ergotamine

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Indications ⬇

REMS

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

Contraind./Precautions ⬆ ⬇

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).

Adv. Reactions/Side Effects ⬆ ⬇

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

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

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

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

Misc: fatigue.

Interactions ⬆ ⬇

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).

Availability ⬆ ⬇

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

Route/Dosage ⬆ ⬇

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.

US Brand Names ⬆ ⬇

Ergomar

Action ⬆ ⬇

Vasoconstriction of dilated blood vessels by stimulating alpha-adrenergic and serotonergic (5-HT) receptors.
Larger doses may produce alpha-adrenergic blockade and vasodilation.
Therapeutic Effects:
Constriction of dilated carotid artery bed with resolution of vascular headache.

Classifications ⬆ ⬇

Therapeutic Classification: vascular headache suppressants
Pharmacologic Classification: ergot alkaloids

Pharmacokinetics ⬆ ⬇

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.

Time/Action Profile ⬆ ⬇

(relief of headache)
ROUTE ONSET PEAK DURATION
SL unknown unknown unknown

Patient/Family Teaching ⬆ ⬇

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.
Rep: 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.

Pronunciation ⬆ ⬇

er-GOT-a-meen

Code ⬆

NDC Code^*
10802- Rosedale Therapeutics
10802-1202- Ergomar 10802-1202-0- 20 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE, UNIT-DOSE (10802-1202-0)
10802- Rosedale Therapeutics
10802-1202- Ergomar 10802-1202-3- 3 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE, UNIT-DOSE (10802-1202-3)
70720- TerSera Therapeutics, LLC
70720-120- Ergomar Sublingual
70720-120-03- 1 BLISTER PACK in 1 CARTON (70720-120-03) > 3 TABLET in 1 BLISTER PACK
70720- TerSera Therapeutics, LLC
70720-120- Ergomar Sublingual
70720-120-20- 2 BLISTER PACK in 1 CARTON (70720-120-20) > 10 TABLET in 1 BLISTER PACK