• Treatment of vascular headaches including:
  • Migraine with or without aura,
  • Cluster headaches.

Contraindicated in:

• Peripheral vascular disease
• Ischemic heart disease
• Uncontrolled hypertension
• Severe renal or liver disease
• Malnutrition
• OB: Pregnancy
• Lactation: Lactation.

Use Cautiously in:

• Illnesses associated with peripheral vascular pathology such as diabetes mellitus
• Concurrent administration of other vasoconstricting agents
• Pedi: Children <6 yr (safety not established).

CV: MYOCARDIAL INFARCTION, hypertension, angina pectoris, arterial spasm, intermittent claudication.

GI: abdominal pain, nausea, vomiting, diarrhea, polydipsia.

MS: extremity stiffness, muscle pain, stiff neck, stiff shoulders.

Neuro: leg weakness, numbness or tingling in fingers or toes , dizziness.
Misc: fatigue.

Drug-Drug:

• Concurrent use with beta blockers, oral contraceptives, macrolide anti-infectives (erythromycin), ornicotine (heavy smoking) may ↑ risk of peripheral vasoconstriction.
• Dihydroergotamine antagonizes the antianginal effects of nitrates.
• Concurrent use with vasoconstrictors may have additive effects (avoid concurrent use).
• Concurrent use with almotriptan, naratriptan, rizatriptan, sumatriptan, or zolmitriptan may result in prolonged vasoconstriction (allow 24 hr between use).

• Sublingual tablets: 2 mg;
• In combination with: caffeine (Migergot). See Appendix [not included in this PDA edition].

• SL (Adults): 1–2 mg initially, then 1–2 mg every 30 min until attack subsides or a total of 6 mg has been given. Should not be used more than twice weekly, with at least 5 days between courses.

Ergomar

• Vasoconstriction of dilated blood vessels by stimulating alpha-adrenergic and serotonergic (5-HT) receptors.
• Larger doses may produce alpha-adrenergic blockade and vasodilation.

• Constriction of dilated carotid artery bed with resolution of vascular headache.

Therapeutic Classification: vascular headache suppressants

Pharmacologic Classification: ergot alkaloids

Absorption: Unpredictably absorbed (60%) from the GI tract. Sublingual absorption is very poor.

Distribution: Crosses the blood-brain barrier and enters breast milk.

Protein Binding: 93–98%.

Metabolism/Excretion: Highly metabolized (90%) by the liver. Some metabolites are active.

Half-life: 1.5–2.5 hours.

(relief of headache)

• Instruct patient to take ergotamine at the first sign of an impending headache and not to exceed the maximum dose prescribed.
  • Encourage patient to rest in a quiet, dark room after taking ergotamine.
  • Review symptoms of toxicity. Instruct patient to report these promptly.
  • Caution patient not to smoke and to avoid exposure to cold; these vasoconstrictors may further impair peripheral circulation.
  • May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to the drug is known.
  • Advise patient to avoid alcohol, which may precipitate vascular headaches.
  • Instruct females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding. Ergotamine should not be taken during pregnancy.

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