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

Contraindicated in:

• Peripheral vascular disease
• Ischemic heart disease
• Uncontrolled hypertension
• Severe renal impairment
• Severe hepatic impairment
• 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: hypertension, angina pectoris, arterial spasm, intermittent claudication, MI.

F and E: polydipsia.

GI: abdominal pain, nausea, vomiting, diarrhea.

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

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

Drug-Drug:

• Concurrent use with beta blockers, oral contraceptives, macrolide anti-infectives (erythromycin), ornicotine (heavy smoking) may ↑ risk of peripheral vasoconstriction.
• 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 receptors.
• Larger doses may produce alpha-adrenergic blockade and vasodilation.

• 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.

Protein Binding: 93–98%.

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

Half-life: 1.5–2.5 hr.

(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.
  • May cause fetal harm. Instruct females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding. Ergotamine should not be used during pregnancy.

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