Brand name
- Ergomar®
Drug Class
- Migraine headaches
Preparations
- Tablets: 2 mg
Indications
- Treatment of migraine headache
- Is a partial agonist and/or antagonist of tryptaminergic, dopaminergic and alpha-adrenergic receptors
Pharmacology
- Metabolism: Extensively hepatic
- Half-life: 2 hours
- Time to peak: 0.5-3 hours
Dosing
- Migraine:
- One tablet under tongue at first sign, then 1 tablet every 30 minutes if needed
- Maximum dose: 3 tablets/24 hours, 5 tablets/week
Drug Interactions
Drugs that may increase the serum concentration of Ergotamine or may enhance the adverse/toxic effect of ergot derivatives
- Boceprevir
- Clarithromycin
- Crizotinib
- Dasatinib
- Efavirenz
- Itraconazole
- Macrolide Antibiotics
- Posaconazole
- Protease Inhibitors
- Telaprevir
- Tocilizumab
Adverse Effects
- Cardiovascular:
- Absence of pulse
- bradycardia or tachycardia
- cardiac valvular fibrosis
- ECG changes
- gangrene
- hypertension
- ischemia
- Central nervous system: Vertigo, drowsiness and dizziness
- Gastrointestinal: Nausea, vomiting, ischemic colitis
- Genitourinary: Retroperitoneal fibrosis
- Neuromuscular & skeletal: Muscle pain, numbness, paresthesia, weakness
- Respiratory: Pleuropulmonary fibrosis
- Others: Cold extremities
Pregnancy and Breastfeeding
- May cause prolonged constriction of the uterine vessels and/or increased myometrial tone leading to reduced placental blood flow. This has contributed to fetal growth retardation in animals
- Ergotamine is excreted in breast milk and may cause vomiting, diarrhea, weak pulse, and unstable blood pressure in the nursing infant. Consider discontinuing the drug or discontinuing nursing
Precautions
- Ergotamine is a CYP3A4 inhibitors so it could increase the serum level of medications that are metabolized with this enzyme.
- Cardivascular effects:
- Cardiac valvular fibrosis: long term use of ergotamine compounds have been associated with fibrotic valve thickening
- ECG changes
- Hypertension;
- Intermittent claudication, aggravation of angina
- MI
- Peripheral vascular ischemia and gangrene
- Ischemic colitis because of sustained vasoconstriction
- Pleural/retroperitoneal fibrosis: Rare cases of pleural and/or retroperitoneal fibrosis have been reported with prolonged daily use
References:
- McGuigan MA, “Ergot Alkaloids,” Clin Toxicol Rev, 1984, 6:1-2.
- Orton DA and Richardson RJ, “Ergotamine Absorption and Toxicity,” Postgrad Med J, 1982, 58(675):6-11