毒理性
◉ 母乳喂养期间的总结：分娩后立即使用麦角新碱会降低血清基础催乳素水平，可能会减少吸吮诱导的催乳素增加。它似乎也会降低母乳喂养的频率。对于希望哺乳的母亲来说，最好避免使用麦角新碱，而依靠吸吮诱导的催产素释放来加速子宫复旧。对于已经建立母乳喂养的母亲，催乳素水平可能不会影响她的哺乳能力。
◉ 对母乳喂养婴儿的影响：截至修订日期，没有找到相关的已发布信息。
◉ 对泌乳和母乳的影响：在一项研究中，12名非哺乳妇女在分娩后第3天口服单剂量的麦角新碱马来酸盐0.2毫克，在服用剂量后0.5至2.5小时内平均血清催乳素水平下降了10至20%。作者表示担忧，重复剂量的麦角新碱可能会抑制泌乳。[1]
在另一项研究中，从分娩后第1天到第7天，每天三次给予10名妇女0.2毫克的麦角新碱，与未接受药物的6名妇女进行比较。这些妇女都没有给她们的婴儿哺乳。到分娩后第2天，接受治疗的妇女的血清催乳素水平显著降低，并在研究的7天内持续降低。在接受治疗的10名妇女中，有7人乳房充血并发生乳汁排出，3人泌乳逐渐受到抑制。另外两名正在哺乳的妇女，静脉注射单剂量0.2毫克的麦角新碱减弱了吸吮对血清催乳素的反应。[2]
在一项非随机研究中，11名正常分娩的妇女被肌肉注射了5单位的催产素加0.5毫克的麦角新碱（n = 5）或单独5单位的催产素（n = 6）。在服用麦角新碱的妇女中，血清催乳素水平在0.5至2.5小时内较低。[3]
在一项随机但非盲法的对照试验中，被认为产后出血风险较低的妇女在婴儿出生后给予了0.5毫克静脉注射麦角新碱（n = 197）或未给予药物（n = 135）。在分娩后48至72小时内获得的血清催乳素水平在两组之间没有差异，但在分娩后4周仍在哺乳的妇女中，接受麦角新碱的人数比未接受的人少。[4]
在一项回顾性研究中，对威尔士18,165名分娩母亲的产科记录进行了回顾，发现分娩第三阶段使用静脉或肌肉注射麦角新碱作为子宫收缩药，减少了母亲在分娩后48小时哺乳的可能性。在整体样本中，这种减少的比例为36%，对于初产妇为49%。[5]
◉ Summary of Use during Lactation:Ergonovine given in the immediate postpartum period lowers serum basal prolactin and possibly suckling-induced prolactin increases. It also appears to decrease the rate of breastfeeding. Ergonovine is probably best avoided in mothers who wish to nurse, relying instead on suckling-induced oxytocin release to hasten uterine involution. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
◉ Effects in Breastfed Infants:Relevant published information was not found as of the revision date.
◉ Effects on Lactation and Breastmilk:In one study, a single oral dose of ergonovine maleate 0.2 mg in 12 nonbreastfeeding women on day 3 postpartum caused a 10 to 20% drop in average serum prolactin levels between 0.5 and 2.5 hours after the dose. The authors expressed concern that repeated doses of ergonovine could suppress lactation.[1]
Ten women who were given ergonovine 0.2 mg 3 times daily from day 1 to 7 postpartum were compared to 6 women who did not receive the drug. None of the women breastfed their infants. Serum prolactin levels were significantly lower in the treated women by day 2 postpartum and persisted through the 7 days of the study. Seven of the 10 treated women developed breast engorgement and had milk letdown and 3 had progressive inhibition of lactation. In 2 additional women who were nursing their infants, a single dose of 0.2 mg of ergonovine intravenously blunted the response of serum prolactin to suckling.[2]
In a nonrandomized study, 11 women with normal deliveries were given an intramuscular injection of either oxytocin 5 units plus ergonovine 0.5 mg (n = 5) or 5 units of oxytocin alone (n = 6). Serum prolactin levels were lower in the women given ergonovine from 0.5 to 2.5 hours.[3]
In a randomized, but nonblinded, controlled trial, women thought to be at low risk of postpartum hemorrhage were given either ergonovine 0.5 mg intravenously following birth of the infant (n = 197) or no drug (n = 135). Serum prolactin levels obtained in the period of 48 to 72 hours postpartum did not differ between the groups, but fewer of those who received ergonovine were still breastfeeding at 4 weeks postpartum than those who did not.[4]
In a randomized, but nonblinded, controlled trial, women thought to be at low risk of postpartum hemorrhage were given either ergonovine 0.5 mg intravenously following birth of the infant (n = 197) or no drug (n = 135). Serum prolactin levels obtained in the period of 48 to 72 hours postpartum did not differ between the groups, but fewer of those who received ergonovine were still breastfeeding at 4 weeks postpartum than those who did not.[4]
A retrospective review of obstetrical records of 18,165 records of mothers giving birth in Wales found that use of intravenous or intramuscular ergonovine during the third stage of labor as a uterotonic reduced the odds of the mother breastfeeding at 48 hours postpartum. The reduction was 36% in the overall sample and 49% for primiparous mothers.[5]
来源:Drugs and Lactation Database (LactMed)
