Ergotamine/Caffeine

DEA Class; Rx

Common Brand Names; Cafergot, Migergot

Ergotamine is an ergot alkaloid used to abort migraine and cluster headaches; caffeine is added to improve ergot absorption; 70% efficacy rate in adults; prolonged use/excessive dosage can lead to ergotism and other side effects. Do not exceed daily and weekly dosage limits.

Indicated as therapy to abort or prevent vascular headache (eg, migraine, migraine variants, “histaminic cephalalgia”)

Potent CYP3A4 inhibitors owing to risk of acute ergot toxicity

Pregnancy

Peripheral vascular disease, coronary heart disease, hypertension, impaired hepatic or renal function, sepsis

Hypersensitivity to any of the ingredients

Gastrointestinal: Nausea and vomiting; rectal or anal ulcer (from overuse of suppositories)

Neurological: Paresthesia, numbness, weakness, and vertigo

Allergic: Localized edema and itching

Ergotism

• Although ergotism rarely develop even after long-term intermittent use of orally administered ergotamine, do not exceed dosage recommendations

• Ergotism manifested by intense arterial vasoconstriction, producing signs and symptoms of peripheral vascular ischemia

• Headache, intermittent claudication, muscle pains, numbness, or coldness and pallor of the digits may occur with chronic intoxication; if the condition is allowed to progress untreated, gangrene can result

• While most cases result from frank overdosage, some cases involve hypersensitivity

• There are few reports among patients taking doses within recommended limits or for brief periods

• Withdrawal symptoms (eg, rebound headache) upon discontinuation are rare; typically reported with long, indiscriminate use

Fibrotic complications

• Retroperitoneal and/or pleuropulmonary fibrosis reported

• Rare reports of fibrotic thickening of the aortic, mitral, tricuspid, and/or pulmonary valves with long-term, continuous use of ergotamine tartrate and caffeine

• Do not use for chronic daily administration

Contraindicated; ergotamine elicits oxytocic effects

There are no studies on placental transfer or teratogenicity of the combination of ergotamine and caffeine

Ergot drugs are known to inhibit prolactin, but there are no reports of decreased lactation with ergotamine/caffeine

Ergotamine is excreted in breast milk and may cause symptoms of vomiting, diarrhea, weak pulse, and unstable blood pressure in nursing infants

Owing to the potential serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue the drug, considering the importance of the drug to the mother