caliskan E et al in a randomised controlled trial compared oral misoprostol 400ug(followed by 2 doses of 100ug 4 hours apart) with intravenous infusion of oxytocin, combination of misoprostol and intravenous oxytocin infusion and combination of methylergonovine
and intravenous oxytocin infusion.
Management includes measures to stabilize the patient, uterine tamponade with Foley's catheter or rolled gauze packing, and medical therapies like estrogens, progestins, methylergonovine
, danazol, and 15-methyl-prostaglandin F2alpha.
The researchers observed that the median ERL was greater in cases that involved administration of misoprostol, methylergonovine
, or carboprost tromethamine vs.
TABLE 6 Short-Term Preventive Treatments for Menstrual Migraine Timing of Preventive Group Examples Administration (d) * Standard [beta]-blockers, calcium -2 to +3 channel blockers, tricyclic antidepressants, anticonvulsants Nonsteroidal Naproxen sodium, -7 to +6 anti-inflammatory mefenamic acid drugs Ergot alkaloids Methylergonovine
-1 to +2 maleate Hormonal Transdermal estradiol -2 to +5 Estradiol gel -2 to +5 Tamoxifen -14 to +3 Triptans Frovatriptan -2 to +4 Naratriptan -2 to +3 * Relative to the first day of menstrual bleeding.
is the second uterotonic agent to try if oxytocin fails.
Research Biochemicals supplied ergocomine, ergocristine, methylergonovine
maleate, and methysergide maleate.
maleate is also available as an intramuscular injection.
Both carboprost and methylergonovine
are contraindicated in patients with cardiovascular and respiratory problems.