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Methylergometrine

From Wikipedia, the free encyclopedia
Chemical compound

Pharmaceutical compound
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
Eliminationhalf-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
PubChemCID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard(EPA)
ECHA InfoCard100.003.661Edit this at Wikidata
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 asmethylergonovine and sold under the brand nameMethergine, is amedication of theergoline andlysergamide groups which is used as anoxytocic inobstetrics and as anantimigraine agent in the treatment ofmigraineheadaches. It reportedly producespsychedelic effects similar to those oflysergic acid diethylamide (LSD) at high doses.[1] Previously thought to be an exclusivelysynthetic compound, it has been reported to occurnaturally inArgyreia nervosa (Hawaiian baby woodrose).[2][3] The drug is on theWorld Health Organization's List of Essential Medicines.[4]

Medical uses

[edit]

Obstetric use

[edit]

Methylergometrine is a smooth muscle constrictor that mostly acts on theuterus. 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 orIV) or in liquid form to be taken orally.[5][6][7]

Migraine

[edit]

Methylergometrine is sometimes used for both prevention[8] and acute treatment[9] of migraine. It is anactive metabolite ofmethysergide.[10] In the treatment ofcluster 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.[10]

Contraindications

[edit]

Methylergometrine is contraindicated in patients withhypertension andpre-eclampsia.[5] It is also contraindicated inHIV positive patients takingprotease inhibitors,delavirdine, andefavirenz (which is also an agonist at the 5-HT2A–mGlu2 receptor protomer and increases the chances of a patient experiencing hallucinations during methylergometrine therapy).[11]

Side effects

[edit]

Adverse effects include:[5]

  • Nausea, vomiting, and diarrhea
  • Dizziness
  • Pulmonary hypertension[citation needed]
  • Coronary artery vasoconstriction
  • Severe systemic hypertension (especially in patients withpre-eclampsia)
  • Convulsions

In excessive doses, methylergometrine can also lead to cramping,respiratory depression and coma.[5]

Interactions

[edit]

Methylergometrine likely interacts with drugs that inhibit the liver enzymeCYP3A4, such asazole antifungals,macrolide antibiotics and many HIV drugs. It can also increase constriction of blood vessels caused bysympathomimetic drugs and other ergot alkaloids.[5]

Pharmacology

[edit]

Pharmacodynamics

[edit]

Methylergometrine is anagonist orantagonist toserotonin,dopamine, andα-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 serotonin5-HT2A receptors,[12] while blood vessels are affected to a lesser extent compared to other ergot alkaloids.[5] It has been found to interact with the serotonin5-HT1A,5-HT1B,5-HT1E,5-HT1F,5-HT2A,5-HT2B,5-HT2C,5-HT5A, and5-HT7 receptors.[13][14][15][16]

Methylergometrine is asyntheticanalogue ofergometrine, apsychedelicalkaloid found inergot, and many species ofmorning glory. Methylergometrine is a member of theergoline family and chemically similar toLSD,ergine,ergometrine, andlysergic acid. According toJonathan Ott, methylergometrine produces LSD-likepsychedelic effects at doses of 2 mg and above.[17] This can be attributed to due to its agonistic action at the 5-HT2AmGlu2 receptorprotomers.[citation needed] Clinical efficacy occurs around 200 μg, ten times lower than the hallucinogenic threshold.[17]

Methylergometrine is an agonist of the serotonin 5-HT2B receptor and may be linked tocardiac valvulopathy.[18]

Activities of methylergometrine at various sites[13][14][19]
SiteAffinity (Ki [nM])Efficacy (Emax [%])Action
5-HT1A1.5–2.0?Full agonist
5-HT1B251?Full agonist
5-HT1D0.86–2.970Partial agonist
5-HT1E89?Full agonist
5-HT1F31?Full agonist
5-HT2A0.35–1.1?Full agonist
5-HT2B0.46–2.2?Full or partial agonist
5-HT2C4.6–43.7?Full agonist
5-HT3?
5-HT5A?24.4[16]Full agonist[16]
5-HT6??Full agonist
5-HT711–52?Full agonist
Notes: All sites are human except 5-HT1B (rat) and 5-HT7 (guinea pig).[13][14][19] Additional refs:[20][21][15][22][23]

Chemistry

[edit]

Methylergometrine, also known asd-lysergic acid 1-butanolamide, is aderivative of theergoline andlysergamide classes and is structurally related toergometrine (d-lysergic acid β-propanolamide) andlysergic acid diethylamide (LSD).

References

[edit]
  1. ^Ott J, Neely P (April 1980). "Entheogenic (hallucinogenic) effects of methylergonovine".Journal of Psychedelic Drugs.12 (2):165–166.doi:10.1080/02791072.1980.10471568.PMID 7420432.
  2. ^Chen W, De Wit-Bos L (2020).Risk assessment of Argyreia nervosa(PDF) (Report).doi:10.21945/rivm-2019-0210.
  3. ^Paulke A, Kremer C, Wunder C, Wurglics M, Schubert-Zsilavecz M, Toennes SW (April 2015). "Studies on the alkaloid composition of the Hawaiian Baby Woodrose Argyreia nervosa, a common legal high".Forensic Sci Int.249:281–293.doi:10.1016/j.forsciint.2015.02.011.PMID 25747328.
  4. ^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.
  5. ^abcdefJasek W, ed. (2007).Austria-Codex (in German) (62nd ed.). Vienna: Österreichischer Apothekerverlag. pp. 5193–5.ISBN 978-3-85200-181-4.
  6. ^Mutschler E, Schäfer-Korting M (2001).Arzneimittelwirkungen (in German) (8th ed.). Stuttgart: Wissenschaftliche Verlagsgesellschaft. p. 447.ISBN 3-8047-1763-2.
  7. ^"Methergin".Fachinformation des Arzneimittel-Kompendium der Schweiz (in German).[permanent dead link]
  8. ^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.
  9. ^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.
  10. ^abLambru 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.
  11. ^"Methylergonovine Maleate Monograph for Professionals".Drugs.com.Archived from the original on 2016-09-20.
  12. ^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.
  13. ^abc"PDSP Database - UNC".pdsp.unc.edu. Archived fromthe original on 16 April 2021. Retrieved15 January 2022.
  14. ^abc"PDSP Database - UNC".pdsp.unc.edu. Archived fromthe original on 16 April 2021. Retrieved15 January 2022.
  15. ^abOlivier B, van Wijngaarden I, Soudijn W (10 July 1997).Serotonin Receptors and their Ligands. Elsevier. pp. 149–.ISBN 978-0-08-054111-2.
  16. ^abcZhang 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.
  17. ^abOtt 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.
  18. ^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.
  19. ^abLiu T."BindingDB BDBM50330860 CHEMBL1201356::METHYLERGONOVINE::Methylergometrine".BindingDB. Retrieved1 November 2024.
  20. ^Rothman RB, Baumann MH, Savage JE, Rauser L, McBride A, Hufeisen SJ, et al. (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.
  21. ^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. Archived fromthe original(PDF) on 2023-05-29. Retrieved2021-04-16.
  22. ^Leff P (10 April 1998).Receptor - Based Drug Design. CRC Press. pp. 181–182.ISBN 978-1-4200-0113-6.
  23. ^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 fromthe original(PDF) on 2021-04-16.
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