Classes
DEA Class; Rx
Common Brand Names; Ergomar
- Ergot Derivatives
Description
Ergot alkaloid; roughly 70% effective for relief of migraine. Prolonged use/excessive dose can lead to ergotism, dependence, or rebound HA; do not exceed daily and weekly dose limits.
Indications
Indicated for the acute treatment of migraine.
Contraindications
Hypersensitivity to drug or excipients
Concomitant strong CYP3A4 inhibitors (ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin and troleandomycin)
Adverse Effects
- Abnormal heart valve findings (chronic use)
- Angina
- Arrhythmia
- Vascular spasm
- Vasoconstriction
- Tachycardia
- Fatigue
- Numbness of extremities
- Rebound headache
- Abdominal pain
- Ergotism
- Possible gangrene
- Paresthesia
- Pruritis
- Nausea
- Vomiting
- Muscle weakness
- Visual disturbances
Warnings
Should be initiated at first sign of vascular headache
Ineffective for muscle contraction headache
Safety/efficacy not established for peds
Although signs and symptoms of ergotism rarely develop even after long term intermittent use of the drug, care should be exercised to remain within the limits of recommended dosage
Ergotism is manifested by intense arterial vasoconstriction, producing signs and symptoms of peripheral vascular ischemia; therapy induces vasoconstriction by a direct action on vascular smooth muscle; in chronic intoxication with ergot derivatives, headache, intermittent claudication, muscle pains, numbness, coldness and pallor of the digits may occur
If the condition is allowed to progress untreated, gangrene can result; while most cases of ergotism associated with ergotamine treatment result from frank overdosage, some cases have involved apparent hypersensitivity
There are few reports of ergotism among patients taking doses within the recommended limits or for brief periods of time; in rare instances, patients, particularly those who have used the medication indiscriminately over long periods of time, may display withdrawal symptoms consisting of rebound headache upon discontinuation of the drug
Pregnancy and Lactation
Contraindicated in pregnancy due to oxytocic effects of ergotamine, which is maximal in the third trimester
Ergot drugs are known to inhibit prolactin but there are no reports of decreased lactation with therapy; the drug is excreted in breast milk and may cause symptoms of vomiting, diarrhea, weak pulse, and unstable blood pressure in nursing infants
Maximum Dosage
6 mg/24 hours or per attack SL; not to exceed 10 mg/week SL.
6 mg/24 hours or per attack SL; not to exceed 10 mg/week SL.
3 mg/24 hours or per attack SL. The weekly dose limit for ergotamine is expected to be lower than for adults.
>= 10 years: 3 mg/24 hours or per attack SL. The pediatric weekly dose limit for ergotamine is expected to be lower than for adults.
< 10 years: Not recommended.